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tuned manner (Billings and Leichsenring, 2005). In general, elderly people want to
live independently as long as possible, even when they need care and support. As a
result, the issues surrounding care provision are extensive, involving many aspects
of life such as health, social services, housing, transportation, and support services
(Leichsenring et al., 2005, Van Bilsen, 2007). Ideally speaking, demand-based care
provision would imply that organizations providing services in housing, welfare and
care (HWC) should take conjointly the needs and demands of an individual elderly
client as a guideline. However, little insight has been gained in how the needs of
individual elderly clients can be translated into a demand-based, client-centered supply
of HWC services (Van Bilsen, 2007). The concept of demand-based care seems to falter
at a policy level, being used by many to express long-term goals, mission statements
and organizational visions only (Rijckmans, 2005). This is detrimental for all parties
involved since a policy or strategy needs accompanying resources and methods for it to
work in daily practice (Slack et al., 2007). Fulfilling the multiple and complex needs of
elderly clients requires organizations to develop sound operational processes in order
to provide the optimal care and service packages to their clients. The aim of this paper,
therefore, is to provide preliminary insights into how it could be possible to bridge
the gap between policy intent, which reflects an increasing client orientation, and the
actual practice of HWC service provision. To fulfill this aim, the following research
question will be addressed by means of literature research and conceptual reasoning:
How can demand-based care be brought into practice on the operational level of HWC
provision to elderly clients living independently?
In order to answer the research question, the authors will turn to the field of operations
management (OM). In general, OM has deepened the understanding of translating
an organization’s policy or strategy into daily activities, processes and working
methods. Furthermore, OM exhibits a natural client focus since operational systems
are considered as means to serve the varying needs of an organization’s client (Slack
et al., 2007).
2.2 Demand based care
2.2.1 Definition
As in most European countries, the Dutch sector for care for elderly persons exhibits a
shift from supply-driven to demand-driven approaches in care and service provision.
According to these approaches, care and related services in welfare and housing should
contribute to the fulfillment of care-related needs of individual elderly people and,
therefore, to their perceived quality of life (Rijckmans, 2005). In the Netherlands,
this trend is known as being one towards demand-driven care (DDC) and demand-
D
emand-based pr
ovision
of housing
, w
elfar
e
and car
e
Chapt
er 2
28
oriented care (DOC) (e.g. Putters, 2003, Rijckmans, 2005). Other concepts that can be
found in international literature are ‘consumer driven health care’ (Herzlinger, 2004),
‘patient/client centered care’ (e.g. McLaughlin and Kaluzny, 2000, Mead and Bower,
2000), ‘patient/client oriented care’ (Schulman, 1979), etc. Although differences can be
seen among the approaches, in terms of their specific emphasis and degree of client-
centeredness (Rijckmans, 2005, Bosman et al., 2008), all developments represent a
client perspective on care and service provision. We will define this general trend,
which takes client demand as the basis for care and service provision, as one towards
demand-based care, where ‘care’ encompasses services in housing and welfare as well.
As such, we acknowledge the importance of the client’s central role. However, for the
purpose of this paper, it is not relevant to go into a detailed discussion on the different
emphases of all terms used.
The concept of demand-based care aims to give individual needs and wishes a more
central role. As opposed to supply-driven approaches, where existing supply is the point
of departure for care and service provision, the individual user’s wants and needs form
the starting point in the demand-based approach (Rijckmans, 2005). To accommodate
individual demand, however, it should be clear what exactly clients’ needs are and what
these needs imply (Van Bilsen, 2007) for the organization. Therefore, we now address
the characteristics of our target population’s needs and subsequently translate these
into implications for day-to-day care and service provision.
2.2.2 Needs: diverse and subject to change
The concept of need generally refers to a condition characterized as ‘some disturbance
in health and well-being’ (Van Bilsen, 2007). An individual elderly client perceives a
disturbance, or gap, when the individual’s current state does not match the desired
state in health and well-being. Intervention, then, is necessary to close or diminish
this perceived gap. When the gap can be closed or diminished by services in housing,
welfare and care, the individual elderly client is said to be in need of these services
(Liss, 1993).
Although all needs for HWC services exist because of some perceived gap or
disturbance, the concept of need might vary considerably among elderly clients and can
be transient and subject to change. First of all, variation is caused by differences in the
current states of individual clients. An elderly client with diabetes has different needs
from an elderly client who currently suffers from a broken hip. Even if two individuals
have the same disability, they might perceive different needs (Van Bilsen, 2007). Elderly
clients vary a good deal with regard to their health definitions, preferences, desires
and priorities (Wilmot, 2007). These aspects will all influence the determination of
the desired state or goal an individual elderly client wants to reach, and this makes
Modular
Care Provision