Assessing the relationship between needs and services in elderly women receiving government subsidized home support services in the St. John's region

Duggal, Anil (2003) Assessing the relationship between needs and services in elderly women receiving government subsidized home support services in the St. John's region. Masters thesis, Memorial University of Newfoundland.

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Abstract

Introduction: The combined effects of low fertility and low mortality levels in Canada have resulted in an aging population and increasing health care costs. A major challenge is to provide high quality, long-term care services and programs while ensuring that the care is appropriately matched to need. -- Objective: To explore the association between assessed need and service provision for women aged 75 years and older receiving government subsidized home support services in the St. John's region of Newfoundland. -- Study Aims: 1. To describe the needs of clients according to functional need indicators for formal care provision. -- 2. To describe the service being provided to the clients (formal and informal service systems). -- 3. To describe the relationship between needs and services as well as the predictors of service allocation and the appropriateness of utilization of home support services. -- Methods: A retrospective design was used to assess clients formal care needs and their amount of formal services. A cross-sectional design was used in administering a questionnaire to community health staff, which focused on the perceived capabilities of all providers of informal support. -- Materials: The statistical package for social sciences (SPSS), and a customized Paradox software program were used in the analysis. -- Results: The average age of the 103 female clients assessed was 86 years. Their high need scores centered around a cluster of problems related to Activities of Daily Living (ADLs). In examining levels of informal support, a large number of clients (85%) had low provision. A significant number of clients (74%) scored in the 8th and 9th decile indicating high formal resource use. A correlation between decile ranking and formal service provision was found to be significant. A correlation between informal support and formal service provision was also significant. -- Clients identified as receiving an under-utilization of home support services (n=14) were compared to those appropriately matched for needs and services (n=40). Mismatches between these two groups existed in the domains of age and memory status. Clients identified as receiving an over-utilization of home support services (n=12) were compared to those appropriately matched (n=37). Mismatches between these two groups existed in the domains of living arrangement and informal support. -- The most important predictors of formal service provision were need and informal support variables. Forty-seven percent of the variance of formal service provision was explained by the variables examined. -- Conclusions: 1. Identified mismatches between need and formal support exist within the home support system in St. John's, Newfoundland (25%). -- 2. In order to improve analysis of the associations between formal service, informal support and need score, caregiver burden and longitudinal data should be examined. -- 3. A multi-disciplinary approach to collecting and evaluating complex data would facilitate the future growth and efficacy of home support services.

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