Abstract

Background: As the emphasis on long-term care has shifted from institutional care to home care, home care units have reported increased work pressure and stress. Care workers report that clients have more needs and require more care workers' time than before, and thus home care work is increasingly straining. Informal care, usually provided by relatives, can help to share the care burden.

Objectives: Using extensive register data based on RAI (Resident Assessment Instrument) assessments, we study the change in the share of home care clients using the minimum of 3.5 hours of home care per week and changes in those receiving informal help between 2017 and 2020. In addition, we compare publicly and privately provided home care. Later on, we will use a more extensive dataset where the use of care can be examined since 2010.

Methods: The study concentrated on RAI-assessed home care clients aged 75 and older and compared public (N 295) and private (N 46) home care units in 2017-2020 in consecutive years. RAI data were drawn from the open RAI database of the Finnish Institute for Health and Welfare. The variables of interest were the proportion of 1) home care clients who used more than 3.5 hours of home care per week and 2) those clients who received informal help. The data were analyzed with descriptive methods. Chi-square test and analysis of variance (ANOVA) were used to explore the differences between the years and public and private home care units.

Results: Preliminary results show that in all years (2017-2020) together, a higher proportion of private service providers' clients received at least 3.5 hours of home care per week than the clients of public service providers (p=0.005), while the clients of public home care received more informal help (p=0.032). The public service providers had slightly more customers with cognitive decline (76% of clients had cognitive decline) than the private ones (73%), but there was no difference in the proportion of clients whose functional ability was classified as independent. Descriptive analysis shows that between 2017 and 2020, the proportion of clients receiving at least 3.5 hours of home care per week fluctuated in private units and increased from 59 percent to 62 percent in public units. The change in the proportion of clients receiving home care for at least 3.5 hours per week was statistically significant in public home care units (p = 0.017) but not in private units. Between 2017 and 2020, the proportion of clients receiving informal help at least once a week fluctuated in both private and public units. Change over time in the proportion of those home care clients who received informal care was not statistically significant.

Conclusions: The results indicate that the proportion of clients in need of more intensive home care has increased in public units, while it remained roughly the same over the years in private units. More detailed information is needed on whether this is related to the difference in client needs or whether there are other drivers for the different changes between public and private care units. A longer study period will give a more reliable result of the changes over time.