Investigating the impact of delivery of care, reablement, workload and organisational factors on homecare services: a systems approach (Preprint)

BACKGROUND Homecare is facing increasing demand due to an aging population. Several challenges have been identified in the provision of homecare, such as the need for support, and tailoring support to the individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and re-learning of everyday life skills and has been found to improve health-related quality of life while reducing service use. OBJECTIVE The objective of this study was to characterise homecare systems variables (elements), and their relationships (connections), relevant to homecare staff workload, homecare user needs and satisfaction, and the reablement approach. This to examine the effects of change-work and interventions, such as the person-centred reablement approach, on the delivery of homecare services, workload, work-related stress, homecare user experience and other organisational factors. The main focus was on Swedish homecare and tax-funded universal welfare systems. METHODS The study employed a mixed methods approach where a causal loop diagram (CLD) was developed grounded in participatory methods with academic healthcare science research experts in nursing, occupational therapy aging and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analysed qualitatively and through simulation methods. RESULTS The final CLD included elements and connections across the categories: stress, homecare staff, homecare user, organisation, social support network of the homecare user, and societal level. The model was able to qualitatively describe observed intervention-outcomes from the literature. The analysis suggested elements to target for change-work and the potential impact of relevant studied interventions. CONCLUSIONS The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of change-work in homecare. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored.