Diversity of care services from one source - A nursing home as the care planner, service provider and gate keeper for elderly and care-dependent people living in the community. An evaluation study of an innovative healthcare service model in Germany.
|Duration:||2016 - 2018|
|Funding:||Stiftung Wohlfahrtspflege NRW|
|Project Management:||JProf. Dr. Margareta Halek|
|Project Coordination:||Ina Hartwig|
|Collaboration:||Städtische Seniorenheime Krefeld, Andreas Kutschke|
Hochschule Esslingen, Prof. Dr. Reinhold Wolke
Organizing home-based care arrangements and providing care for older people in the need of care and support at home presents several challenges. The main reason lies within the fragmentation in the German social security system: One consequence of our fragmented system is a variety of service providers and care institutions. Another consequence is that there are different logics of provision, financing and sourcing. This leads to a care situation that may not be client-oriented or not suitable to cover objective demands.
The uniqueness of the care service delivery model of the Städtische Seniorenheime Krefeld (SSK, provider of 4 nursing homes) lies in the provision of the whole range of care (home care, adult day care, short term and nursing home care). This means, that the nursing home provides additionally home care in four districts within a defined radius in direct proximity to the nursing homes of the SSK.
In order to do so, the SSK negotiated health care provision contracts with all respective social insurance agencies as the legal framework for their project. This contract allows the SSK to offer a “basket” of broad services that covers all kind of different needs. The aims of this care service delivery model are a) to address the user’s individual needs and demands and b) to provide the services from a single source. Such a healthcare provision contract is novel within the German long-term care systems and unprecedented in North Rhine-Westphalia.
The aim of the study is to find out whether the care service delivery model is beneficial for the users and stakeholders who are involved. Therefore, several perspectives are being examined (user, staff, CEO of the provider, health insurance agency, other regional service providers, society ).
The study concentrates on the following research questions:
- What are the benefits of the care service delivery model for people in need of care and their informal caregivers in relation to the design of the care arrangement?
- What are the facilitators and barriers during implementation of the care service delivery model?
- How do relevant stakeholders (specifically service providers and decision-makers) evaluate the care service delivery model and its implementation?
- Which economic consequences (for the provider / the insurance system?) can be observed?
The evaluation is designed as a multi-perspective observation study. Within the project period, data is collected at three time points in the four districts of the users and their families as well as from the staff of the SSK. Both groups participate in a survey / answer questionnaires in individual or focus-group interviews. The expert interviews with different stakeholders were conducted with decision-makers from the care landscape in NRW. Furthermore, economic data was collected from all four nursing
The SSK is responsible for the operationalization, refining, and implementation of the healthcare provision contract and the care service delivery model. Key contents are contract drafting, advanced training of employees, the organization of processes, the implementation of case management and quality management.
The study is intended to provide insights into whether or not
- the implementation of the care service delivery model can lead to the successful provision of needs-based care for users and their families across all sectors and
- a positive influence on the stability of home-based care arrangements can be observed.
The study also provides insights into the potential and challenges of implementing such a model.
This care service delivery model is unique within the German long-term care system and might change the way in which home care is provided in the future. For the user the care service delivery model has the potential to dissolve fragmentation of services. Moreover, we expect a stabilization of care arrangements and an increasing client satisfaction concerning their care situation at home. Furthermore, the care service delivery model might increase work satisfaction of the professionals and therefore may influence the perspective on long-term-care service providers.