Supporting older people’s independent living at home through social and health care collaboration

5 Sini Eloranta SUPPORTING OLDER PEOPLE’S INDEPENDENT LIVING AT HOME THROUGH SOCIAL AND HEALTH CARE COLLABORATION Department of Nursing Science, Faculty of Medicine, University of Turku, Finland Annales Universitatis Turkuensis. Sarja-Ser D Medica-Odontologica Osa-Tom 869, Turku, Finland ABSTRACT This study was undertaken to describe and explore independent living among older people from the point of view of social and health care collaboration. Its purpose was to increase understanding about the resources of older home care clients and to investigate aspects of social and health care collaboration in home care provision. This was a cross-sectional study that used a descriptive and comparative design. The data for the research were collected among home care clients (aged 65 or over) and their professional carers in one municipality in Western Finland. Open-ended interviews were conducted with 21 older clients, who were asked about their everyday coping resources and their experiences of multi-professional collaboration in care provision. Data analysis was based on the method of content analysis. In addition, 25 home care professionals – 13 home service workers, 11 home health care nurses and one medical doctor – described their experiences of multiprofessional collaboration. These data were collected in focus group interviews and analysed using the method of content analysis. These results and the earlier literature were then used to develop a structured questionnaire for purposes of analysing and comparing the views of home care clients and professionals on multi-professional collaboration in care provision. Following the completion of pilot tests, the questionnaire was sent out to 200 home care clients and to 570 carers: 485 home care workers, 81 home health care nurses and 4 doctors. Responses were received from 120 clients (60%) and 370 professional carers (65%). Group differences were analysed using cross-tabulations, Pearson’s Chi-Square Test and Fisher’s Exact Test. The older home care clients described their resources in terms of a sustained sense of life control and will. They derived strength in managing everyday life from their leisure activities and social networks, but on the other hand they were greatly challenged by the conditions imposed by outsiders on their everyday life, by their deteriorating health and their loneliness. The results showed that the care provided by professionals sometimes conflicted with older clients’ expectations and did not always support the clients’ own resources. Professionals took care-related decisions and actions on behalf of their clients, even though the clients themselves stressed the importance of retaining their sense of life control and will. Factors hampering multi-professional collaboration in supporting client resources included the difficulties that care professionals had in identifying those resources and threats to those resources, communication problems, the lack of clear goals as well as care professionals’ contrasting views and ways of working. Clients’ and care professionals’ views on care provision differed statistically significantly (p<0.05). Clients had lower assessments than care professionals of the support provided for independence and the provision of physical, psychological and social care. The research highlights a number of challenges for the development of collaboration in home care services. Importantly, steps are needed to strengthen clients’ expertise of their own life, to promote a more client-driven and goal-oriented approach to care provision, to clarify the roles and responsibilities of professional care providers and to improve methods of communication. The results of this work strengthen the knowledge base of gerontological nursing science and provide valuable information that can be used in social and health care education as well as in administrative practice.