Meinow Bettina, Kåreholt Ingemar, Lagergren Mårten
Department of Social Work, Stockholm University, Stockholm, Sweden.
Health Soc Care Community. 2005 Jul;13(4):366-77. doi: 10.1111/j.1365-2524.2005.00570.x.
Given the cutbacks which have been carried out in the Swedish welfare state despite the unchanged official policy of allocation of home help services according to needs, it is essential to evaluate the factors which guide the allocation of home help today. Whereas numerous studies have identified factors which predict entry into the home help system, the present paper concentrates on predictors of the amount of home help amongst those allocated assistance. Data were obtained from the population-based care and services section of the 2002 Swedish National Study of Aging and Care-Kungsholmen (SNAC-K). All home help recipients (> or = 65 years of age) living in an inner city district of Stockholm (Kungsholmen) were analysed with ordinary least squares regressions to identify predictors of the number of hours of home help (n = 943). Need indicators, i.e. dependency in activities of daily living (ADLs) and instrumental ADLs (IADLs), and cognitive impairment (Berger scale) were the strongest predictors of more hours of home help. The addition of sociodemographic (i.e. age, gender and income), environmental (i.e. informal care, housing adaptations and housing accessibility) and structural (i.e. variations in allocation decisions between one care manager and another) factors contributed only marginally to the explained variance. Hours of help entitlement increased slightly with greater age. Co-residing individuals were allocated significantly fewer home help hours than those living alone. Income and regular access to informal care were not significant predictors. The fact that services are provided according to need criteria does not necessarily mean that the provided services are adequate to meet needs. On the macro level, social policy decisions and available economic and manpower resources determine the allotment of municipal home help. However, this study in an urban sample suggests that, within the available resources, the amount of home help allocated is guided mainly by need indicators amongst those given assistance.
尽管瑞典官方仍维持根据需求分配居家护理服务的政策不变，但瑞典福利国家体系已进行了削减，因此评估当前指导居家护理分配的因素至关重要。尽管众多研究已确定了预测进入居家护理体系的因素，但本文着重关注在已获援助人群中，居家护理量的预测因素。数据取自2002年瑞典全国老龄化与护理—— Kungsholmen研究（SNAC-K）中基于人群的护理与服务部分。对所有居住在斯德哥尔摩市中心城区（Kungsholmen）的居家护理接受者（年龄≥65岁）进行普通最小二乘法回归分析，以确定居家护理时长的预测因素（n = 943）。需求指标，即日常生活活动（ADL）和工具性日常生活活动（IADL）的依赖程度，以及认知障碍（伯杰量表）是居家护理时长增加的最强预测因素。社会人口统计学因素（即年龄、性别和收入）、环境因素（即非正式护理、住房改造和住房可达性）以及结构因素（即不同护理经理之间分配决策的差异）的加入，对解释方差的贡献仅微乎其微。居家护理时长随年龄增长略有增加。与他人同住的个体获得的居家护理时长显著少于独居者。收入和定期获得非正式护理并非显著的预测因素。根据需求标准提供服务这一事实并不一定意味着所提供的服务足以满足需求。在宏观层面，社会政策决策以及可用的经济和人力资源决定了市政居家护理的分配。然而，这项针对城市样本的研究表明，在可用资源范围内，分配的居家护理量主要由受助者的需求指标来指导。
