Abstract
This paper aims to identify barriers that frail community-dwelling older adults experience regarding access to formal care and support services. Universal access to healthcare has been set by the World Health Organisation (WHO) as a main goal for the post-2015 development agenda. Nevertheless, regarding access to care, particular attention has to be paid to the so-called vulnerable groups, such as (frail) older adults. Both inductive and deductive content analyses were performed on 22 individual interviews with frail, community-dwelling older adults who indicated they lacked care and support. The coding scheme was generated from the conceptual framework '6A's of access to care and support' (referring to work of Penchansky and Thomas, 1981; Wyszewianski, 2002; Saurman, 2016) and applied on the transcripts. Results indicate that (despite all policy measures) access to a broad spectrum of care and support services remains a challenge for older people in Belgium. The respondents' barriers concern: 'affordability' referring to a lot of Belgian older adults having limited pensions, 'accessibility' going beyond geographical accessibility but also concerning waiting lists, 'availability' referring to the lack of having someone around, 'adequacy' addressing the insufficiency of motivated staff, the absence of trust in care providers influencing 'acceptability', and 'awareness' referring to limited health literacy. The discussion develops the argument that in order to make care and support more accessible for people in order to be able to age in place, governments should take measures to overcome these access limitations (eg, by automatic entitlements) and should take into account a broad description of access. Also, a seventh barrier (a seventh A) within the results, namely 'ageism', was discovered.
Highlights
The World Health Organisation (WHO) pointed out universal access to healthcare as an overarching goal for health in the post-2015 development agenda (Evans, Hsu and Boerma, 2013; Marziale, 2016)
The interviews revealed a whole range of barriers concerning the access to a broad spectrum of formal care and support services for community-dwelling older people
This study reports on qualitative experiences concerning access to care and support for frail community-dwelling older adults, following the framework of Penchansky and Thomas (1981) as adapted and actualised by Wyszewianski (2002) and Saurman (2016), resulting in six As of access to care and support: accessibility, affordability, availability, acceptability, adequacy and awareness
Summary
The World Health Organisation (WHO) pointed out universal access (ie, the absence of sociocultural, organisational, economic, geographical and gender-related barriers) to healthcare as an overarching goal for health in the post-2015 development agenda (Evans, Hsu and Boerma, 2013; Marziale, 2016). This is recognised by the United Nations sustainable development goals by which all of its United Nations member states have agreed to try to achieve universal health coverage (ie, the capacity of health systems to respond to the populations’ needs at any care level, without causing financial damage) by 2030 (World Health Organisation, 2018a). Different researchers point to the necessity to operationalise frailty as a multidimensional and dynamic concept that
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