From the state to the family: reconfiguring the responsibility for long-term nursing care at home

This paper discusses the implications of the shift in the location of the provision of healthcare services from healthcare institutions to the home, which has occurred or is projected to occur in coming years. It is argued that the responsibility for the provision of care and assistance needed by the elderly living at home and people with long-term conditions living at home has shifted from public services to the family. Studies of care-givers have shown that in many situations they experience tremendous burdens, financial difficulties and health problems. Their social lives have been confined to the home, and contacts with friends and neighbors have been significantly reduced. This situation needs to be addressed by nurses, who in many cases serve as the bridge between the home and the official healthcare system. Using Foucault's exploration of power, particularly his idea of governmentality, a genealogy of care-giving in the home in Iceland's health-care has been constructed. The main findings were that, although this is occurring somewhat later than in many other countries, the state is withdrawing from its previously defined responsibility for the health and well-being of the nation. At the same time the citizen's responsibility for maintaining health is emphasized. Based on these findings, the argument is made that nurses in Iceland can have a profound influence on policy-making in relation to the organization of services provided in those homes. Suggestions are made as to how this can be done, which may be of interest to nurses in other countries.     

Sharing the care

The expansion of healthcare support workers' roles has created tensions and opportunities for all staff. Key issues include delegation and accountability, education, regulation and pay.     

Standardized care plans for home care

Standardized Care Plans reflect the expected, accepted, normal nursing care and outcome of a patient with a specific diagnosis, problem, or condition. The patient's progress can therefore be evaluated against the expected outcome.     

Re-ablement for home care

We can learn much from the evaluation (SPRU & PSSRU, 2010) of short-term re-ablement interventions within home care settings as a means of promoting effective care in the home and reducing the need for long-term support. These services are generally provided by local authorities as part of adult social care provision with a focus upon promoting self-care skills and rebuilding confidence. Many of these schemes began as initiatives to manage people being discharged home from hospital or recovering from an illness or accident - just the same group who form a significant part of community nursing caseloads.