Of rebels, conformists, and innovators: applying Merton's typology to explore an effective home care policy for the emerging Alzheimer's epidemic

Abstract

Purpose – To explore how home care social worker perceptions of their organizations' dominant goals and means affect direct service home care professionals' care delivery and meeting of patient needs for persons with Alzheimer's disease. Methodology/approach – The study used a convenience sample of 34 home care social workers in the New York City metropolitan area and an extensive literature review. Findings – The study found that literature indicates a dissonance between effective, evidence-based research psychosocial Alzheimer's disease interventions and Medicare home health policy which does not cover their use. Furthermore, interviews indicated home care social workers' different strategies to cope with organization demands, which affect their perceptions and care delivered to patients. The coping strategies are characterized using a modified version of Merton's (1957) adaptation model – conformist, innovator, and rebel. Contribution to the field – The study is the first to use the voice of home care social workers to explore how perceptions of organizational dominant goals and means affect direct service home care professionals' care delivery and meeting of patient needs. The study asserts the need for a home care-based policy model drawing on the Hospice Medicare Benefit (HMB) to address Alzheimer's disease more cost-effectively with a more positive quality of life manner, thus limiting the adverse consequences of the evolving epidemic.