Challenges faced by employees in the home care of elderly people

In Finland the care of frail, elderly people is increasingly moving out of institutions and into clients' homes. To cope with the challenges, nursing staff have to recognize the specific nursing problems involved in home care, as well as the most appropriate nursing interventions. The purpose of this study was to discover how homecare employees (n=109) perceived the problems involved in the home care of elderly people, what they thought were the most relevant nursing interventions, and what type of assistance they expected and received in dealing with homecare problems. The focus was on homecare problems because they form the basis for planning, implementing and evaluating interventions. The data were analysed using statistical methods and descriptive statistics. The results showed that elderly patients' memory and their cognitive and physical capacity were the main sources of problems for homecare employees, defined as registered nurses, nursing assistants and home-help personnel. These problems were usually tackled by means of nursing interventions, such as memory tests, evaluations of the clients' abilities to wash and dress themselves, encouragement of the clients to use their existing capacities, and allowing clients sufficient time in care situations. The most effective source of assistance to employees was managerial supervision and collaboration with co-workers. It is concluded that, in training, more attention needs to be paid to support employees' abilities to identify nursing problems and to use specific interventions. In-service training and clinical supervision should be tailored to address specific problems.