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2014 Conference Presentation

Domiciliary care Finland

1 September 2014

Choice and effectiveness of home care for the elderly

Ismo Linnosmaa, The National Institute for Health and Welfare, Centre for Health and Social Economics (CHESS), Finland


The possibility of service recipients to get personal and tailored services is emphasized in social care argumentation. There is also evidence from previous research that freedom to choose the services improves the effectiveness of social care. Both policy makers and those who need social care services prefer domiciliary care to institutional care. Most of the home care in Finland is provided by the public sector. It has been argued that the recipients of the public sector services do not have enough possibilities to choose their services. Our objective in this study is to examine, first, if the recipients of public home care services have a choice to decide about their services, and secondly, if the choice is associated with higher effectiveness of home care.

We have data from 529 public home care recipients in three cities in Finland, Pieksämäki, Savonlinna and Hämeenlinna, gathered by a postal survey between November 2013 and February 2014. The average age of the recipients is 85 years, and two-thirds of them are women and onethird men. Information about services used by the recipients was collected from the service providers’ customer information systems. We used Social Care Related Quality of Life gain (SCRQoL gain) to measure the effectiveness of home care. We cooperated with the ASCOT team of the University of Kent in applying the ASCOT tools. Regression analysis will be used to test if the choice improves effectiveness. A bit more than 80% of public home care recipients told that they have a possibility to choose at least some of the elements of their home care.

In this respect, differences were found between the three cities (77,8% – 82,6%). On the other hand, almost 27 percent of the respondents told that they do not want to make decisions about the services themselves. The average SCRQoL gain of the recipients who felt they had choice of the home care services was 0.18, compared to 0.12 of those who felt they had no choice. Also the preliminary regression analyses confirm that the effectiveness of home care is associated with the recipients’ possibility to choose the elements of the services. The final results will be presented in the ILPN conference.

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