Abstract
One of the primary objectives of health systems is to provide a fair system by providing a comprehensive and holistic approach to caregiving rather than focusing on a single aspect of a person’s care needs. This approach is often embodied by using standardized care assessments across health and social care settings. These assessments are completed by professional assessors and yield vital information regarding a person’s health or contextual characteristics (e.g., civic engagement, psychosocial wellbeing, environmental characteristics, informal care). However, these scores may be subject to bias that endangers the fairness of the health system. In this study, we investigate to what extent socio-economic and psychological indicators and assessor-related indicators are associated with BelRAI Screener care assessment scores amongst 743 community-dwelling adults nested within 92 assessors in Flanders, Belgium. Findings indicate that there is significant variance in scores at the assessor-level. Socio-psychological characteristics of clients are associated with scores: being fluent in Dutch and providing informal care are associated with low care dependency, while living with children, feelings of depression, and the presence of an informal caregiver during assessment are associated with high care dependency. We discuss the importance of rigorous assessor training and the potential for socio-psychological factors to contribute to the allocation of welfare benefits in light of the Flemish home care system’s potential (lack of) fairness.
Highlights
Published: 11 November 2021A steady increase in the prevalence of complex and often chronic care needs of people living at home in Flanders confronts care providers and policymakers with important challenges [1,2,3,4,5]
Our data were collected from December 2018 to December 2019, resulting in a sample of Ni = 743 social care services clients nested in Nj = 92 assessors
Each social care service client was assessed during a home visit using a BelRAI Screener and BelRAI Social Supplement
Summary
A steady increase in the prevalence of complex and often chronic care needs of people living at home in Flanders (the Dutch-speaking region of Belgium) confronts care providers and policymakers with important challenges [1,2,3,4,5]. Persons with complex care needs are often characterized by Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. A combination of comorbidities, mental health challenges and/or social vulnerability [6,7]. Gaining insight into the relationship between these three aspects across time, institutions, and regions supports the different stakeholders that are embedded in specific health systems in making informed decisions about how to address the complexities of maintaining quality and continuity of care [8].
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