The impact of the integrated services to home care personnel's job, job satisfaction and quality of services: an intervention study

INTRODUCTION: Health and social care services are undergoing integration worldwide. The reform has changed home care work considerably. According to previous studies, home care work has become more versatile and home care workers' responsibility for home-dwelling elderly who are more fragile has increased. Organisational interventions can strengthen home care work, staff resources and staff well-being. Only a few studies have studied the restructuring from a home care staff point of view. AIM: The aim was to examine the impacts of a work reorganisation intervention on home care personnel's job, job satisfaction and the quality of services. This work forms part of a larger Finnish project entitled PALKO (Integrated Services in the Practice of Discharge and Home Care). METHOD: The design involved 11 municipalities randomised to the intervention municipalities and the other half to the controls. The data from home care personnel were gathered via a questionnaire in spring 2001 (n=1183) and in autumn 2003 after the intervention (n=1291). The response rate was 63 per cent in both cases. RESULTS: Nearly all respondents were women and two-thirds were home aids and home help workers. The mean age was 46 years in the intervention group and 44 years in the control group (p<0.001). Otherwise the groups did not differ statistically in background variables. The information flow between home care and hospitals improved in the intervention group compared to the controls. The work load was not reduced. Skill discretion scores did not change in the intervention group between baseline and follow-up. Interestingly, decision authority scores had reduced in the intervention group compared to the control group. There were no statistically significant changes in the job satisfaction scores in either group. The quality of services was rated as better in the intervention group at the follow-up compared to the baseline. CONCLUSIONS: There were favourable changes in the home care personnel's job control and the quality of services in the intervention group compared to the control group. However, outcome measures and possible effects of socially complex interventions need to be discussed more.