29
the goal in health and well-being highly personal (Liss, 2003). For example, an elderly
client who is recovering from a stroke has always been accustomed to clean her house
herself. Therefore, she might feel it is very desirable to work towards a state of health
in which she will be able to clean her house again. During rehabilitation she needs her
care professionals to support this goal by means of physical therapy, for example. If she
cannot recover fully, this elderly client will need help at home, where the domestic help
will take over the heavy household work. Furthermore, the domestic help worker might
assist the client herself to do some light household activities, such as dusting. Another
elderly client who is also recovering from a stroke is used to contract out all cleaning
activities: regardless of this lady’s state of health, the house is cleaned every week by a
private cleaning lady. This client, therefore, perceives no need in this particular aspect
of her life and might feel that it is much more important to focus on other aspects
during rehabilitation. To reach the goals of these two individuals, and close the gaps
between their similar current states but dissimilar desired states, different services in
housing, welfare and care are needed. The need for care and related services, therefore,
is highly personal (Liss, 1995), since it depends on the perspective of the individual
(Liss, 2003, Rijckmans et al., 2005). As such, great variety in needs for HWC services
can be expected among elderly clients living independently.
Furthermore, the needs of an individual elderly client are changeable. Needs might alter
over time both as a result of changing health conditions, which could either deteriorate
or improve, and developments in knowledge (Van Bilsen, 2007). These developments
might alter either the current state of health and well-being, or the desired state. When
the perceived gap between the current and desired state diminishes, manifest needs
might disappear; when it increases, latent needs might become manifest. In both cases,
manifest needs might change in content, breadth or depth. For example, an elderly
client who currently has problems with bending or stretching needs some assistance
in the morning when taking a shower. Over time, his condition might deteriorate, and
as a result, he will need support when getting out of bed and total assistance when
taking a shower.
Both variety among elderly people and variation over the life course of an individual
elderly person cause a high diversity on the demand side of HWC services. This will
have implications for the supply side of HWC services, when organizations aim to
provide their care and services in a demand-based manner.
2.2.3 Conversion to daily practice: implications for providers
The concept of demand-based care stimulates providers of care and related services
to be sensitive to the diversity in needs. However, the provision of a care and service
package that is exactly in line with each individual client’s preferences is not feasible
D
emand-based pr
ovision
of housing
, w
elfar
e
and car
e
Chapt
er 2
30
for most care and service providers. Instead, organizations look for broader classes of
clients, or segments, that can be reached more efficiently with options that match their
unique needs (Kotler et al., 1999), also with respect to independently living elderly
clients, segments have been identified (Luijkx et al., 2004, Luijkx and Pardoel, 2005,
Luijkx
and De Blok, 2007).
Within these segments, elderly
clients have similar needs
and requirements that differ substantially from the needs of elderly clients in another
segment. At the same time, the needs of individual elderly clients within a particular
segment might show a slight diversity (De Blok et al., 2007, Luijkx and De Blok, 2007).
Over time, the needs of an individual elderly client might change, which might even
cause a shift from one segment to another.
An organization that adapts its supply to segments recognizes that clients differ in
their needs and perceptions (Kotler et al., 1999). For each segment of elderly people,
a generic package of HWC services can be identified that matches the needs profile of
this segment. However, due to the differences amongst individuals within a segment,
this generic package requires further specification and its contents need fine-tuning
(Luijkx and De Blok, 2007). On the supply-side, services in housing, welfare and care
can be better tuned to the diversity in needs when the available range of options in
service supply increases (e.g. Etty, 2000, Ware et al., 2003, Wilmot, 2007). Only then
will clients be able to fulfill their needs with care and services of their preference, given
their personal background, taste and circumstances. Choice options within a certain
type of service are required to provide an optimal solution per individual. When
alternatives are offered, elderly clients themselves, as much as possible and as far as
they desire to avail themselves of the options, can select those that are best suited to
their needs (Etty, 2000).
In addition, the set-up of the care and service packages should be flexible. As well as
choice options in the individual types of care and services needed, variation has to be
enabled when combining different categories of services into a single package. Variation
will allow for diversified care and service packages among elderly clients. Moreover,
variation in HWC services is needed over the life course of an individual elderly client.
Depending on the current state of health and well-being of the individual client, needs
arise in order to enable him or her to stay in his or her own living environment as long
as possible. However, this situation changes over time, mostly due to deteriorating
health, and therefore adaptation and expansion in the nature, amount, and intensity
of care and services will be required at different points in time.
Furthermore, to continuously provide the optimal answer to the needs of an individual,
organizations have to interact regularly with the elderly client. Clients value being
involved in the care process, being taken seriously and being consulted in the
determination of their needs for care and services (Rijckmans et al., 2007) with respect
Modular
Care Provision