Marja Vaarama

Care-related quality of life in old age

Promoting quality of life is a central theme in recent ageing policies, but what quality of life means in concrete terms for people in different stages of old age is rather unclear. This study presents a multi-dimensional model of care-related quality of life (crQoL) and, based on analyses of three Finnish cross-sectional datasets from the years 2004–2007, examines the distinctions between dimensions of QoL by age and gender, with a special focus on older home care clients. Correlation analyses (Pearson) and stepwise linear regression were applied to analyse variation in QoL by age group and the association between QoL and perceived quality of home care. The results suggest that individual QoL and the priorities of (physical, psychical, social, and environmental) dimensions in the assessment of QoL by older persons vary considerably and exhibit distinct profiles in different stages of ageing. In addition, four dimensions for good care corresponding to the crQoL model were identified and their empirical relevance demonstrated. From the perspective of older people in need of help, home care is not just about giving them the instrumental help they need to perform their daily activities, but rather about giving responsive care that reflects their personal preferences or their view on a “good life”, and treats them with dignity and respect. The criteria for the evaluation of quality of home care should reflect these insights, and policy measures should take these differences into account.

Traceability in requirements through process modelling, applied to social care applications

Abstract This paper relates experiences of using a business-process approach to the determination of requirements for social care systems. A method has been developed and used successfully with a number of major research projects, most specifically PLANEC. A protocol and framework are presented that utilise the Unified Modelling Language and adopts best practice from IT and social science methods. It utilises a loose-coupled hierarchical grouping of processes as a strategic view, and more tightly coupled models such as workflows. The method, as it has evolved, has produced a clear linkage between stakeholder goals and expectations, and IT functionality expressed as UML use cases.

The Concept of Quality of Long-Term Care

To study quality of care (as well as quality of life) in a cross-national research design requires the use of some pre-defined criteria on what is or what is not good quality. This is not easy as on the one hand, quality of care has been defined in many ways, and on the other, the quality of long-term care of older people is weakly defined. Further, the definitions of quality of care from the perspectives of the clients are rare (e.g. Baldock & Hadlow, 2002; Bowling, 1997), and same regards definitions of quality from a multi-professional perspective (Nies & Berman, 2004). Regarding the quality of long-term care of older people, homecare seems to lack quality definitions (e.g. Paljarvi, Rissanen, & Sinkkonen, 2003; Thome, Dykes, & Rahm Hallberg, 2003), more often than nursing care and institutional care (e.g. Ranz, Zwygart-Stauffacher, & Popejoy, 1999). In health care, the definition given by Donabedian (1969, 1980) is a widely accepted framework to evaluate quality of care. According to this model, the quality of (health) care needs to be ensured in the three following aspects:

Care-related Quality of Life: Conceptual and Empirical Exploration

In this chapter the concept of care-related quality of life (crQoL) is discussed as a basis for research within social gerontology and as a framework for evaluation of quality and performance within health and social care services for older people. The motivation for this, both theoretically and practically oriented work, lies in an increasing awareness that issues of quality of life (QoL) are particularly relevant in the study of older people who are vulnerable, frail or disabled. The changes in personal capacities, abilities, and circumstances that often accompany old age may fundamentally challenge the basis of a person’s well-being and may undermine their ability to cope with everyday life (Sixsmith, 1994; Hughes, 1990). For those people who rely on daily support from health and social care services this is likely to have a major impact on their QoL. Enhancing QoL should be a major component in how we assess the value and impact of the services. Considerable attention has been given to issues of health-related QoL (Bowling, 1995, 2004), e.g. in respect to particular illnesses or conditions. Attention has been given to QoL for people, especially older people, who are suffering from chronic, long-term conditions, such as congestive heart failure, stroke, and arthritis. Rather less attention has been given to older people who are described as ‘frail’, or who experience multiple low-level conditions that have impact on their abilities to cope with everyday life (Birren et al., 1991). Many of these people are dependent on the care and support they receive from formal (e.g. health and social care) and informal (e.g. family and neighbours) sources and their well-being is inevitably bound up in these care relationships. If care is fundamental to the well-being of frail older people, then a framework that specifically incorporates the role of care in the production of wellbeing is needed, rather than a more general concept of well-being. From an applied perspective, organisations involved in the monitoring, commissioning, and delivery of care services are specifically interested in evaluating the impact of care services. The work reported in this chapter has been carried out as part of the Care Keys – a project funded under the European Union’s Quality of Life Research and Development programme.1 Care Keys is a multidisciplinary project that aims to develop a conceptual model of crQoL, and a ‘tool kit’ for the evaluation and management of the quality of long-term care of older people, with emphasis on client voice and outcomes. This study was performed at the initial stage of the project to find our fitting outcome measures, and to test the connection between care and well-being for justifying the basic Care Keys approach and whether it provides a promising avenue for the project working.