Client Satisfaction with Home Care Services in Rural Russia

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Practitioners and analysts alike in North America and Western Europe appreciate the importance of providing at-home supportive services to the frail elderly to maintain their independent living arrangements and improve their life quality. The countries of Eastern Europe and the Commonwealth of Independent States, like their western counterparts, have recognized this for some years; and their health care systems are evolving away from institution-based care. Koulaksazov et al. (2003, pp.58-9), for example, report a strong shift since 1999 in Bulgaria in where "social care" is provided to the frail elderly, from institutions to clients' homes. There has, however, been little documentation of the scope and quality of the services provided, at least in terms of English-language publications.

It is known that typically these services have been provided by public agencies, i.e., by social workers directly employed by municipalities. While NGOs became active in this arena in some countries during the transition, they generally have not evolved into contracted providers of such services (Struyk, 2002). In other words, municipal agencies are often monopolistic suppliers of such services. Without strong internal quality controls, this kind of arrangement can breed poor service quality and little responsiveness to clients' specific needs. Thus it is possible that there are problems of service delivery in some countries.

This paper provides a critical assessment of the quality of services provided in one Russian locality. In-home services are new in Russia, being created in 1995 by a specific federal law. Under the law, such services are to be available throughout the country, and coverage is perceived to be good. Based on the project team's experience and the opinion of the responsible Deputy Governor for the study region, the program assessed can be considered to be better than most. While this is indeed a case study, it nevertheless applies a rigorous methodology to document the situation. The methodology itself can serve as a model for governments in Eastern Europe and the CIS to follow in undertaking similar assessments. In brief, we find surprisingly high levels of client satisfaction with the service provided and that satisfaction varies as expected with clients' degree of impairment and the volume of supportive services received.

The next section provides some context for the analysis, with a short description of the allocation of responsibilities for delivering these services in Russia and the basis for selecting the study locality. The following section outlines the assessment methodology, and is followed by the analytic results. The paper closes with some conclusions.

Note: This report is available in its entirety in the Portable Document Format (PDF).

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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