title: Goal setting as a feature of homecare services for older people: does it make a difference?
abstract: BACKGROUND
  Health services delivered in an older person's home are often implemented at a critical juncture in an individual's functional status. Although homecare has potential to improve this situation, it often focuses on treating disease and 'taking care' of the patient rather than promoting independence. The aim of restorative homecare is to change the philosophy from one where delivery of care may create dependency to provision of care which maximises independence, self-esteem, self-image and quality of life, and reduces the care required.
  
  
  OBJECTIVE
  To assess impact of a designated goal facilitation tool on health-related quality of life (HRQoL), social support and physical function among community-dwelling older people referred for homecare.
  
  
  METHODS
  A total of 205 participants [mean age 79.1 years, 71.3% female (intervention group) and 76.9 years with 60.8% female (control group)] were cluster randomised to an intervention or control assessor. The intervention arm involved participants completing a goal facilitation tool with assessors. This established rehabilitation aims. Control participants received a standard needs assessment. Clients from both groups were then referred to a homecare organisation for service delivery.
  
  
  RESULTS
  There was greater change over time in HRQoL [measured by Short Form 36 Survey (SF-36)] in the intervention group (P = 0.0001). There was a marked variation across homecare providers in types of services provided (P < 0.001). Identification of a goal did not predict completion of a formalised review of participants' needs by the homecare organisation.
  
  
  CONCLUSIONS
  Use of a goal facilitation tool in assessment of an older person's needs on referral for homecare leads to significant improvements in HRQoL. This may be through a higher proportion of individualised activities tailored to a successful identification of the person's goals. The findings contribute to greater understanding of factors necessary to implement improvements in homecare services for older people.
authors: School of Nursing, The University of Auckland, ECOM House Ferncroft St Grafton, Auckland 1150, New Zealand. j.parsons@auckland.ac.nz
authors: John
authors: J
authors: Parsons
authors: Paul
authors: P
authors: Rouse
authors: Elizabeth M
authors: EM
authors: Robinson
authors: Nicolette
authors: N
authors: Sheridan
authors: Martin J
authors: MJ
authors: Connolly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006699:Home Care Services; D006801:Humans; D057187:Independent Living; D008297:Male; D010347:Patient Care Planning; D011788:Quality of Life / Q000523:psychology; D012944:Social Support