The Association between Freedom of Choice and Effectiveness of Home Care Services.
OBJECTIVE
The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors.


METHODS
A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients' subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations.


RESULTS
As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services.


CONCLUSIONS
Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients' opinions and to thereby improve the effectiveness of home care services.
Research and Development Services for Social and Health Economics, Diaconia University of Applied Sciences, Pieksämäki, Finland.
Marina
M
Steffansson
Research and Development Services for Social and Health Economics, Diaconia University of Applied Sciences, Pieksämäki, Finland.
Marjo
M
Pulliainen
Research and Development Services for Social and Health Economics, Diaconia University of Applied Sciences, Pieksämäki, Finland.
Aija
A
Kettunen
Centre for Health and Social Economics - CHESS, National Institute for Health and Welfare - THL, Helsinki, Finland.
Ismo
I
Linnosmaa
School of Computing, University of Eastern Finland, Joensuu, Finland.
Miikka
M
Halonen
effectiveness; freedom of choice; home care