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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

Resultatevaluering av Omsorg2020

Alternative title: Evaluation of results from the Governments action plan Omsorg2020

Awarded: NOK 11.4 mill.

How well adapted are the care services to current and future demand for services? The main goal of this project is to evaluate Care Plan 2020. We have organized the project into three main parts: In part A of the project we focus on the investment grant. Which municipalities have applied for the grant in the period 2015-2020, and what characterizes these municipalities? We also run analysis on a dataset for the period 2003-2020 where we ask what the effects of the investment grant are for other sectors. Do the municipalities who apply for the grant also use less on other sectors later on? If so, this is an important factor to consider when addressing whether the grant should be continued in its current form. In part B the main focus in 2020 and 2021 has been on writing articles based on the qualitative material that was gathered earlier on in the project. This work has resulted in two scientific articles. We find that the informants in our case municipalities work with user involvement in a way that mirrors the intentions in Care Plan 2020. Both the Care 2020 plan and our informants focus on user involvement, and the understanding of user involvement matches a liberal perspective on citizenship. One important steering signal in Care Plan 2020 is that municipalities are encouraged to expand home services and thereby enable elderly to live at home as long as possible. We find in our analysis that this has been an important goal in the municipalities for some time, but that they do not have a strong focus on this currently. One possible explanation for this is that home services have been prioritized less because of the focus on expanding 24-hour care using the investment grant. We aim to continue the focus on this theme in an English article where we use both quantitative and qualitative data. Part C of the project focuses on innovations for users who receive everyday rehabilitation and users who have dementia. It consists of a qualitative and a quantitative part. An article about the effects of rehabilitation outside of municipal institutions has been published, and an article about everyday rehabilitation has undergone review. Both articles are published/submitted in a level-2 journal. The qualitative part of the project has gathered data in two phases. In the first phase we focused on two important themes in Care Plan 2020: enablement and welfare technology. There is much variation, both in scope and intensity, in how the municipalities work with enablement and everyday rehabilitation. We find that the same elements that are emphasized in reablement in the literature are emphasized in our case municipalites, but we also find that everyday rehabilitation is resource-demanding for the municipalities. Fosse et al (2021) find that the rehabilitation setting for hip fracture patients increases the likelihood of later institutionalization. This suggests that providing rehabilitation at home is beneficial for hip fracture patients. We also find that the persons with dementia who are living at home can have difficulties utilizing the benefits of welfare technology. This is not the case for all the users we have talked to. Some still use welfare technology, but it is limited to safety alarms to some extent sensor technology, but even here we see that use can be challenging. We also find that welfare technology can have a pacifying effect for users who receive everyday rehabilitation. Relying too much on the aid that technology can provide may be counterproductive for this group. Another important theme in Care Plan 2020 is the shift in focus towards early intervention and prevention. We are planning an article where we ask how the municipalities experience this when planning and delivering services to people who have dementia and/or people who receive everyday rehabilitation. We are also working on an article where we ask whether the prioritized areas in Care Plan 2020 are reflected in local municipal care plans.

De statlige handlingsplanene innenfor omsorgstjenestene har i all hovedsak nådd målene som har vært satt. Dette gjaldt også Omsorgsplan 2015 (Hagen m.fl. 2015, Hagen og Tingvold 2017) der målsettingen om 12 000 nye årsverk ble nådd selv om årsverksveksten i perioden var marginalt svakere enn tidstrenden. En nådde også målet om å gi tilskudd til 12 000 nye omsorgsplasser, primært fordi tilskuddssatsene ble økt betydelig i siste fase av planperioden. Omsorg2020 viderefører tilskuddsordningen til omsorgsplasser. I tillegg oppfordres kommunene til økt innovasjon, samarbeid med næringslivet og omstillingsevne for å møte framtidige omsorgsutfordringer. Delprosjekt A har som mål å studere kommunenes omstilling til endringer i demografi ved analyser av drifts- og investeringsnivået innenfor omsorgstjenestene på tre måter: (1) ved en nærmere beskrivelse av drifts- og investeringsnivået i kommunenes pleie- og omsorgstjenester i perioden fram til 2020, (2) ved en nærmere analyse av forklaringer på kommunenes tilpasning basert på tradisjonelle tilbuds- og etterspørselsvariabler, og (3) ved nærmere analyse av effektene av virkemidlene i Omsorg2020, herunder investeringstilskuddene fra Husbanken, den enkelte kommunes omsorgsplaner og andre lokale institusjonelle og politiske forhold. I delprosjekt B konsentreres analysene om brukerinvolvering, helsefremmende arbeid og eldres bosituasjon som vi betrakter som de «nye» innsatsfaktorene i omsorgstjenestene. Gjennom analysene er målene (1) å beskrive kommunenes strategier på de tre områdene og (2) klargjøre effekter for brukernes opplevelse av tjenestene, pårørendes opplevelses av tjenestene og ansattes opplevelse av tjenestene. Delprosjekt C har som mål å undersøke hvordan tjenester for demente og tjenester forbundet med hverdagsrehabilitering utvikles samt se på effekter av ulike modeller. Vi vil eksperimentere med kvantitative analyser der vi utnytter data fra samtlige relevante registre, og gjøre kvalitative intervjuer.

Activity:

HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester