People with multimorbidity assessed for home-based rehabilitation: Supporting vulnerable and complex everyday life?

Helle Vedsegaard; Betina  Dybbroe

doi:10.7146/tfss.v17i32.120976

People with multimorbidity assessed for home-based rehabilitation: Supporting vulnerable and complex everyday life?

Bidragets oversatte titel: Mennesker med multisygdom i vurdering til hjemmerehabilitering: Understøttelse af komplekse hverdagsliv eller skabelse af sårbarhed?

Helle Vedsegaard, Betina Dybbroe

Publikation: Bidrag til tidsskrift › Tidsskriftsartikel › Forskning › peer review

Abstract

I denne artikel undersøges, hvad der sker i mødet mellem borgere der lever et komplekst hverdagsliv med multisygdom, og den kommunale visitation der skal afgøre tildelingen af hjemmerehabiliteringsforløb, hjemmehjælp eller ingen af delene. Baggrunden er en politisk vending mod hjemmerehabilitering og tilbagetrækning af hjemmehjælp, som indtrådte i Danmark med en revision af Serviceloven i 2015. Spørgsmålet der rejses er, hvorledes møderne understøtter borgeres hverdagsliv med multisygdom eller skaber yderligere sårbarhed for borgere, der allerede er i en sårbar situation, samt hvordan borgeres handlekraft indgår i afgørelser om tildelingen.
Artiklen bygger på et etnografisk feltstudie i en Dansk kommune, og omfattede 26 borgere med multisygdom i alderen 28-86 år, som ansøgte om eller allerede modtog hjemmehjælp. Igennem tre cases ser artiklen på distinkte og forskellige måder borgere møder visitationen, og hvorledes møderne påvirker borgernes sårbare situation, og vi viser igennem analyserne hvordan borgernes ret forskellige handlekraft indgår heri. Analysen vise, at borgere understøttes i et hverdagsliv med multisygdom, når hverdagsliv og udfordringer i dagligdags praktiske gøremål forstås i en sammenhæng, og når mødet med visitator tager udgangspunkt i borgernes oplevelse af deres hverdagsliv med multisygdom. Modsat, når mødet med visitationen ekskluderer borgeres oplevelse af et meningsfuldt hverdagsliv og behov for hjælp til at magte dette komplicerede hverdagsliv med multisygdom, da resulterer det i en begrænsning i adgang til rehabilitering og hjemmehjælp. Der skabes på denne måde ulighed i adgang til velfærdsydelser og til at kunne leve et meningsfuld hverdagsliv, hvilket forstærker den sårbarhed borgere med multisygdom lever i og med.

Bidragets oversatte titel	Mennesker med multisygdom i vurdering til hjemmerehabilitering: Understøttelse af komplekse hverdagsliv eller skabelse af sårbarhed?
Originalsprog	Engelsk
Tidsskrift	Tidsskrift for Forskning i Sygdom og Samfund
Vol/bind	17
Udgave nummer	32
Sider (fra-til)	75-94
Antal sider	20
ISSN	1604-3405
DOI	https://doi.org/10.7146/tfss.v17i32.120976
Status	Udgivet - 18 jun. 2020

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10.7146/tfss.v17i32.120976

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title = "People with multimorbidity assessed for home-based rehabilitation: Supporting vulnerable and complex everyday life?",

abstract = "This article examines meetings between people living a complicated everyday life with multimorbidity and an assessor responsible for providing a rehabilitation programme, home care or neither. The background to this is a health policy change towards more home-based rehabilitation and less home care, which began with new legislation in the Danish Consolidation Act on Social Services in 2015. The question raised is whether these meetings support the everyday lives of people with multimorbidity or exacerbate their already vulnerable situation, and how their agency plays a role in the assessor{\textquoteright}s decision.The article is based on an ethnographic field study in Denmark. Twenty-six individuals with multimorbidity aged 28-86 years, applying for or already receiving home care, were studied. The article uses three cases to explore the distinct ways in which the people relate to the assessment meeting, and how the meeting affects their vulnerable situation, while the analysis reveals the widely varying involvement of the people{\textquoteright}s agency. We find support for these people in their everyday lives with multimorbidity, when everyday life and challenges in practical daily activities are understood in context, and when the meeting is based on the people{\textquoteright}s experience of their lives. Conversely, assessment meetings that exclude their experience of meaningful everyday life and their need for help to handle their complicated life with multimorbidity result in restricted access to rehabilitation and home care. This creates inequality in access to health and social care and in the possibility to live a meaningful everyday life, which reinforces these people{\textquoteright}s vulnerability. ",

author = "Helle Vedsegaard and Betina Dybbroe",

note = "Artiklen indg{\aa}r i et temanummer omhandlende multisygdom",

year = "2020",

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doi = "10.7146/tfss.v17i32.120976",

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AU - Dybbroe, Betina

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PY - 2020/6/18

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N2 - This article examines meetings between people living a complicated everyday life with multimorbidity and an assessor responsible for providing a rehabilitation programme, home care or neither. The background to this is a health policy change towards more home-based rehabilitation and less home care, which began with new legislation in the Danish Consolidation Act on Social Services in 2015. The question raised is whether these meetings support the everyday lives of people with multimorbidity or exacerbate their already vulnerable situation, and how their agency plays a role in the assessor’s decision.The article is based on an ethnographic field study in Denmark. Twenty-six individuals with multimorbidity aged 28-86 years, applying for or already receiving home care, were studied. The article uses three cases to explore the distinct ways in which the people relate to the assessment meeting, and how the meeting affects their vulnerable situation, while the analysis reveals the widely varying involvement of the people’s agency. We find support for these people in their everyday lives with multimorbidity, when everyday life and challenges in practical daily activities are understood in context, and when the meeting is based on the people’s experience of their lives. Conversely, assessment meetings that exclude their experience of meaningful everyday life and their need for help to handle their complicated life with multimorbidity result in restricted access to rehabilitation and home care. This creates inequality in access to health and social care and in the possibility to live a meaningful everyday life, which reinforces these people’s vulnerability.

AB - This article examines meetings between people living a complicated everyday life with multimorbidity and an assessor responsible for providing a rehabilitation programme, home care or neither. The background to this is a health policy change towards more home-based rehabilitation and less home care, which began with new legislation in the Danish Consolidation Act on Social Services in 2015. The question raised is whether these meetings support the everyday lives of people with multimorbidity or exacerbate their already vulnerable situation, and how their agency plays a role in the assessor’s decision.The article is based on an ethnographic field study in Denmark. Twenty-six individuals with multimorbidity aged 28-86 years, applying for or already receiving home care, were studied. The article uses three cases to explore the distinct ways in which the people relate to the assessment meeting, and how the meeting affects their vulnerable situation, while the analysis reveals the widely varying involvement of the people’s agency. We find support for these people in their everyday lives with multimorbidity, when everyday life and challenges in practical daily activities are understood in context, and when the meeting is based on the people’s experience of their lives. Conversely, assessment meetings that exclude their experience of meaningful everyday life and their need for help to handle their complicated life with multimorbidity result in restricted access to rehabilitation and home care. This creates inequality in access to health and social care and in the possibility to live a meaningful everyday life, which reinforces these people’s vulnerability.

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People with multimorbidity assessed for home-based rehabilitation: Supporting vulnerable and complex everyday life?

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