Low expectations

In measuring the
quality of home care services Margareta Lindelöf finds that
users’ views are coloured by the belief that they should not
expect too much of the service.

In order to measure
the quality of care among the clients within the home help service
in Sundsvall, I conducted telephone interviews with a random group
of primarily older clients. We were unable to include a number of
clients who had become ill or preferred not to participate. As a
result the number fell from a total of 195 to 125 respondents, whom
I talked to on the phone.

One aspect of quality
was the link between the needs assessment completed earlier by home
care co-ordinators and the resulting home care service actually
delivered to the clients. Eighty per cent of the decisions
corresponded exactly when comparing the assessments with the
reality as described by the clients. The remaining 20 per cent
either received more or less help than the assessment had
recommended. However, this discrepancy can be seen as an expression
of the continual need for the home help system to adapt to changing
needs. 

Interestingly, three
years earlier a similar survey showed that cleaning was the most
frequent service provided. In the present survey cleaning had been
replaced by personal care and the installation of security
telephones.

Many clients felt
that:

– They didn’t
get help at the time agreed.

– The quality of
service differed owing to who came to help.

– Help was provided by
too many different home-helps.

Ninety-two per cent
said that they were very politely treated by the home-helps. Eighty
per cent were either content or very pleased with the help they
received.

It was astonishing to
discover the extent to which clients put up with home-helps
sometimes having to hurry or not arriving at all. The recipients
were seemingly very understanding that these disruptions in service
were caused by other factors affecting the carers’ ability to
do their work. They were aware that the staff were under pressure
and doing what they could to help. It even seemed as if the
recipients were in solidarity with the home-helps and were
satisfied to a large extent.

However, if we look at
the situation described above and that about 25 per cent told me
that they did not get the help they needed, I would suggest that
recipients were expressing a kind of “disciplined
satisfaction”.

There has been an
extensive discussion in the media about the economic strains both
nationally during recent years and in the local newspapers
concerning social work in Sundsvall. This debate may both create
and lower the expectations on the home care service among people in
general, especially the elderly in need of the home care service
system. As a result it seems as if the lowered expectations create
a better measure of quality in the eyes of the service
users.

This perspective of
service users who have learned to expect less and are therefore
more satisfied is what I am referring to as a “disciplined
satisfaction”. The question is whether the quality is better
in reality?

Margareta Lindelöf
is a social issues investigator working for social services in
Sundsvall.