Savla Jyoti, Davey Adam, Sundström Gerdt, Zarit Steven H, Malmberg Bo
Center for Gerontology, Virginia Polytechnic and State University, Blacksburg, VA USA.
College of Health Professions, Temple University, 1300 North Broad Street, Suite 313, Philadelphia, PA 19122 USA.
Eur J Ageing. 2008 Feb 9;5(1):47-55. doi: 10.1007/s10433-008-0071-y. eCollection 2008 Mar.
Decreases in Swedish home help services have not resulted in increased rates of unmet need. To understand these changes, we identified predictors of home help services and rates of institutional care and how these effects changed over time using longitudinal data (1994-2000) from 286 Swedish municipalities. Outcomes were home help coverage rates, intensity of home help per recipient, and rates of institutional living. Predictors reflected availability and need for services. Services decreased over time, but not uniformly. Coverage rates were higher in municipalities with a greater proportion of population 65 and older and greater proportion of unmarried elders. Decreases in coverage rates were greater in municipalities with a higher proportion of unmarried elders, greater ratio of older women to men, with more home help staff workers, and more expensive services. Home help was provided more intensively in municipalities with higher median incomes, higher unemployment rates and municipalities spending more per inhabitant on child care. Decreases in intensity were greater in municipalities with lower proportions of unmarried elders and fewer home help staff workers. Rates of institutional living were higher in municipalities that spent more on old age services and with a greater proportion of unmarried elders. Decreases in institutionalization were greater in municipalities with a greater proportion of unmarried elders and lower ratio of older women to men. Variability in how municipalities responded to these changes may explain continued low rates of unmet need. Results are consistent with both increased efficiency and more effective targeting, but cannot capture service quality.
瑞典居家护理服务的减少并未导致未满足需求率上升。为了解这些变化，我们利用来自瑞典286个市政当局的纵向数据（1994 - 2000年），确定了居家护理服务的预测因素、机构护理率以及这些影响如何随时间变化。结果指标包括居家护理覆盖率、每位接受者的居家护理强度以及机构生活率。预测因素反映了服务的可获得性和需求。服务随时间减少，但并不均匀。在65岁及以上人口比例较高且未婚老年人比例较大的市政当局，覆盖率更高。在未婚老年人比例较高、老年女性与男性比例较高、居家护理工作人员较多且服务成本较高的市政当局，覆盖率下降幅度更大。在收入中位数较高、失业率较高以及人均儿童保育支出较多的市政当局，居家护理提供得更为密集。在未婚老年人比例较低且居家护理工作人员较少的市政当局，强度下降幅度更大。在老年服务支出较多且未婚老年人比例较大的市政当局，机构生活率更高。在未婚老年人比例较高且老年女性与男性比例较低的市政当局，机构化程度下降幅度更大。市政当局对这些变化的反应差异可能解释了未满足需求率持续较低的情况。结果与效率提高和目标定位更有效相一致，但无法体现服务质量。
