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M. Phil. Social Anthropology
Merete Tonnesen
DEFACTUM, Central Denmark Region
Goal-Setting
in Home-Based Rehabilitation
Oc...
Danish Social and Health Care System
www.defactum.dk | Følg os på LinkedIn
Levels of Responsibilities:
State
• Health poli...
Challenges
Demographic:
• Less people to care for
more elders
Economic:
• Less money for health &
social welfare (programs...
Welfare system Social service is a right
Helping people
- but you have an
obligation to make an
own effort
We help you hel...
Home Based Rehabilitation (Age groups: 18+ / 65+)
Team (flexible)
OT
PT
GP
Nurse
Care
worker
Relatives
Care
assessor
Proce...
Qualitative field studies
Methods
• In-depth interviews with professionals, people
undergoing rehabilitation and their rel...
We set goals
• To improve clinical outcomes
• To evaluate outcomes
• To enhance the patient’s / client’s autonomy
• To mee...
It’s a great idea, but
Gap between the
ideal world and the real world
www.defactum.dk | merete.tonnesen@rm.dk
Goal and Motivation
”It’s difficult! Can’t you just set some for me?
(Annie, 78 years old, post-surgery + urinary tract in...
Understanding of the word goal
”Goal?”
www.defactum.dk | merete.tonnesen@rm.dk
When do we set goals?
”It is not always easy, being in my situation, to think
about the future”
(Kurt, 83 years old. Lost ...
”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 ...
Professionals
• Realistic goals ?
• Common goals = difficult
• Lack of motivation
• Structure - agency
www.defactum.dk | m...
Goal setting in rehabilitation
– a contested arena
• Gap between the ideal world and the real world.
• Different views bet...
Thank you for your attention
merete.tonnesen@rm.dk
(+45) 2361 7480 / 7841 4438
www.defactum.dk | merete.tonnesen@rm.dk
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RIWC_PARA_A120 rehabilitation goal setting in danish home based care is challenging for all parts involved

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

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RIWC_PARA_A120 rehabilitation goal setting in danish home based care is challenging for all parts involved

  1. 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. 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. 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. 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. 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. 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. 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. 8. It’s a great idea, but Gap between the ideal world and the real world www.defactum.dk | merete.tonnesen@rm.dk
  9. 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. 10. Understanding of the word goal ”Goal?” www.defactum.dk | merete.tonnesen@rm.dk
  11. 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. 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. 13. Professionals • Realistic goals ? • Common goals = difficult • Lack of motivation • Structure - agency www.defactum.dk | merete.tonnesen@rm.dk
  14. 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. 15. Thank you for your attention merete.tonnesen@rm.dk (+45) 2361 7480 / 7841 4438 www.defactum.dk | merete.tonnesen@rm.dk

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