The new role of interdisciplinary mapping and assessment teams as gatekeepers of long-term care services

Abstract Introduction: A selection of Norwegian municipalities has replaced the traditional model for allocating long-term-care (LTC) services with municipal interdisciplinary mapping and assessment (MIMA) teams. These teams aim to carry out an intensive initial mapping and assessment of applicants’ needs for up to four weeks, aiming to make the applicants self-reliant through rehabilitation. In the traditional model, services were assigned rapidly without such an intensive assessment and follow-up phase. The research question of this study was: What do the accounts of the employees of the MIMA team reveal about the expectations placed on applicants of the LTC services and their relatives?Method: Three focus group interviews with healthcare professionals in one MIMA team, and four individual semi-structured interviews with the coordinator and leaders of the team were conducted. Institutional ethnography constituted the epistemological foundation of this study and was used in the analysis of the data material.Result: The work of the professionals of the MIMA teams consisted of three processes: 1) reception of applications; 2) mapping and the follow-up of applicants; and 3) the assessment and recommendation. Through an exploration of the healthcare professionals shared work-knowledge, we identified a need to clarify expectations between healthcare professionals and the applicant as the main issue.Conclusion: The strong focus on clarification of the users’ expectations represents a change in the gatekeeper role of municipalities in the allocation of LTC services. We find that the assessment of long-term care needs is strongly linked to a discourse characterized by understandings of a squeezed municipal economy. A lack of prioritized resources to address demographic changes is supposedly fuelling this transformation but is also supported by discursive arguments that older people preferably wish to manage in their homes on their own. As healthcare professionals’ assessments of applicants’ rehabilitation potential and needs may contrast to the applicants’ own perception, conflicting expectations between professionals and applicants may occur.