Quality of Life of Older Homecare Clients.

The objective of enabling older people to live in their own homes as long as possible is a widely accepted guiding principle of old age policies in most western societies. "Ageing in place" is seen as a goal that accommodates the preferences of both older people themselves and society. Homecare (HC) is one of the key means to support older people who need regular external help to remain living at home. Underlying the provision of homecare, there is an implicit or explicit goal to enhance the general well-being of the clients. However, there is still little known, especially from the perspective of old people themselves, about the ways that different types of homecare and how they are organised and delivered can impact on the quality of life (QoL) of the clients. Although patterns of homecare provision may vary considerably between European countries, reflecting different approaches to provision within "mixed economies of care", services usually range from help for housekeeping and daily activities of living to nursing care at home, as well as social, emotional and psychological support to maintain independence and autonomy. During the last two decades, most European countries have introduced policies for prioritising or targeting client needs in order to allocate the available scarce resources to those in most need (e.g. Evers & Svetlik, 1993; Pacolet, Bouten, Lanoye, & Versieck, 1998). For example, in Finland, a shift from a publicly provided social model of home help towards a more medically orientated care at home is apparent, as well as a shift from public provision towards a more mixed economy, involving providers from both the public and private sectors (Vaarama & Noro, 2006). For "better targeting of care", eligibility for formal homecare is increasingly targeted on those people with highest needs in respect to personal daily activities (PADL—help with personal hygiene, going to the toilet, etc.), whereas those persons needing help in housekeeping and other instrumental daily activities (IADL) are increasingly likely to be cared for by families or to buy the services privately. Importantly, services that support the psycho-social and environmental and housing needs of clients tend to be ignored. [ABSTRACT FROM AUTHOR]