Abstract

Background: The public sector in Europe is under increasing pressure to provide quality long-term care (LTC) for an ever-growing older population, with ever-limited resources at its disposal. One of the areas within LTC that often ends up being squeezed by these interlocking phenomena is the professional workforce. Funded by the Vienna Chamber of Labor, this study investigates the often neglected perspective of care professionals and their perception of how ‘good’ quality care should be defined, and what its achievement entails.

Objectives: The primary objective of the study was to explore the perception of ‘good’ care for older people from the point of view of care professionals, using Donabedian’s framework to distinguish between structural, process- and outcome-related dimensions of quality. A secondary objective and the main output of the study was the development of a catalog of main themes and issues involved in the provision of ‘good’ care.

Methods: The study employed qualitative methods. These included expert interviews with representatives of the main professional groups working in LTC in Austria, as well as focus groups with mixed groups of care professionals carried out in different regions. The data collection also incorporated a focus group with family carers to explore important overlaps and differences between formal and informal care, as well as interviews with 24-hour migrant carers. The latter constitute a growing ‘grey’ workforce in Austria, a group in many ways caught between the formal and informal sector.

Results: The study highlights a number of factors critical to the provision of quality care. First, the continued development of a LTC identity that is distinct from health and social care has important implications for the way in which LTC professionals see themselves, and by extension, for the sector’s public image. A distinct LTC identity would pave the way for the selection of more appropriate indicators of LTC quality, away from largely medical, clinical indicators and towards a more desirable, holistic conceptualization of user wellbeing. Second, care professionals’ working conditions have a strong impact on the provision of quality care. Third, relationships and inter-personal dynamics are central to care work. This includes relationships between care professionals and users, and crucially, between professionals and users’ family members and other informal carers, including 24-hour migrant carers. Fourth, the capacity of providers to integrate and coordinate care services depends in large part on how care is structured and financed at the national level.