Do municipalities ensure provision of adequate respite care and support contact services?
In 2007 the County Governors carried out countrywide supervision of respite care and support contact services, as laid down in the Social Services Act. The aim of supervision was to see whether these services are provided, and whether the municipalities ensure that people who provide respite care (respite carers) and support contact services (support contact persons) have adequate knowledge and skills. In 61 of the 66 municipalities where supervision was carried out, the County Governors detected nonconformities (breaches of laws or regulations) or observations were made (this means that the supervision authority commented about areas identified as having potential for improvement) in one or both of the areas investigated.
The municipalities have a duty to provide respite care and support contact services, but can organize these services in the way they think is most appropriate, as long as the right of clients to receive these services is fulfilled. The municipalities must also manage the services in such a way that they detect cases of clients who receive respite care and support contact services that are not adapted to the clients’ individual needs.
Knowledge and skills
Awareness of and adequate knowledge about the special needs of each individual client is essential for providing high quality respite care and support contact services. People who provide these services must receive training in different aspects of care for each individual client, such as communication, technical aids, diet and medication. The municipality has responsibility for providing training for all social services staff, so that they have the knowledge and skills required to carry out their work. The staff also have a duty to participate in the training that the municipality has decided they shall have. Even if the municipalities ensure that training and guidance are provided, this does not automatically lead to high quality services. Knowledge and skills must be applied and used in practice, for example in interaction with the client.
Adequate allocation of services?
In three-quarters of the municipalities, the County Governors detected deficiencies related to allocation of respite care and support contact services.
In many of the municipalities, administrative procedures were found to be inadequate, for example procedures for assessing needs and making individual evaluations. The municipalities often provided support contact services for a set number of hours per week, for example three hours, without assessing the need of each individual client for support contact. Regular assessments for detecting the need for changes were seldom carried out. In many municipalities, decisions were given orally, without the possibility to appeal against the decision, documentation was lacking, and information was not given about the possibilities to apply for other services. Information about the possibility for applying for respite care was often only given for children and people with physical disabilities. Private respite care and support contact services are seldom available for elderly people. Allocation and provision of respite care and support contact services were often carried out by several different units in the municipality, and often organized according to diagnosis or the age of the client. This could lead to differences in allocation practice within the same municipality.
The results of supervision also show that some municipalities do not distinguish clearly between respite care in an institution according to the Social Services Act, and short-term residence in an institution according to the Municipal Health Services Act. Short-term residence is granted to a person who needs rehabilitation after he or she has been treated in an institution. Respite care is granted when the carer needs respite from providing care. The municipality can demand payment from the client for short-term residence. When the municipality does not distinguish clearly between respite care and short-term residence, the result can be that payment may be claimed for respite care, which is not in accordance with the regulations.
Many of the municipalities have problems in providing the services they have allocated. One reason for this may be that it is difficult to recruit respite carers and support contact persons. This applies particularly to private persons who provide these services. When services that had been allocated were not provided, provisional measures were often not provided either, as should be done according to the regulations. For example, respite care can be provided in an institution until a respite carer is appointed. In many places, respite care was provided according to what was available, for example a place in an institution – a nursing home or sheltered housing – and not according to the needs of the client.
Do respite carers and support contact persons have adequate knowledge and skills?
In well over half of the municipalities that were included in the supervision, the County Governors found that the municipalities did not ensure that respite carers and support contact persons had adequate knowledge and skills to carry out their work. Many municipalities do not follow up the services, do not have regular contact with respite carers and support contact persons, and do not offer them training and guidance. Training is given more often before these services are initiated rather than during the time the client is actually receiving the service. Often the client or his or her family have to find a respite carer or support contact person themselves, and have to provide training and give information about the job. Many of the municipalities lacked routines or procedures for evaluating the services. Evaluation is essential in order to be able to improve the services and to ensure that clients receive the services they are entitled to according to the legislation.
Respite care has two aims. The first aim is to take care of the client, for example a physically handicapped child or an elderly person with needs for care. The second aim is to help the carers, for example parents and spouses. Respite care is only provided for people who have especially burdensome caring work, and includes both people who provide care, but who have no duty to do so, and parents who have a duty to provide care for their children. Usually the municipalities provide three different types of respite care:
- individual or private respite care in which the respite care is provided in private homes, or in the home of the client. This type of respite care is often provided for young children, but also for people with physical disabilities.
- respite care provided in sheltered housing, or in an institution such as a nursing home
- respite care provided for a group of clients, such as trips or journeys.
For someone to have the right to receive respite care, they must fulfil the requirements laid down in the Social Services Act, Section 4-3, that is to say: “persons who are unable to care for themselves, or who are completely dependent on practical or personal help to manage their daily tasks…”. The municipality can provide respite care for people in all phases of life, and respite care must be adapted accordingly. Respite care can make it possible to maintain good family relationships and prevent the carer becoming worn out.
Support contact is a service that aims to help clients to have meaningful leisure-time and social contact. The support contact person shall accompany the client to different leisure-time activities, ensure that the client has social contact, and provide support for the client to deal with social situations. This service can be an important measure for elderly people, children, young people and adults with mental disorders, people with physical disabilities, immigrants who are unfamiliar with Norwegian society, families with complex problems, and people with alcohol and drug problems.
“Awareness of and adequate knowledge about the special needs of each client is essential for providing high quality respite care and support contact services.”
“In well over half of the municipalities that were included in the supervision, the County Governors found that the municipalities did not ensure that people who provide respite care and support contact services have adequate knowledge and skills to carry out their work.”
- Report from the Norwegian Board of Health Supervision 4/2008 Pdf in Norwegian.