Taking home-based services into everyday life; older adultsrsquo; participation with service providers in the context of receiving home-based services
Aud Elisabeth Witsoslash;, Borgunn Ytterhus and Kjersti Vik
ABSTRACT
This article aims to increase the understanding of older adultsrsquo; participation with home-based service providers. It is critical to ensure that home-based services promote older adultsrsquo; ability to live in their own homes, and to participate in daily life and society as long as possible. Exploring older adultsrsquo; experiences with participation in home-based service delivery is essential for development and delivery of high-quality services that support older adultsrsquo; participation. Older adults with a variety of age-related physical impairments and frequency of home-based services were interviewed. The data was collected by in-depth face-to-face interviews in the older adultsrsquo; homes. A constant comparative method inspired by constructivist grounded theory was applied to analyze the data. The study highlights the importance of understanding emotional and intellectual aspects of older adultsrsquo; participation, and to recognize their strategies for balancing agency in everyday life.
Keywords: participation; older adults; home-based services; qualitative study
Introduction
There is an increasing focus on activity and participation for older adults due to the active and healthy ageing policy frameworks. An important goal is to support older adultsrsquo; possibilities and capacity to live in their own homes as long as possible, and to participate in daily life and society. Policy and research relating to disability issues like equal rights to participate in society has to a large extent addressed people with functional limitations at working age. The majority of people living with functional limitations are older, and thus calls for broadening policy and research of disability issues to include this group (Johansson 2008). As the ageing population grows, the number of older adults living in place and depending on home-based services will increase (WHO 2004). Studies of older adults with reduced capacity and functional decline have found relationships between participation and increased duration of life, less illness and deferral of further functional decline.
Several studies have found that depending on home-based services in old age may represent barriers to participation (Lyttle and Ryan 2010; McGarry 2009; Vik, Nya°rd, and Lilja 2007). Encounters with staff and the service system may represent barriers to control and self-determination in everyday life (Ellefsen 2002; Vik, Nya°rd, and Lilja 2007). Other studies indicate that home-based services are given as passive help and that there is a need to explore factors promoting participation in older recipients of home-based services (Vaboslash; 2007; Witsoslash;, Eide, and Vik 2011). Knowledge of how older adults perceive and experience participation when living in place and depending on home-based services is limited, and needs to be further explored. More knowledge about how home-based services influence older peoplesrsquo; participation in daily life will increase the possibility of designing services that facilitate their participation.
Participation in service delivery has frequently been understood as user involvement, co-determination, empowerment and involvement in decision-making (Adams 2008; Eldh, Ekman, and Ehnfors 2010; Kemshall and Littlechild 2000; Willumsen 2005). Moreover, perspectives on participation range from a strong focus on civil rights for all at a societal level (Shakespeare 2004; WHO 2002) to an individual level, with a focus on participation in nursing care (Larsson et al. 2007; Sahlsten et al. 2005), participation as autonomy (Cardol, Jong, and Ward 2002) and agency (Vik et al. 2008). The World Health Organization defines participation as engagement in life situations (WHO 2001). Accordingly, the concept of participation has various meanings and different levels. In this article, the focus is on participation in service delivery.
Several studies concerning older home-based service recipientsrsquo; participation in everyday life have taken the perspective of the professionals (McGarry 2009; McWilliam et al. 2001; Vik 2011; Vik and Eide 2012a, 2012b; Witsoslash;, Eide, and Vik 2011). In a study of Witsoslash;, Eide, and Vik (2011), professionals understood older adultsrsquo; participation in service delivery as lsquo;being included and taking part in decision-makingrsquo;, lsquo;socializing during service deliveryrsquo; and lsquo;collaboration in keeping up or regaining functionsrsquo;. According to the professionals, a prominent need in the older adults was social participation with the service providers. Other studies have focused on relational aspects (McGarry 2009; Olsson and Ingvad 2001; Sahlsten et al. 2005, 2008; Wreder 2008) and interpersonal skills (Belcher et al. 2006), and the impact on participation in interaction between professionals and older adults. Olsson and Ingvad (2001) showed that service providers were likely to experience the relational climate with the older service recipients with a higher degree of emotion than the service recipients. This finding was explained as an expression of a wish for a warm and close relationship and a desire to be kind, loving, appreciated and confirmed as competent. McGarry (2009) found that care interactions between service providers and older adults often are disempowering. Other studies emphasize continuity of care and time as key for professionals to facilitate and enhance participation in older home-based service recipients (Olsson and Ingvad 2001; Vik 2011; Vik and Eide 2012a, 2012b). Recent studies have found that older adults in the context of living in place and receiving home-based services emphasize family, friends and neighbours as important for participation and facilitating participatio
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Taking home-based services into everyday life; older adultsrsquo; participation with service providers in the context of receiving home-based services
Aud Elisabeth Witsoslash;, Borgunn Ytterhus and Kjersti Vik
ABSTRACT
This article aims to increase the understanding of older adultsrsquo; participation with home-based service providers. It is critical to ensure that home-based services promote older adultsrsquo; ability to live in their own homes, and to participate in daily life and society as long as possible. Exploring older adultsrsquo; experiences with participation in home-based service delivery is essential for development and delivery of high-quality services that support older adultsrsquo; participation. Older adults with a variety of age-related physical impairments and frequency of home-based services were interviewed. The data was collected by in-depth face-to-face interviews in the older adultsrsquo; homes. A constant comparative method inspired by constructivist grounded theory was applied to analyze the data. The study highlights the importance of understanding emotional and intellectual aspects of older adultsrsquo; participation, and to recognize their strategies for balancing agency in everyday life.
Keywords: participation; older adults; home-based services; qualitative study
1.Introduction
There is an increasing focus on activity and participation for older adults due to the active and healthy ageing policy frameworks. An important goal is to support older adultsrsquo; possibilities and capacity to live in their own homes as long as possible, and to participate in daily life and society. Policy and research relating to disability issues like equal rights to participate in society has to a large extent addressed people with functional limitations at working age. The majority of people living with functional limitations are older, and thus calls for broadening policy and research of disability issues to include this group (Johansson 2008). As the ageing population grows, the number of older adults living in place and depending on home-based services will increase (WHO 2004). Studies of older adults with reduced capacity and functional decline have found relationships between participation and increased duration of life, less illness and deferral of further functional decline.
Several studies have found that depending on home-based services in old age may represent barriers to participation (Lyttle and Ryan 2010; McGarry 2009; Vik, Nya°rd, and Lilja 2007). Encounters with staff and the service system may represent barriers to control and self-determination in everyday life (Ellefsen 2002; Vik, Nya°rd, and Lilja 2007). Other studies indicate that home-based services are given as passive help and that there is a need to explore factors promoting participation in older recipients of home-based services (Vaboslash; 2007; Witsoslash;, Eide, and Vik 2011). Knowledge of how older adults perceive and experience participation when living in place and depending on home-based services is limited, and needs to be further explored. More knowledge about how home-based services influence older peoplesrsquo; participation in daily life will increase the possibility of designing services that facilitate their participation.
Participation in service delivery has frequently been understood as user involvement, co-determination, empowerment and involvement in decision-making (Adams 2008; Eldh, Ekman, and Ehnfors 2010; Kemshall and Littlechild 2000; Willumsen 2005). Moreover, perspectives on participation range from a strong focus on civil rights for all at a societal level (Shakespeare 2004; WHO 2002) to an individual level, with a focus on participation in nursing care (Larsson et al. 2007; Sahlsten et al. 2005), participation as autonomy (Cardol, Jong, and Ward 2002) and agency (Vik et al. 2008). The World Health Organization defines participation as engagement in life situations (WHO 2001). Accordingly, the concept of participation has various meanings and different levels. In this article, the focus is on participation in service delivery.
Several studies concerning older home-based service recipientsrsquo; participation in everyday life have taken the perspective of the professionals (McGarry 2009; McWilliam et al. 2001; Vik 2011; Vik and Eide 2012a, 2012b; Witsoslash;, Eide, and Vik 2011). In a study of Witsoslash;, Eide, and Vik (2011), professionals understood older adultsrsquo; participation in service delivery as lsquo;being included and taking part in decision-makingrsquo;, lsquo;socializing during service deliveryrsquo; and lsquo;collaboration in keeping up or regaining functionsrsquo;. According to the professionals, a prominent need in the older adults was social participation with the service providers. Other studies have focused on relational aspects (McGarry 2009; Olsson and Ingvad 2001; Sahlsten et al. 2005, 2008; Wreder 2008) and interpersonal skills (Belcher et al. 2006), and the impact on participation in interaction between professionals and older adults. Olsson and Ingvad (2001) showed that service providers were likely to experience the relational climate with the older service recipients with a higher degree of emotion than the service recipients. This finding was explained as an expression of a wish for a warm and close relationship and a desire to be kind, loving, appreciated and confirmed as competent. McGarry (2009) found that care interactions between service providers and older adults often are disempowering. Other studies emphasize continuity of care and time as key for professionals to facilitate and enhance participation in older home-based service recipients (Olsson and Ingvad 2001; Vik 2011; Vik and Eide 2012a, 2012b). Recent studies have found that older adults in the context of living in place and receiving home-based services emphasize family, friends and neighbours as important for participation and facilitating participat
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