Macro Context Of Home Care

Macro Context
The macro context consists of four components (Fig. 1, McCormack & McCance 2017) in which the health and social care policy is setting sets the agenda for to which the extent to which the carers are able to meet many of the needs discovered in this study. The financial framework controls the conditions for service delivery from home care services. Organizational structure will also influence the standard for the service provided in each home care district. With the introduction of new public management in the early eighties (Klijn 2012) the focus became the efficiency of the public sector through management principles from the private sector. An overall focus on efficiency puts restrictions on the service delivery. With a working

and its influence must not be underestimated. According to McCormack & and McCance (2017), to not have the absence of supportive policies and strategic directions will “…feel at best like swimming against the tide, or at worst drowning in a sea of competing and changing priorities” (p. 262). The macro level is thus an important backdrop for discussing other aspects of person-centredness in the context of care

2001, Ploeg et al. 2001, Armstrong-Esther et al. 2005, Wilkins et al. 2009, Van Houtven et al. 2010, Saunders 2012, Hautsalo et al. 2013, Landmark et al. 2013, McCaffrey et al. 2015, McCormack & Skatvedt 2016). For instance, McCaffrey et al. (2015) highlighted the challenge of choosing among different service possibilities without adequate information. It is reasonable to assume that with a more holistic approach to competence, the formal carers will be in a better position to capture these needs of the care partners, as well as taking take action to meet them. On the other hand, knowledge and skills alone will not automatically lead to changes. This is reflected in the construct Developed interpersonal skills. Here, it is contended that being Being a warm and friendly practitioner is not enough to make an effective impact; there is a need to step into the world of the other person and engage profoundly in courageous conversations (McCormack & McCance 2017). In this context, “the other person” is the care partner. The first step in meeting their needs, is for the home care staff to be aware of the existence of those needs. In one of the included studies (Hegli & Foss 2009), some of the care partners wanted to be involved in decision-making processes. However, they did not express their wish to the home care staff. This was explained in various ways, including the care