Organisational Structures
Nursing and Residential Care Homes
programmes integrating prevention/rehabilitation/reintegration
COUNTRY / LOCATION: Austria
Keywords: residential care, health promotion, organisational development, mobility, quality of life
Keywords: residential care, health promotion, organisational development, mobility, quality of life
Development of residential care homes into health promoting settings
Summary
Demographic changes challenge established forms of residential support and care in quantitative ways (growing number of older people) and qualitative ways (increasing age and deteriorating health status on entry to care). The project 'Health has no age' investigates the potential of comprehensive health promotion in residential care using a settings approach (focusing not only on older people but also on organisational processes and structures). The project addresses positive health (functional health and well-being) among residents, relatives and staff. A needs assessment explores stakeholders’ perceptions of stresses and strains as well as resources for health and social support. Interventions focus on development of organisational structures and processes in a health promoting direction. A specific action on user mobility is addressed in a scientific study. The three participating organisations with approximately 1,000 inhabitants and 300 staff members are part of a public provider (KWP – Kuratorium Wiener Pensionisten-Wohnhäuser) for residential long term care in Vienna, Austria. The example was set up by Ludwig Boltzmann Institute for Health Promotion Research (LBIHPR) and its practice partners, Fonds Gesundes Österreich, Wiener Gesundheitsförderung and the Austrian Board of Social Insurance Agencies. Project duration is from January 2011 to December 2012.
What is the example's benefit for the user/carer?
The main benefit of the project is to generate knowledge about feasibility and effectiveness of using a health promoting settings approach to develop the quality of residential long term care.
What is the main message for practice/policy?
For policy and practice the project should demonstrate the potential of putting health promotion on the agenda for residential LTC.
Why was this example implemented?
There is a lack of systematic knowledge on feasibility and effectiveness of health promotion for frail older people and on usability of a settings approach in residential LTC in general.
The promotion of health of older people living in residential care organisations is important because they are in a particularly vulnerable position. The settings approach is relevant because of the organisation’s impact on the overall health outcome of its population in making healthy or unhealthy decisions. The assumption is that the development of health promoting interventions depends heavily on adaptations of structures and processes within the organisation. The project “Health has no age” is implemented to look into this development process of health promotion within residential long term care.
Description
A systematic needs assessment has been conducted targeting users (residents and relatives), staff (employees and volunteers) and management of the organisation - using questionnaire, interview and focus group techniques. The needs assessment was complemented by health circles for staff members. A health circle is a structured discussion group which is conducted under the guidance of a trained facilitator with the aim to identify resources and problems at their workplace, develop improvement suggestions and start the implementation process. The intervention targeting the overall organisation (strategy development) is currently implemented based on results from the needs assessment. This process is organised in local steering groups and supported by an external consultant. The aim of this strategy development is to identify issues, define an agenda and plan specific health promoting interventions within the organisation. One specific intervention has been defined beforehand targeting residents for the promotion of mobility (mobility intervention). This intervention is set up as a randomised controlled health promotion study including 300 participants (150 in intervention group versus 150 in control group). Pre- and post-assessments will be conducted to compare the status of mobility among participants.
What are/were the effects?
The effects for health outcomes will be observed at different levels. A clear distinction needs to be made for the evaluation of the overall development of the setting (development of HP in residential LTC) versus evaluation of single interventions throughout the project phase (e.g. strategy development and mobility intervention). Concerning the strategy development, we will be able to observe which health issues are set on the agenda of the organisation for which groups, with what priority and what specific measures planned to take. Concerning the mobility intervention, effects should be an improvement of positive health (functional status and well-being) of participating residents. As for the overall development of residential LTC towards a health promoting setting, we will be able to observe promoting and hindering factors for health promotion and what kind of structural adaptations the organisation is able to make for the reorganisation of certain processes.
What are the strengths and limitations?
The pilot project uses a complex and comprehensive approach, important stakeholders are included. The project is well anchored within the organisations and fully supported by the central owner of participating residential care organisations. The fact that the practice partner is currently in a stage of reorganisation can be seen as an opportunity for change but also competes for attention and resources. Obstacles became visible during the needs assessment addressing all staff members. This might be a sign for resistance of change within the organisation but can not be fully interpreted at the present time.
A definite limitation of this project is the narrow time frame. Thus the strategy development is an open process concerning the implementation of specific health promotion interventions. As such the project suffers of limitations for not being able to measure health outcomes at the end of the pilot period; this will only be possible for the predefined mobility intervention. The restriction to work only with one provider as practice partner facilitates project work but limits the generalizability of findings.
Credits
Author: Martin Cichocki & Karl KrajicReviewer 1: Jenny Billings
Reviewer 2:
Verified by:
