Shaping home care services in Lithuania

Background: Lithuanian society is one of the rapidly aging societies in Europe, because of low birth rates and constant emigration processes. Lithuanian Health Care system is in the transition from the institutional (hospitalization) services to home care services. Primary health care is directed towards development of community based services. The questions how the services shall be provided to chronically ill elder persons by creating conditions for them to live in dignity and independently at home as long as possible; how to develop co-ordinated assistance between social and health providers. Aims and objectives: to evaluate development possibilities for home care service in Lithuania. Design/methods/settings/participants: conducted qualitative study based on social constructivist strategy. Using semi-structural in depth interviews were interviewed 12 persons responsible for home care service provision in primary health care units. Results: The main burden of home care lies on the informal care providers. The access to home care services in primary health care units is impediment. Informal care givers and dependent with chronic conditions elder persons in reality are their own case managers. Home care service providers assign to the patients the role of asking for the service and collecting all the needed documentations, and undergo all the procedures on their own in order get eligibility for home care service. The home care service providers do not see their role in the improvement of systems for better service access. Conclusions: The inadequate vertical integration (between institutions of micro, mezzo and macro levels) is the main obstacle in the development of home care service delivery. The service providers are reluctant to give feedback to upper standing institutions. Another constrain in home care service development is the lack of integration between health care and social care sectors.