Continuity in long-term home health care. Perspectives of managers, patients and their next of kin

Abstract

Home health care is increasingly preferred as the setting for care for older people who depend on daily and long-term care. During a long-term care trajectory in a context where home health care is a 24-hour service with three shifts of staff patients meet many professional carers. Research on continuity of care abound, studies in such care settings are scarce. Three sub-studies were performed in order to 1) develop a new method for assessing interpersonal continuity of care by adapting existing measures to context and to measure and assess interpersonal continuity of care in that context; 2) to study how managers define continuity of care and what they do to ensure continuity of care in practice and; 3) to study the perspective of patients and their next of kin on continuity in home health care and to measure the degree of agreement between them. The degree of interpersonal continuity of care was low for all patients. Managers defined continuity of care as a patient having few carers, yet they accepted low interpersonal continuity as a working compromise. They made priorities between and within patients and staff on the expense of interpersonal continuity of care for patients. Patients reported low interpersonal continuity of care, but the majority did not consider the large number of carers a problem, which was in strong contrast to the next of kin’s views. Patients and their next of kin reported experiencing continuity of care with regard to how management and informational continuity is understood, yet predominately, poor agreement was found between them. The results from the study show that, in the realm of long-term home health care, continuity of care is challenging to achieve.