Autonomy of clients in long-term care

Abstract In the literature, there has been a lot of research on autonomy with another subject or a particular clinical picture. No research was found that was conducted solely from the client’s perspective concerning autonomy in general in long-term care. The focus of this research was autonomy from the perspective of clients through restructuring care processes using an alternative work model “supporting self-directing” (OER) in long-term care. For the long-term care organization, it is important to know to what extent the OER-model affects the client’s autonomy. If so, other long-term care organizations can implement this model too. Therefore, the overarching goal of this study is to identify to what extent the restructuring of care processes using the OER-model affects clients' autonomy compared to the usual model in long-term care. To answer the research question, qualitative research was conducted. Interviews were conducted with thirteen clients to explore their perspectives regarding autonomy at two locations, one with the OER-model and the other without it. Six of them were men, and seven were women between the ages of 68 and 97 with physical problems. These clients were able to speak and lived for at least one year at Zorggroep Almere. The data was transcribed with Amberscript and coded with ATLAS.ti. Then the data was thematically analyzed. From the responses to the interviews, the most crucial difference that emerged at the location with the OER-model was the encouragement of clients’ self-reliance. This means that clients were stimulated to do as much as possible by themselves to remain independent for as long as possible. Throughout this study, it was revealed that locations with the OER-model found the OERmodel too complicated and time-consuming for their employees. This location made different choices to implement certain tools of the OER-model and omit others. They kept two of the five OER-model tools. The results mostly show the differences between the two locations and their policies rather than the differences in implementing the OERmodel. The fact that a minor difference is visible between the two locations may also have to do with this. Due to this, the results of this study may not be reliable or representative of other locations and organizations using the OER-model. Therefore, one of the most important implications for further research is to compare a location without the OER-model with a location where the OER-model is completely implemented. Only then can a real conclusion be drawn about the influence of the OER-model on client autonomy.