Perceived health and need for support
All the participants interviewed were asked about their health. Four participants (n = 4/22) described their health as good; one of them did so despite receiving support from the municipality. Many of the older participants (n = 18/22) reported that their health status varied; however, at the moment of the interviews, there was no ongoing severe illnesses reported. Of those who perceived themselves as having poor health, six (n = 6/18) reported that they recently had been going through a turbulent time with sickness and emergency visits and that their health might worsen rapidly.
Seven (n = 7/18) of the participants who received formal support or care from the municipality and/or PC perceived themselves as having poor health. The remaining eleven persons (n = 11/18) did not have any ongoing formal support from the municipality or PC. However, there were two participants who received help from their partners in activities related to daily life (n = 2/18).
The analysis of the 33 interviews showed two main themes on how older persons and their relatives experienced being part of the intervention of the GerMoT. One theme was “safety and security”, with the four subthemes of “easy accessibility”, “contacts according to needs”, “recurrent health examinations” and “taking the time needed”. The other main theme was “not fulfilling expectations”, with the subthemes of “unclear information” and “who should be to contacted and when?”
Safety and security
The main experience reported was almost exclusively benefitting from enrolment in the intervention group. The repeated contacts meant feelings of security and safety, that the older person was recognized and that someone cared for and asked about the older person.
One of the reasons for feeling secure was the possession of a direct telephone number. This meant that there was always someone to call to discuss issues or get advice in regard to some matter, which felt very valuable. Even if the need for contact did not exist for a moment, it was a safety mechanism that was in place if there should be a deterioration, which the participants knew could happen quickly. Several relatives mentioned that the participants had become more secure after joining the team, and they were happy that they also had the opportunity to call the team, which felt safe.
Easy accessibility
Being enrolled in the GerMoT was described by both the participants and their relatives as having easily accessible health care. The GerMoT helped with other health care contacts or planned treatments, and enrolment in the project allowed advice to be obtained regarding questions related to their health. The participants described how they often received an answer immediately when they called or that they could leave a message on the answering machine if a nurse was not available. One participating older person (27) who described having on-going ill health and no formal support or care in daily life said:
First, I think you get in touch immediately… and if they have time… they give you time or they explain how you should do… and then when you get there, they have time for you. So, I feel now, at least when I was there last… I felt… that I received more time and more help in one hour than I probably received in one year [earlier]… (27).
When there was a need to make contact with health care, regardless of whether the GerMoT initiated it, the participants felt as if they had a ‘VIP lane’ in the health care system. They did not have to wait in an emergency room for hours. The fact that they had a ‘VIP lane’ was even questioned in relation to fairness. They described that when visiting an emergency unit, during the time of their enrolment with the GerMoT, everything seemed to go quicker. They suggested that this ought to be a special “track” for older people at the emergency department to gain access to geriatric competence.
As one relative described:
We have called and there has been an answering machine at some point; then, they called back as soon as they could, and she did what she should (4).
Participant number 18, who had reported having ongoing ill health and no formal support, described the value of easy care contact:
….I think that when you reach the age that I am and the illnesses creeps up on you, you want….you want….the great value lies in the fact that you have a phone number that connects you to a person you have talked to before… because we who are in these small primary care centres, we are tired of people being replaced all the time… there are doctors and nurses….but you do not get this contact with your “channel” in the system… and it sometimes works very poorly … So, it feels very good to have this (18).
Although the participants described that they were aware that they should turn to PC in the first place, the experiences described above resulted in them calling the GerMoT instead. The participants and their relatives expressed that they would again consent to the participate in the project if they were asked to take part in such a study again and that they saw no disadvantages of being connected.
The participants compared the PC with the GerMoT. An older person could not call primary care just for advice; rather, an appointment had to be booked in advance. As one participant with ongoing ill health (7) stated:
So, you have somewhere to call... you cannot call the PC and say ‘Oh, oh I feel so bad’… you cannot do that…. then you have to book an appointment with a doctor… No, I actually think it is good (meaning the GerMoT) (7).
The need for contact with the GerMoT was sometimes a result of the long waiting times for an appointment with the PC or that the older person’s request for an appointment had been turned down. This created a lack of trust in PC and in favour of the GerMoT.
Contacts according to needs and continuity
To be enrolled in the treatment group meant follow-ups regarding health status, which were conducted via telephone calls, home visits and appointments at the geriatric clinic. The older persons said that since a lot happens in regard to health during ageing, it was good that they was regularly asked about their health. There were doubts about how often the follow-up telephone calls from the team were made, but the perception was that they were done with continuity. The overall experience was that the follow-ups took place more often during periods of poorer health and then gradually returned to fewer follow-ups when one’s health was improved. One participant (29) with ongoing ill health stressed the importance of the follow-ups:
… They call every fortnight and check how I am… Yes, now when it has been stable for a while; before, they called every week… (29).
Some of the participants wished that the telephone follow-ups would be somewhat more frequent; however, at the same time, they concluded that it was a question of resources. Others argued that the frequency of the follow-up telephone calls was sufficient as their health was stable.
The participants described that the GerMoT retained the whole picture of the person, which meant that the person did not have to give the same information about their medical history over and over again. When the older person called the telephone number they had been given, they could talk to staff they had talked to before and who knew the person. There was a slight turnover of staff during the project; however, the older person still felt recognized. Something that was also put forward as a positive aspect was that different professions that were part of the team promoted holistic care. Several participants compared this format with that of PC, in which they described as having a major shortage in terms of staff continuity.
The experience was that the staff who took the phone calls were very competent and asked relevant questions that revealed unseen problems that could be alleviated. Alternatively, as one older person (22) described, you sometimes need help describing possible symptoms:
… And so maybe there are problems that you do not think about….and… when you sit and talk, they come out a little (22).
Advice or actions initiated by the team were always followed up with a telephone call.
These follow-ups were considered even more critical for those who could not speak for themselves or did not have a close relative present to help them. The older persons and the relatives believed that these follow-ups could be seen as preventive care that might avoid emergency visits:
Because it is better that they do them while she's healthy too… they should not only be done when one is feeling ill…… health care is a lot better if it is preventive (4 relative).
For some of the participants, these follow-ups were the only occasions when they contacted the team. Often, they had well-functioned and ongoing care contacts (for example, private care or geriatric care nurses at PC) and did not understand why they would benefit from calling the GerMoT in case of problems. However, they were aware that the opportunity existed. Those who only had sporadic contact with the GerMoT still felt safe having the telephone number to call if the need arose. However, they expressed that it was easy to forget the possibility as contact was infrequent but that the follow-up telephone calls sometimes reminded them:
… It (sporadic contact)… is probably the only thing that can be a little negative because you can forget that you have that opportunity (6).
In line with this, relatives described that the older person might have wished for more regular contact with the team, but they thought that one reason for this lack of contact was that the older person did not want to disturb the team or make any fuss.
Something that was appreciated was that the examinations could be done at home if the person had difficulty travelling to the clinic. Some persons put forward that it was better to get a home visit because it was sometimes difficult to gather one’s thoughts during a phone call. Relatives also talked about obtaining a holistic picture of the person when they are examined in their ordinary environment at home.
Recurrent health examinations
The thorough health examinations that were performed during the visits by the nurse and the physician in connection with enrolment in the GerMoT were considered very positive.
The older persons and their relatives thought that the geriatric team provided what was described as “care”, which they have never experienced before. Several participants stated that the evaluation of their health that was done and examined so properly was very valuable precisely because they were older. It felt like a consolation that someone cared about older people. One person described the tests as ‘car maintenance’ ("thousand-mile service").
One examination that was explicitly mentioned consisted of the cognitive tests that were done. The reason why the older persons were particularly in favour of that test was that they had a feeling that it was challenging to detect cognitive impairments themselves. Participant number two, who experienced ongoing ill health and needed assistance in everyday life, stated the importance of confirming that the “mind” was still intact:
… I like that they test my memory and stuff … so I get to know a little about if it has gotten worse or if it has gotten better. Yes, my fear is that I should lose my mind yes… that I should not be able to cope like that (2).
Several participants felt that they had received valuable confirmation that everything was working fine when they conducted these tests. They expressed pride over their maintained ability, although there was an awareness that this situation could change quickly.
Taking the time needed
Something that both relatives and the older person experienced was that there was a difference in the encounter when contacting the GerMoT versus when contacting the PC. The GerMoT was compliant and helpful, listened and let the encounter take time, facilitated other care contacts, and speeded up processes related to care and making contact with the municipality. The older persons’ experiences were that visits to their usual health care are often at a fixed day and time. This fact sometimes makes it hard for people living with multimorbidity, who need time to describe their symptoms and worries. This situation might lead to the consequence that only the most prevalent symptom is mentioned, which does not give an overall picture of the person’s situation. One relative used the expression “the clock is ticking” in regard to the usual health care services.
… Otherwise… the clock is ticking…oh….I have 20 minutes… what should I catch up with…what do I want to talk about… no, I have to talk about the most important… (33).
The participants said that the accessibility and commitment present in the GerMoT is the opposite of the ‘clock is ticking’ feeling. The older persons talked about occasions in which they had been in contact with the GerMoT in emergency situations and how they then received a quick home visit. Their contact could also have been about guidance or advice about, for example, calling an ambulance and helping to receive care when needed. The comparison was made by several participants between this situation and how the PCs are organized, i.e., where a first contact is eventually made and an appointment might be delayed for days. Something that was also mentioned as a positive side of the GerMoT was that after a hospital stay or after an emergency visit, the team called them for a check-up, as a participant described:
… And then when I came home again… the day after …… the team nurse called... and I thought it was very nice… and then I did know that there was someone who was keeping in touch with me....and then she called again after one or two day and asked how I was… (24).
Unfulfilled expectations
The information provided during enrolment and in connection to the project was that participation in the GerMoT would be in addition to the usual care that was experienced by participants. Some participants wondered what the GerMoT could accomplish that their usual emergency care could not. Some explained that they would not participate if given the offer again because their expectations were not met. Disappointment was expressed by both relatives and older persons, and some areas were excluded, for example, help with mobility services, as one relative expressed in the quotation below:
I do not truly understand this….the purpose is to support joint efforts for older persons in addition to the usual care... with what as a supplement… I have understood that…(mobility service), I thought that maybe was something you could help with… (17).
The written information about the project referred to "collective efforts," which by some was interpreted as holistic care without omitting any parts. The anticipation was that when the person agreed to participate in the project, the team would be able to give ‘tips and tricks’ about support related to the person's health, which was not understood to be the case. Some expressed that they did not notice any differences after joining the team apart from the follow-ups that were done in the project. Thus, the enrolment had not lived up to their expectations.
Some of the relatives were unsure if they could contact the team on behalf of the older person and thought that the older person should get in touch themselves.
Unclear information about being enrolled
When older people received written information about the suggestion to join the GerMoT, the reason to do so and the purpose were not entirely clear to everyone. There was a disparity among the participants regarding the anticipation of enrolment and what it could mean, which ranged from a lack of anticipation to the experience of being frustrated that it turned out to be something completely different. Some of the participants explained the sampling procedure and what they could expect when part of the intervention group. Others were still puzzled about their participation since they, in that moment, experienced good health. Nevertheless, most participants recapitulated the fact that they were asked to take part in relation to earlier periods of ill health, during which they sought emergency care frequently, and the fact that they live with multimorbidity, or with numerous conditions as one participant explained:
…. it was probably that I have so-called multimorbidity…. I have several diagnoses… (6).
Who should be contacted when?
Some uncertainty was experienced about when or on what occasions the PC should be contacted and when to contact the GerMoT. Some older people were puzzled how it came to that they had been asked to take part in the intervention in the first place. The relatives stressed that they needed more information about the GerMoT and were concerned about when the older person was asked to take part and eventually enrolled in the study. They deemed this information helpful in the event of the acute need for support or care:
Now she was quite confused the last time she went in…. there have been other times when she went to the hospital….but I never understood how we could use them (the team)… I became mostly a little annoyed with her because she was kind of stubborn that they had taken blood samples and they would at least call... if I had known that I could access this team myself, maybe we could have taken her that way (31 relative).
However, the relatives explained that they were aware of the secrecy and the self-determination of the older people.
Despite doubts and hesitations about the reason and purpose of participation in the study, the participants gave their consent to being enrolled with the team. Reasons why they agreed to take part were curiosity and an interest in how the project would end up. There were also experiences of being persuaded to participate. Nevertheless, at the same time, the overall opinion was that by participating, you could contribute to increasing knowledge about the care of older people, which seemed to be a good thing. Some participants thought that it all seemed interesting because specialists in the care of older people were part of the team, which they felt increased the probability that, if such help were needed, more appropriate care would result if something were to happen. It was also perceived as self-evident to take part because doing so could be of importance and benefit to someone, which was seen as an exchange for the previously received care, as one participant (21) who, for the moment, was experiencing good health explained:
… What the hell…they have taken care of my head now for 15 years…..so, I can give back with this...that is….if it can be of any joy for someone… (21)
The older person did not always inform their relatives about their contact with the team. The relatives thought the reason for this was that the older people did not want to burden their relatives but also because they had a desire to manage independently. Although some participants explained that they had no expectations when they agreed to join the GerMoT, they still expressed satisfaction that they had agreed to join in. One relative stated:
… incredibly good... that is what we can call the health care… (8 relative)
However, some explained that they would not choose to participate if given the offer again because their expectations had not been met.