A120 rehabilitation goal setting in danish home based care is challenging for all parts involved

1. M. Phil. Social Anthropology
Merete Tonnesen
DEFACTUM, Central Denmark Region
Goal-Setting
in Home-Based Rehabilitation
October 26 2016
www.defactum.dk | merete.tonnesen@rm.dk|

2. Danish Social and Health Care System
www.defactum.dk | Følg os på LinkedIn
Levels of Responsibilities:
State
• Health policies and legislation
• Framework for the economy
5 regions
• Hospitals
• Psychiatry
• Primary health care
98 municipalities
• Preventive care and health promotion
• Rehabilitation outside hospital
• Treatment of alcohol and drug abuse
• Home nursingEqual and free access for all citizens
Financed through general taxes
GP as gatekeeper

3. Challenges
Demographic:
• Less people to care for
more elders
Economic:
• Less money for health &
social welfare (programs)
• Reduced admission time at
hospitals
www.defactum.dk | merete.tonnesen@rm.dk
Admission
time in days
65+
2008:
6,79
2013:
5,28
www.defactum.dk | merete.tonnesen@rm.dk

4. Welfare system Social service is a right
Helping people
- but you have an
obligation to make an
own effort
We help you help yourself
The way we work Compensation
Late intervention
Parallel interventions
Doing for
Professionals = experts
Rehabilitation
Early intervention
Multidisciplinary teamwork
Doing with
Citizen = co-expert
Change in discourse
Change in the way interventions are organized
2014: new rehabilitation law. Goals mandatory

5. Home Based Rehabilitation (Age groups: 18+ / 65+)
Team (flexible)
OT
PT
GP
Nurse
Care
worker
Relatives
Care
assessor
Process
(Wade 2005)
Goal
setting
Intervention
Evaluation
Identification
and
assessment of
needs
Next step
www.defactum.dk | merete.tonnesen@rm.dk

6. Qualitative field studies
Methods
• In-depth interviews with professionals, people
undergoing rehabilitation and their relatives
• 25 focus group interviews with professionals
• Observation (including shadowing)
Focus on Goal Setting as part of studies
• 2010 – 2013 (Home Based Rehabilitation)
• 2015 – 2016 (Home Based Rehabilitation + other
rehabilitation settings)
www.defactum.dk | merete.tonnesen@rm.dk

7. We set goals
• To improve clinical outcomes
• To evaluate outcomes
• To enhance the patient’s / client’s autonomy
• To meet contractual, legislative or professional
requirements
(Levack & Siegert 2015)
• To monitor change, and change strategy if so
needed
(Wade 2009)
www.defactum.dk | merete.tonnesen@rm.dk

8. It’s a great idea, but
Gap between the
ideal world and the real world
www.defactum.dk | merete.tonnesen@rm.dk

9. Goal and Motivation
”It’s difficult! Can’t you just set some for me?
(Annie, 78 years old, post-surgery + urinary tract infection)
”You would like me to say that my goal is to be
able to wash the floor again. But that just
doesn’t really interest me”
(Hans, 67 years old, pneumonia, alchohol misuse)
www.defactum.dk | merete.tonnesen@rm.dk

10. Understanding of the word goal
”Goal?”
www.defactum.dk | merete.tonnesen@rm.dk

11. When do we set goals?
”It is not always easy, being in my situation, to think
about the future”
(Kurt, 83 years old. Lost his wife a year ago, undergoing cancer treatment)
www.defactum.dk | merete.tonnesen@rm.dk

12. ”How did you experience the first meeting?
Well, I was in pain and I was tired, but it was okay, the first
meeting. But I do remember being asked about my goals just
as we were about to round up the meeting. I hesitated, and
then the PT suggested: ”Let’s just say your goal is to be able
to drive again?”.
I don’t think I was given enough time to think about my goals.
[….. ]
It’s okay to set goals, but we never spoke about them again -
only for maybe two minutes in the end.”
(Jeanett, 26 years old, participant at a rehabilitation course for patients with
low-back pain)
www.defactum.dk | merete.tonnesen@rm.dk

13. Professionals
• Realistic goals ?
• Common goals = difficult
• Lack of motivation
• Structure - agency
www.defactum.dk | merete.tonnesen@rm.dk

14. Goal setting in rehabilitation
– a contested arena
• Gap between the ideal world and the real world.
• Different views between professionals on how to set
goals
• Different expectations from all involved in the
rehabilitation process
• Ethical debate about the ownership of the goals
Calls for a need to
• address the act of goal setting in the daily practice of
rehabilitation programmes
• incorporate a more hands-on education on goal
setting in the educational system
www.defactum.dk | merete.tonnesen@rm.dk

15. Thank you for your attention
merete.tonnesen@rm.dk
(+45) 2361 7480 / 7841 4438
www.defactum.dk | merete.tonnesen@rm.dk