People with multimorbidity assessed for home-based rehabilitation: Supporting complex everyday life or creating vulnerability?

This article examines meetings between people living a complicated everyday life with multimorbidity and an assessor responsible for providing a rehabilitation programme, home care or neither. The background to this is a health policy change towards more home-based rehabilitation and less home care, which began with new legislation in the Danish Consolidation Act on Social Services in 2015. The question raised is whether these meetings support the everyday lives of people with multimorbidity or exacerbate their already vulnerable situation, and how their agency plays a role in the assessor’s decision.
The article is based on an ethnographic field study in Denmark. Twenty-six individuals with multimorbidity aged 28-86 years, applying for or already receiving home care, were studied. The article uses three cases to explore the distinct ways in which the people relate to the assessment meeting, and how the meeting affects their vulnerable situation, while the analysis reveals the widely varying involvement of the people’s agency. We find support for these people in their everyday lives with multimorbidity, when everyday life and challenges in practical daily activities are understood in context, and when the meeting is based on the people’s experience of their lives. Conversely, assessment meetings that exclude their experience of meaningful everyday life and their need for help to handle their complicated life with multimorbidity result in restricted access to rehabilitation and home care. This creates inequality in access to health and social care and in the possibility to live a meaningful everyday life, which reinforces these people’s vulnerability.