Impact and Outcome in long-term care: introducing a measure of Care Related Quality of Life (QUALcare)

Municipal health and care services constitute a large and important part of the Norwegian welfare state. These constantly evolving services aim to ensure that people requiring care receive the appropriate help. The development seen in Norway follows international trends, with an increasing focus on the elderly being able to live as long as possible in their own homes, increased user involvement and control over their own lives. We also see a shift towards involvement of new actors, like local community and volunteers, in service delivery. An important purpose of the described development is to be able to provide high quality services that contribute to increased quality of life for persons receiving care. In Norway today, we have few output measures of the effect of the services provided. Increased knowledge of the results of the services provided, and which of the measures put in place are important for the quality of life of the care service recipients are important in order to be able to evaluate and develop the services further. In this project, we will translate an English toolkit (The Adult Social Care Outcomes Toolkit, ASCOT) and test this in a Norwegian context. The service-related quality of life is measured by eight domains, covering people?s basic needs (personal cleanliness and comfort, accommodation cleanliness and comfort, safety and food and drink) and higher order needs (social participation, occupation, control over daily life), as well as a domain designed to measure the impact of the way the care is delivered (dignity). The project will show service-related quality of life for a sample of service recipients in Norway today, and form the basis for cross-country comparison, primarily with England. Furthermore, the translated tool will be made available for use in the services and may be useful in the evaluation of measures implemented in the ongoing "Leve hele livet" reform.

Norwegian policies for elderly care are showing increased focus on ageing in place, user participation, choice and control and increased involvement of local communities and volunteers. Quality improvement in the care services has received large attention, most lately through the reform “Leve hele livet- en kvalitetsreform for eldre”, which encourages quality improvements through diffusion of good examples and local innovations. In order to evaluate the care service performance, and the impact of quality improvement initiatives, there is a current need for suitable measurements of care outcome. The Adult Social Care Outcomes Toolkit (ASCOT) assesses the way in which care services help to maintain or improve quality of life of their users, focusing on those aspects of quality of life most affected by long-term care. Following, ASCOT is a measure of Care related quality of life (CRQoL). The toolkit was developed in the UK and are widely used by care providers as well as local and central government. It is also translated to several other languages and used in research and care development in several countries. This project will translate and validate the ASCOT in a Norwegian care context. Based on a comprehensive data collection, including care users receiving care at home, in sheltered living and in nursing home, in three different municipalities, this project will generate new knowledge on 1) How CRQoL are expressed among Norwegian care service users, and how the care services they receive influence on their CRQoL, 2) How CRQoL in Norwegian are compared to CRQoL in the UK, 3) How sensitive the ASCOT is in comparing CRQoL among different groups and care settings, and finally 4) How suitable ASCOT is as a tool in innovation processes.