The report is based on a serious incident in which the health services in a municipality failed to detect and follow up on a marked functional decline in an elderly woman receiving care at home. In the report, the woman is referred to as Bjørg.
In the summer of 2021, Bjørg was granted home care services following an assessment that she could no longer manage her medications and meals independently. While showing signs of cognitive decline, her caregivers assumed she had decision-making capacity, and she was given the opportunity to participate in shaping the care she received . Over a 15-month period, she experienced multiple declines in function, but her care was not adjusted. Eventually, she was found in a distressed state, admitted to the hospital, and diagnosed with advanced dementia. She passed away shortly after being discharged.
Our findings indicate that there were several contributing factors to the lack of follow-up on Bjørg, all of which collectively compromised her patient safety. We emphasize these factors in the report:
- The task-oriented structure of the municipal home care services led caregivers to focus primarily on the tasks specified in her care plan.
- The administration in the municipality prioritized operational and budgetary aspects over the quality of care provided.
Our findings suggest that the organization of municipal home care services may result in an overly task-driven approach, where it is unclear who is responsible for the patient care. During the 15-month period, 117 different caregivers attended Bjørg, and the home care service was unable to provide holistic, person-centered care that addressed her overall situation and needs.
The organization of the services around Bjørg allowed little scope for professional leadership and lacked a shared understanding of her needs. Her next of kin felt excluded as it became increasingly difficult for them to support her. These factors resulted in a lack of continuity in care, and Bjørg did not receive the assistance she required. The report discusses factors that can help identify individuals experiencing functional decline. Since Bjørg showed signs of dementia—and given that a large proportion of home care patients experience cognitive impairment—this aspect is given particular focus.
Municipalities are autonomous and may implement national regulations and guidelines differently. In this report, we present learning points that stress the importance of considering the quality of care while administering the municipal home care services. We suggest ways municipalities can organize to ensure continuity around the patients. The report also addresses what is needed to monitor functional decline in home care patients, highlighting the importance of continually assessing this patient group’s capacity to consent.
Key characteristics of effective home care services for monitoring functional decline include:
- The services are managed with a focus on quality, utilizing relevant indicators, and with a narrower management scope.
- The patient’s expectations and needs are clarified early through routines for collaborating with family members.
- Staff with relevant healthcare education coordinate information and services around each patient and allocate responsibility for unresolved issues.
- The patients’ care plans serve as a foundation for comprehensive and continuous care, based on updated assessments and a shared understanding of the situation.
- Team-based organization of the home care services helps ensure continuity of care.
- Electronic tools and documentation systems facilitate continuity of information to capture changes in needs.
- The home care services are organized so all stakeholders can develop a shared understanding of a patient’s needs, regardless of diagnosis. Signs of cognitive impairment necessitate a dialogue on safeguarding patient rights. The municipal home care services cooperate with the patient’s general practitioners on individual patient care.
Our investigation shows that the municipal home care services are increasingly being assigned more advanced tasks but are finding it difficult to adapt their organization and resources to meet these growing demands effectively. The report indicates that municipal home care services for the elderly may have reached a critical threshold, both in their capacity to deliver quality care and in maintaining acceptable working conditions for employees.
The report identifies several patient safety risks and can be valuable for those working to improve and develop municipal health and care services for elderly people living at home, as well as for all employees in these services. The report may also benefit patients, families, educators, and elected officials.
The translation from Norwegian to English is based on AI. Ukom has reviewed, edited and quality assured the translation.