Title : The impact of different organizational structures of home-care provider organizations on the negotiation process between formal and informal care in German home and community-based care
Abstract:
Background:
In Germany, 84% of people in need of care (a total of 5.0 million people) are cared at home, either by relatives (2.55 million people) or with/by home-care provider organizations (1.05 people) (Statistisches Bundesamt, 2022). People in need of care and their social environment have heterogeneous resources, needs, social relationships, housing, and living conditions (Räker et al., 2020). In contrast, the utilization of home- and community-based care in Germany is based on a highly fragmented catalogue of services. The provision of care by home-care provider organizations creates a negotiation process between formal and informal care (Büscher, 2007). The organizational structures are different. The patient-centered Buurzorg model from the Netherlands is an example of new organizational structures. It is based on small, self-organized teams of nurses who provide care, promote the independence of those in need of care and establish as well as develop networks in the neighborhood (Monsen and Blok 2013).
There is a lack of knowledge of how organizational structures impact the negotiation process from the perspective of all participants. Examining this impact is the aim of the research project.
Methodological research approach:
To answer the lack of knowledge, a qualitative research approach is chosen to reconstruct the social reality within the negotiation process. In this context, the organizational structure of the Buurtzorg model is a contrast to the traditional home-care provider organizations. Therefore, a comparison between traditional organizations and the Buurtzorg teams is aimed for data collection. The high level of heterogeneity of people in need of care and their environment leads to methodological challenges in this study. To be able to deal with these differences, a matching method is carried out. For each person cared by the Buurtzorg teams, a „twin“ will be found who is cared by a traditional organization. The matching criteria are:
Age of the person in need of care
Gender
Degree of care
Prevalence of limited everyday ability (due to cognitive impairments or psychological problems)
Duration of the need for care
The question of whether someone lives alone or not.
The individual variables are coded in such a way that a maximum distance of one results in each case. The variables are used with equal weighting in the calculation of the total distance. The aim is to integrate care arrangements with the smallest possible total distance, which may have a maximum value of one. The research design is based on the grounded theory method (Strauss & Corbin, 1996). In the selected care arrangements, data collection is conducted in the form of qualitative interviews with people in need of care and their relatives.
Conclusion:
A comparative methodological approach is necessary to examine the impact of different organizational structures on the negotiation process between formal and informal care. The presented approach is a response to the high heterogeneity of people in need of care. Research on new organizational structures can be used to develop approaches that enable people in need of care to stay in their own homes.
Audience Take Away Notes:
There is a lack of knowledge about the impact of different organisational structures of care services on the negotiation process between formal and informal care
People in need of care and their relatives are highly heterogeneous in their needs as well as in their housing and living situations
To respond to this heterogeneity, a comparative methodological research approach is necessary using a matching procedure
This comparative research approach can also be useful in answering further research questions in home- and community-based care
