Abstract

Objective: to describe to what extent characteristics of home care organizations – i.e. Their organizational structure and their view regarding the care potential of informal caregivers – are associated with characteristics of mixed care networks of frail older adults.

Data and methods: 30 older adults living at home receiving both informal and formal care were approached via two home care organizations in Amsterdam. In structured face-to-face interviews all informal and formal helpers of an older adult were identified. Information was collected regarding care activities and background variables of each of the helpers, including the contact and cooperation with each of the other helpers identified in the network. The 30 mixed care networks of these older adults were compared on size, proportion of formal- and informal caregivers, task differentiation and (frequency of) communication between formal and informal caregivers. For the two home care organizations the level of mechanistic versus organic orientation was determined by looking at hierarchy, division of tasks and responsibilities, locus of control and communication channels. To determine the organizational view on informal caregivers, policy documents were studied. Both organizational structure and view on informal caregivers were also discussed in semi-structured interviews with managers. Descriptive analyses are used to describe the characteristics of the mixed care networks of each of the two home care organizations. Differences are interpreted in light of differences in organizational structure and views on informal caregivers.

Results: Preliminary descriptive analyses show that care networks in which formal caregivers coming from an relatively mechanistic oriented organization operate, are relatively large (10.7 caregivers on average), have a smaller proportion of informal caregivers (33%) and that tasks of formal caregivers are more differentiated. Care networks in which professionals from a organic oriented organization are involved are smaller (8.9 caregivers on average), the proportion of informal caregivers is (a little bit) higher (35%) and task differentiation for formal caregivers is lower (more formal caregivers perform more than one task). Communication between formal caregivers from an organic oriented organization and informal caregivers seems to be more timely and accurate than communication between formal caregivers from an mechanistic oriented organization and informal caregivers. The view with regard to informal caregivers is comparable for both organizations and is focused on cooperation between formal and informal caregivers. It does not seem to be associated with network characteristics.

Policy implications: Although both home care organizations seem to value cooperation between formal and informal caregivers, the care networks of their clients differed with regard to size, composition and task differentiation. These differences seem to be associated with the level of mechanistic versus organic orientation in home care organizations. This raises the question how actual work processes, resulting from organizational structure, hinder or contribute to truly matching policy and practice.

Slides