Abstract

Background: Driven by the ageing in place policy and cost containment measures, care of elderly people in Sweden has undergone substantial cuts in institutional care and these cuts have not been compensated for by a corresponding increase in the provision of home based care. One consequence of this development is that elderly people with complex health problems and severe needs are being forced to seek acute hospital care, often as a result of a breakdown in home care provision.

Objectives: In 2010, the national government granted financial incentives to projects aimed at improving home based care for elderly people with complex health problems and severe needs. The objective was to try to stimulate new, innovative eldercare models to alleviate the problems involved with providing coordinated round the clock services and care to very frail older people living at home. In 2011, the Aging Research Center (ARC) was commissioned by the government to carry out a scientific evaluation of these projects over a three year period (2011–2014).

Methods: Under the first phase of the evaluation a descriptive base study was conducted during which all local project sites were visited and reviewed. Project plans, local data and local evaluation plans were collected and analyzed.

Results: Only a minority of the projects can provide the data necessary for a scientific evaluation. This is mainly due to poor targeting of people with complex health problems, lack of base-line data, poor descriptions of the interventions and also poor basic evaluations knowledge/experiences. Further none of the projects have included the institutional care setting; Primary Health Care is notable by its absence; and family carers and support to families have not received any special attention.

Conclusions: The vast majority of projects have focused on prevention of or to delay or postpone admission to hospital care. Most of the innovative eldercare models have focused on different kinds of Care Management models and multiprofessional teams, to improve access to home health care.

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