Home-based care services: User categories and organisation

The home care service is part of the care service in Norwegian municipalities, and includes, among other things, practical assistance (formerly called home help) and home nursing care. Home care services are offered to owner occupiers and local authority housing tenants, and are provided by establishments in the municipalities that either offer ambulant home care or have a fixed base in the immediate area of residents in local authority housing or private homes (residential base).

In 2014, the Norwegian municipalities’ expenditure for the home care service was almost NOK 50 billion. Despite this, there is little information on how the costs are distributed between the different types of home care services and user categories. Due to assumed integration between service types, the extent and type of education of those working in the home care service has not been published so far. 

The purpose of the survey of the home care service was:

• To examine how the home care service is organised.
• To highlight which user categories the activities of the home care service are aimed at.
• To examine how municipalities recognise home care service expenditure in their accounts.
• To examine whether the size of a municipality has a bearing on its organisation, user categories and accounting.

The results of the survey showed that in 2014 there were a total 2 680 establishments in the home care service. Of these:

• 52 per cent worked solely from a residential base in the vicinity of users
• 15 per cent offered only ambulant home care
• 14 per cent had a combination of a residential base and ambulant home care
• 16 per cent combined home care services with another type of establishment, such as nursing homes or day centres.

The group that most establishments aim their home care services at is people with disabilities. A total of 45 per cent of home care establishments were aimed at this group. Another group that many establishments provide home care services for is people with mental health problems. Home care services for this group are often combined with those for people with disabilities or substance abuse problems. Home care services often serve just one main user category, and ambulant home care mostly serves two categories or no specific category. 

The extent of integration between residential bases and ambulant services, and between the home care service and other types of services such as institutions or day centres, depends on the size of the municipality; the larger the population the lesser the degree of integration. In other words, integration is more common in the smaller municipalities than in the larger municipalities. The total integration between home care services and nursing homes is less than previously assumed. 

With regard to accounting, the results show that many municipalities keep more detailed accounts than is required. However, the majority do not want more detailed accounts than the current standard.