Homecare refusal or acceptance? A framework analysis of perceptions of older people receiving homecare in Scotland

Abstract

Older people want to live at home for as long as possible and expect a system of care to enable this. This desire is also recognised in many national policies, where ageing in place with the support of informal caregivers is increasingly seen as a viable solution to institutional care. Despite this, refusal of such care at point of delivery can create further health issues for individuals as well as organisational challenges for care providers. There is very little research about why homecare is refused. This study aims to explore older people’s perceptions of why homecare is, or may be, refused. It builds on the results of a quantitative study, where 18 per cent of instances of non-delivery of homecare in one major care provider in Scotland were categorised as “Service Refusal”. A convenience sample of 17 people, aged 65 years and older, who had experience of homecare, were recruited from four day care centres in the Greater Glasgow and Clyde area in Scotland. Data collected through interviews were analysed using framework analysis. In contrast to the results of the quantitative study, this study’s findings uncovered an unexpected propensity for service acceptance rather than refusal, regardless of the quality of care. Living at home was the presiding value and the main motivating factor to accept homecare, irrespective of its quality. This study provides a deeper understanding of the complexities of homecare from those who receive it, highlighting critical insights to inform governmental initiatives and homecare service providers. Allowing people to remain at home for as long as possible with appropriate and sustainable homecare should be central to national outcomes in Scotland, with the findings of this study also providing useful insights for homecare providers internationally.