Voluntary work in Norwegian Long Term Care - Prevalence, Forms, Interaction with Professionals and Potentials for the Future

BACKGROUND The overarching goal of the project was to generate new knowledge about unpaid, voluntary work in the Norwegian long-term care services, focusing on prevalence, forms, interaction with professionals and potential for the future. We have also studied informal caregiving to close family members as well as to relatives, neighbours and friends in separate households. Demographic changes and a scarcity of resources have put voluntary efforts in the long-term care services on the political agenda. Politicians and administrators alike argue in favour of mobilising more volunteers in long-term care and improved interaction between public services and unpaid carers in the years to come. METHODS We utilised mixed methods in the project. First, we collected nationally representative population data about long-term care volunteering and informal care. Second, we conducted a survey in nursing homes and home care services in 50 municipalities. Third, we conducted in-depth interviews with 24 people involved in coordination of volunteer activities in long-term care. In parallel, we collected qualitative data about nine elderly service recipients and the interaction between their informal and formal carers over a period of 6-30 months. RESULTS In Norway, representative population data about voluntary work in long-term care have been lacking. Our study shows that only 4.4 percent of the population did voluntary work in long-term care in 2014. An additional 20.1 percent provided help or care to family or friends with special care needs. In full-time equvalents (FTEs), this equals 8 500 voluntary FTEs and 153 000 FTEs by informal carers. Women are more likely to do unpaid care work than men, and long-term care volunteering is most common in the oldest age groups. Types, volume and organisation of voluntary work in nursing homes and home care services have not previously been studied in Norway. A survey of long-term care units in 50 municipalities showed that 83 percent of the units had one or more volunteer activities. 79 percent had cultural or social activities, 29 percent had physical exercise, 27 percent had practical help/transport, and a smaller percentage had other activities. Measured in hours, cultural and social activities made up three-quarters of the volunteer activities. Volunteer activities were more widespread in nursing homes than in home care. In nursing homes, only 7 percent reported not having any volunteer activities, while 30 percent of home care units said the same. Interviews with representatives from voluntary organisations and long-term care services showed that good utilisation of volunteers was undermined by coordination challenges between volunteers and professionals. The care services often formulated terms for volunteer activities, practical and professional, and they wanted to know about volunteers' contributions, arrival times, competencies and suitability. Some of the activites under study required coordination, and friction arose as a result of unclear division of tasks, added workload for staff or poor communication between staff and volunteers. Clarification of expectations was regarded as important to retain volunteers. The intention of the legal framework is to protect service recipients' autonomy and self-determination and shield family members from responsibilities. In our study, these limits entailed that contact between the public services and informal carers was not established until a problem had arisen. We also found that even if informal carer's (next of kin's) contact information was recorded, there were few routines for contact and collaboration with informal carers, except if informal carers or recipients initiated contact, or recipients were not competent to give consent. Good collaborative relations were more likely to develop when the parties knew and trusted each other. Staff desired more contact with informal carers, but they did not express expectations of informal carers to take on more practical tasks. Informal carers wanted more information, not only about the services, but about observations and assessments by staff. DISCUSSION Considering the limited scope of voluntary work and activities in long-term care, it seems unlikely that voluntary resources, in today's setting, will contribute considerably towards making future care services more sustainable. Improvements will require better recruitment of volunteers as well as new forms of collaboration between professionals and unpaid caregivers. Nevertheless, municipal leaders and staff view volunteers and informal caregivers as a desired and enriching supplement to municipal care service provision.

Through population and institutional surveys and case studies of local activities, this project will establish a broad base of new information about voluntary work in institutional and home based long term care in Norway. A population survey will for the first time in Norway analyze the extent, background and motives for volunteering on population level among persons participating in this type of work. This survey is part of a Scandinavian project comparing voluntary work in Sweden, Denmark and Norway. An institutional survey in 50 Norwegian municipalities stratified by size and region will map existing voluntary work looking at content, volume and organization of these activities and analyzing reasons for variations in and between the municipalities in t he sample. The interaction between professionals and volunteers will be analyzed through case studies with the objective to reveal characteristics of good and dynamic interaction to be used as demonstration cases for further development. Lastly, based on the information gained from the project, we will explore possible scenarios for the contribution of voluntary work in the Norwegian LTC in the future. In doing so we will contribute to a informed discussion of the role and possibilities of voluntary work in solving challenges for the modern welfare state in an aging society.