Abstract
Background: Older adult patients who receive homecare services are entitled to free oral healthcare services in Norway. However, there is no guarantee that they would receive such care due to the disintegration of coordination between homecare and dental care services. The oral health care services are organised at the county level while the homecare service at the municipality level. The two organizational levels are governed by different policies, legislations, and funding systems that make collaboration between the healthcare providers at the two levels challenging.
Aim: This study aimed to explore the homecare service personnel’s perspective on the existing collaboration and coordination with the oral healthcare services.
Methods: Four focus group interviews in three municipalities with different population andorganisation models were conducted. The participants were recruited by their manager and those who consented to participate consisted of registered nurses, auxiliary nurses, auxiliary nursing students and assistants. In the analysis of the interviews, a deductive approach, based on the integrated care model ""rainbow model"", was applied. The model provided a framework to organise the interviews and gather knowledge of the challenges faced by the health personnel for integrating continuity and safe oral health across the two service levels.
Result: The health personnel had experienced organizational, professional and ethical dilemmas in the process of providing oral health care to patients. They expressed that there is limited systematic collaboration between homecare services and oral healthcare services in today’s practise. Some of them had experienced that a dental hygienist sometimes assisted the older adults. However, the main finding was that they had insufficient routines for the allocation of responsibilities for initiating, informing, planning and following-up the oral health for individual patients. Thus, it had implication for the health personnel’s feeling of their professional responsibility for addressing the individual patient’s oral health need. The homecare services is in a position to detect changes in the older adults’ oral health. However, the fact that the health services are provided in the homes of the elderly often creates ethical dilemmas between the patients’ wishes and the opinions from professional assessments.
Conclusion: The older adults living at home need coordinated healthcare services, of which oral health is an important part. The homecare services need to circumvent organisational and professional barriers and establish a repertoire to manage challenges and dilemmas that occur in their efforts to provide quality oral healthcare services.
Implications for applicability, sustainability, and limitations: For ensuring sustainability in integrated oral health services, the result will be used as one of the components in the development of generic and validated guidelines that would be ready for large-scale implementation. However, a limitation is that the oral health personnel’s’ perspective on coordination has not yet been examined in this study which will be addressed in next study.