Table 1
Home care services and clients in the study area.
| Home services | Home nursing | Support services |
|---|---|---|
| – Ensure sufficient care for clients – Ensure good quality of life – Ensure autonomy for all clients through support and help with tasks that these clients are unable to manage with on their own or without the help of their relatives | – Nurse clients at home according to physician’s instructions | – Meal service – Help with shopping and other personal business – Bathing and sauna services – Safety services – Cleaning tasks |
| Client: Individuals who cannot manage their daily tasks independently or with help from their relatives or other service. Client’s care requires professional social and healthcare staff. The need for services is daily or occurs several times a week. Services are granted on the basis of individual assessments of service needs | ||
Table 2
Questions relating to freedom of choice.
| I get to choose (check where applicable) |
| – Care worker |
| – The time when my home care worker visits me (e.g. morning, daytime, evening) |
| – The day on which my home is cleaned |
| – My meals (e.g. from a menu) |
| I would like to influence the home care services I receive: |
| – Yes |
| – No |
Table 3
The ASCOT measure.
| Domains | Levels |
|---|---|
| 1) Control over daily life 2) Personal cleanliness and comfort 3) Food and drink 4) Personal safety 5) Social participation and involvement 6) Occupation 7) Accommodation cleanliness and comfort 8) Dignity | 1) Ideal state: The individual’s wishes and preferences in that particular aspect of their life are fully met 2) No needs: The individual has no needs or the type of temporary trivial needs that would be expected in this area of life for someone with no impairments 3) Some needs: Some needs are distinguished from no needs by being sufficiently important or as frequently affecting an individual’s quality of life 4) High needs: High needs are distinguished from some needs by having mental or physical health implications if they are not met over a period of time. This may be because of severity or number |
Table 4
Functioning, EQ-5D measure.
| Dimensions | Three-level answer options |
|---|---|
| 1) Mobility (walking) 2) Self-care (washing or dressing) 3) Usual activities (work, study, housework, family or leisure activities 4) Pain/discomfort 5) Anxiety/depression | 1) No problems 2) Some problems 3) Extreme problems |
Table 5
Characteristics of the sample included in the analyses.
| Variables | |
|---|---|
| Demographic variables | Age; gender; marital status |
| Coping at home | Any children? Do they live at home? Does help from relatives or friends influence coping? Are the currently received home care services sufficient? |
| Information about home care services | Received sufficient information? More information available if needed? |
| Socio-economic status | Highest degree of education; subjective financial standing |
| Living environment | Place of living; type of housing |
| Utilisation of services | What home care services are in use? For how long she/he has used it? |
Table 6
Description of the sample.
| All n = 1054 | Pieksämäki n = 233 | Hämeenlinna n = 486 | Hospital District of East-Savo n = 335 | ||
|---|---|---|---|---|---|
| All (%) | 22.1 | 46.1 | 31.8 | ||
| Average age | 84.6 | 84 | 85.4 | 84 | |
| Gender (%) | Male | 30 | 30 | 29 | 31 |
| Female | 69 | 70 | 69 | 69 | |
| NA | 1 | 2 | |||
| Marital status (%) | Unmarried | 10 | 8 | 10 | 10 |
| Married | 21 | 25 | 21 | 18 | |
| Common law marriage | 1 | 3 | 1 | 2 | |
| Divorced | 9 | 10 | 7 | 9 | |
| Widowed | 56 | 52 | 60 | 58 | |
| NA | 3 | 2 | 1 | 3 | |
| Highest education level (%) | Vocational or lower | 83 | 88 | 77 | 85 |
| Tertiary | 13 | 9 | 19 | 11 | |
| NA | 4 | 3 | 4 | 4 | |
| Place of living (%) | Urban area | 73 | 73 | 73 | 77 |
| Rural area | 18 | 19 | 18 | 14 | |
| NA | 9 | 8 | 9 | 9 | |
| Type of housing (%) | Owned | 67 | 70 | 68 | 66 |
| Rented | 17 | 16 | 16 | 18 | |
| Rental housing for older persons | 11 | 11 | 11 | 12 | |
| NA | 5 | 3 | 5 | 4 | |
| Any children? (%) | Yes | 81 | 79 | 82 | 79 |
| No | 16 | 17 | 15 | 17 | |
| NA | 3 | 4 | 3 | 4 | |
| Live (%) | Alone | 73 | 72 | 73 | 74 |
| With someone | 23 | 26 | 23 | 22 | |
| NA | 4 | 2 | 4 | 4 | |
| Received sufficient information about | Yes | 64 | 65 | 60 | 70 |
| services (%) | No | 29 | 28 | 30 | 25 |
| NA | 7 | 7 | 10 | 5 | |
| Help from friends and relatives influences | Significantly | 56 | 52 | 60 | 53 |
| coping at home (%) | Somewhat | 27 | 29 | 27 | 27 |
| Not at all | 12 | 15 | 8 | 15 | |
| NA | 5 | 4 | 5 | 5 | |
| Can cope when aided by the services received (%) | Yes | 58 | 60 | 52 | 67 |
| No | 14 | 12 | 15 | 13 | |
| NA | 28 | 28 | 33 | 20 |
[i] NA, not available.
Table 7
Respondents’ experience of their possibility to choose home care services, percentage.
| All n = 1054 | Pieksämäki n = 233 | Hämeenlinna n = 486 | Hospital District of East-Savo n = 335 | ||
|---|---|---|---|---|---|
| Have you been able to choose? | Your care worker? | 14 | 19 | 13 | 11 |
| The time of the care worker visit? | 34 | 33 | 33 | 41 | |
| The day to clean your home? | 31 | 37 | 30 | 30 | |
| Meals you desire? | 20 | 17 | 22 | 20 | |
| At least one of the above | 63 | 64 | 61 | 67 | |
| Would you like to influence the home care services you receive? | Yes | 62 | 57 | 64 | 65 |
| No | 24 | 30 | 21 | 24 | |
| NA | 14 | 13 | 15 | 11 |
[i] NA, not available.
Table 8
Change in quality of life in the study areas.
| Area | N | Average | Median | Std. error of mean |
|---|---|---|---|---|
| Pieksämäki | 112 | 0.18 | 0.14 | 0.018 |
| Hämeenlinna | 216 | 0.15 | 0.10 | 0.013 |
| Hospital District of East-Savo | 189 | 0.20 | 0.16 | 0.015 |
| Total | 517 | 0.17 | 0.12 | 0.009 |
Table 9
The basic model tested the assumption that the needs brought about by ageing impact quality of life.
| Estimate | Std. error | t value | Pr(>|t|) | |
|---|---|---|---|---|
| (Intercept) | –0.148 | 0.087 | –1.695 | 0.09 |
| Age | 0.002 | 0.001 | 2.46 | 0.014* |
| Tertiary education | –0.027 | 0.017 | –1.566 | 0.118 |
| Rental housing for older persons | 0.026 | 0.022 | 1.222 | 0.224 |
| Yes, children | –0.039 | 0.019 | –2.039 | 0.042* |
| Live with someone | –0.019 | 0.016 | –1.182 | 0.238 |
| Receive sufficient information about home care services | 0.016 | 0.016 | 1.005 | 0.315 |
| Help by friends or relatives impacts coping at home, slightly or not at all | 0.027 | 0.014 | 1.967 | 0.05* |
| Can cope when aided by the services received | 0.057 | 0.017 | 3.304 | 0.001** |
| Mobility, extreme problems | –0.026 | 0.02 | –1.264 | 0.206 |
| Self-care, some problems | 0.056 | 0.016 | 3.46 | 0.001** |
| Self-care, extreme problems | 0.128 | 0.028 | 4.508 | 0.000*** |
| Usual activities, some problems or extreme problems | 0.032 | 0.017 | 1.928 | 0.054 |
| Home service, under 12 months | 0.041 | 0.02 | 2.066 | 0.039* |
| Home service, over 12 months | 0.079 | 0.016 | 4.844 | 0.000*** |
| Meal service, 4 months or over | 0.053 | 0.014 | 3.62 | 0.000*** |
| Multiple R-squared: 0.1682 | Adjusted R-squared: 0.1543 |
[i] Signif. Codes. p < 0.1, p < 0.05, **p < 0.01, ***p < 0.001.
Table 10
The extended model tested the assumption that the needs brought about by ageing and freedom of choice would impact quality of life.
| Estimate | Std. error | t value | Pr(>|t|) | |
|---|---|---|---|---|
| (Intercept) | –0.105 | 0.085 | –1.2343 | 0.217 |
| Would you like to influence the services you receive? | –0.017 | 0.015 | –1.1724 | 0.241 |
| Have been able to choose the care worker | 0.017 | 0.019 | 0.9012 | 0.368 |
| Have been able to choose the day of the care worker’s visit | 0.029 | 0.015 | 1.9973 | 0.046* |
| Have been able to choose the day for house cleaning | 0.033 | 0.014 | 2.4273 | 0.015* |
| Have been able to choose the desired meal | 0.045 | 0.016 | 2.7606 | 0.006** |
| Age | 0.002 | 0.001 | 2.0104 | 0.045* |
| Tertiary education | –0.037 | 0.017 | –2.1516 | 0.032* |
| Rental housing for older persons | 0.031 | 0.021 | 1.4638 | 0.144 |
| Yes, children | –0.039 | 0.019 | –2.0828 | 0.038* |
| Live with someone | –0.02 | 0.016 | –1.2419 | 0.215 |
| Receive sufficient information about home care services | 0.004 | 0.016 | 0.2677 | 0.789 |
| Help by friends or relatives impacts coping at home, slightly or not at all | 0.023 | 0.014 | 1.6862 | 0.092 |
| Can cope when aided by the services received | 0.048 | 0.017 | 2.7873 | 0.005** |
| Mobility, extreme problems | –0.023 | 0.02 | –1.1556 | 0.248 |
| Self-care, some problems | 0.051 | 0.016 | 3.2358 | 0.001** |
| Self-care, extreme problems | 0.12 | 0.029 | 4.1715 | 0.000*** |
| Usual activities, some problems or extreme problems | 0.026 | 0.017 | 1.5689 | 0.117 |
| Home service, under 12 months | 0.04 | 0.02 | 2.0128 | 0.044* |
| Home service, over 12 months | 0.075 | 0.017 | 4.5185 | 0.000*** |
| Meal service, 4 months or over | 0.052 | 0.014 | 3.6432 | 0.000*** |
| Multiple R-squared: 0.1916 | Adjusted R-squared: 0.1735 |
[i] Signif. codes. p < 0.1, *p < 0.05, **p < 0.01, ***p < 0.001.