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‘We’re giving them choice which is controlled choice’ – care managers’ views on finding social care support for people with learning disabilities
- Authors:
- RICHARDSON Lisa, et al
- Journal article citation:
- British Journal of Social Work, 50(7), 2020, pp.2063-2082.
- Publisher:
- Oxford University Press
Choice and control are pivotal in UK Government policy for achieving personalisation of social care for people with learning disabilities; however, little is known about the role care management plays in supporting people with learning disabilities finding social care services. This article explores that the support care managers provide people with learning disabilities, how care managers source and use information to offer choice in relation to accommodation and support, with a focus on people receiving managed budgets. Qualitative interviews with eight care managers from two local authorities in the South East of England were analysed using thematic network analysis, producing three global themes. The first ‘shaping choice’ describes the role of the care management process and assessments have in determining opportunities for choice. The gathering and interpretation of quality information is explored in the second global theme, highlighting the role of visiting settings to understand their quality. ‘Choice in principle’ is the third global theme, whereby the factors shaping choice come to be seen as choice akin to that anyone else has. These findings have implications for future policy and practice in relation to care management for people with learning disabilities. (Edited publisher abstract)
From the service user association's perspective: what contributes to value in integrated mental health and social care services?
- Authors:
- KLINGA Charlotte, et al
- Journal article citation:
- Journal of Integrated Care, 28(2), 2020, pp.53-63.
- Publisher:
- Emerald
The aim of this study was to identify key components of integrated mental health and social care services that contribute to value for service users in Sweden.Design/methodology/approach: An explorative research study design was used, based on data from four group interviews conducted in June and August 2017 with service user representatives.Findings: The analysis resulted in eight subcategories reflecting components that were reported to contribute to value for service users. These subcategories were grouped into three main categories: (1) professionals who see and support the whole person, (2) organizational commitment to holistic care and (3) support for equal opportunities and active participation in society.Research limitations/implications: The findings are primarily transferable to integrated mental health and social care services, as they emphasize key components that contribute to value for service users in these specific settings.Practical implications: The complexity of integrated mental health and social care services requires coordination across the individual and organizational levels as well as ongoing dialogue and partnerships between service users, service user associations and health and social care organizations. In this integration, it is important that service users and service user associations not only are invited but also keen to participate in the design of care and support efforts.Originality/value: Service User Associations (SUAs) can act as a bridge between county and municipal services through their participation in the development of local activities; at the regional and national levels, SUAs can help achieve more equitable integrated services. It is important that SUAs are not only invited but encouraged to actively participate in the design of such care and support efforts. (Edited publisher abstract)
Co-creation of a family-focused service model living with younger onset dementia
- Authors:
- HUTCHINSON Karen, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 19(4), 2020, pp.1029-1050.
- Publisher:
- Sage
Families living with younger onset dementia face unique social challenges, which services do not currently address. There is a gap in understanding the experiences of families affected by younger onset dementia, including the interactions and relationships within the family units, and with existing services and supports. In this qualitative research study, semi-structured interviews were conducted across Australia with seven health and social care providers, five persons living with younger onset dementia, six spouse/carers, and 17 children. A thematic analysis was conducted using a theoretical lens drawn from the combined perspectives of the social model of disability and family systems-illness model. Two central themes emerged in the data: (1) Understanding the social demands on the family – lifecycle challenges living with younger onset dementia from a social and family context; and (2) Interactions of health and social care providers with families living with younger onset dementia – opportunities and challenges in providing support and services geared to a whole family approach. In order to provide families for those living with younger onset dementia with optimal assistance and support, co-creation of a family-focused services model is proposed. Its purpose is to support effective therapeutic interactions and service development among service users, service providers, and stakeholders. (Edited publisher abstract)
Effects of health and social care spending constraints on mortality in England: a time trend analysis
- Authors:
- WATKINS Jonathon, et al
- Journal article citation:
- BMJ Open, 7(11), 2017, p.e017722. Online only
- Publisher:
- BMJ Publishing Group
Objective Since 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). This study sought to determine whether these constraints have affected mortality rates. Methods: this study collected data on health and social care resources and finances for England from 2001 to 2014. Time trend analyses were conducted to compare the actual mortality rates in 2011–2014 with the counterfactual rates expected based on trends before spending constraints. Fixed-effects regression analyses were conducted using annual data on PES and PEH with mortality as the outcome, with further adjustments for macroeconomic factors and resources. Analyses were stratified by age group, place of death and lower-tier local authority (n=325). Mortality rates to 2020 were projected based on recent trends. Results: Spending constraints between 2010 and 2014 were associated with an estimated 45 368 (95% CI 34 530 to 56 206) higher than expected number of deaths compared with pre-2010 trends. Deaths in those aged ≥60 and in care homes accounted for the majority. PES was more strongly linked with care home and home mortality than PEH, with each £10 per capita decline in real PES associated with an increase of 5.10 (3.65–6.54) (p<0.001) care home deaths per 100 000. These associations persisted in lag analyses and after adjustment for macroeconomic factors. Furthermore, this study found that changes in real PES per capita may be linked to mortality mostly via changes in nurse numbers. Projections to 2020 based on 2009-2014 trend was cumulatively linked to an estimated 152 141 (95% CI 134 597 and 169 685) additional deaths. Conclusions: Spending constraints, especially PES, are associated with a substantial mortality gap. This study suggests that spending should be targeted on improving care delivered in care homes and at home; and maintaining or increasing nurse numbers. (Edited publisher abstract)
Commissioning social care for people with dementia living at home: Findings from a national survey
- Authors:
- DAVIES Sue, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 35(1), 2020, pp.53-59.
- Publisher:
- Wiley
Objective: To explore the complexities, circumstances, and range of services commissioned for people with dementia living at home. Method: A national survey was used to collect data from English local authorities in 2015. Commissioners of services for older adults were invited to complete a questionnaire. An exploratory cluster analysis of nominal data was conducted using a TwoStep procedure to identify distinct groups. Results: A total of 122 authorities (83%) responded to the request. Four approaches to commissioning were identified, reflecting commissioning practices at the organisational, strategic, and individual service user levels. Commissioning at the service user level was most apparent. Bivariate analysis found that these configurations were not associated with the types of dementia specific services provided but were related to the number available. Authorities delivered a greater range of specialist services when joint commissioning between social care and health partners was undertaken. However, the joint commissioning of services was less observed in services specifically for people with dementia than in generic services for all older people. There was limited evidence that local circumstances (population configuration and deprivation levels) were associated with this approach to commissioning. Conclusions: The significant role of health partners in the delivery of social care services to support older people living with dementia in their own homes is evident. As the population with dementia ages and physical health needs increase, how dementia specific services differ from and complement those services available to all older people warrants further investigation. (Publisher abstract)
What happens to quality in integrated homecare? A 15-year follow-up study
- Authors:
- PALJARVI Soili, et al
- Journal article citation:
- International Journal of Integrated Care, 11(2), 2011, Online only
- Publisher:
- International Foundation for Integrated Care
A case study of a joint homecare unit in Finland, created following the merger of home healthcare and home help services in 1994 - 1995, is used to explore the impact of structural integration on home care quality. The case study included a before–after comparison with baseline and four follow-up measurements during 1994–2009, using interviews with clients (n=66–84) and postal inquiries to relatives (n=73–78) and staff (n=68–136). Home care quality was analysed in three domains: sufficiency of care; responsiveness of care; and guiding, counselling and informing clients. Despite the organisational reform involving extensive mergers of health and social care organisations and cuts in staff and service provision, homecare quality remained at almost the same level throughout the 15-year follow-up. According to the clients, it even slightly improved in some homecare areas. The results show that despite the structural integration and cuts in staff and service provision, the quality of homecare remained at a good level. The results suggest that structural integration had a positive impact on homecare quality. To provide firmer evidence, the authors call for additional research with a randomised comparison design. (Edited publisher abstract)
Outcomes of reablement and their measurement: findings from an evaluation of English reablement services
- Authors:
- BERESFORD Bryony, et al
- Journal article citation:
- Health and Social Care in the Community, 27(6), 2019, pp.1438-1450.
- Publisher:
- Wiley
Reablement – or restorative care – is a central feature of many western governments’ approaches to supporting and enabling older people to stay in their own homes and minimise demand for social care. Existing evidence supports this approach although further research is required to strengthen the certainty of conclusions being drawn. In countries where reablement has been rolled out nationally, an additional research priority – to develop an evidence base on models of delivery – is emerging. This paper reports a prospective cohort study of individuals referred to three English social care reablement services, each representing a different model of service delivery. Outcomes included healthcare‐ and social care–related quality of life, functioning, mental health and resource use (service costs, informal carer time, out‐of‐pocket costs). In contrast with the majority of other studies, self‐report measures were the predominant source of outcomes and resource use data. Furthermore, no previous evaluation has used a global measure of mental health. Outcomes data were collected on entry to the service, discharge and 6 months post discharge. A number of challenges were encountered during the study and insufficient individuals were recruited in two research sites to allow a comparison of service models. Findings from descriptive analyses of outcomes align with previous studies and positive changes were observed across all outcome domains. Improvements observed at discharge were, for most, retained at 6 months follow‐up. Patterns of change in functional ability point to the importance of assessing functioning in terms of basic and extended activities of daily living. Findings from the economic evaluation highlight the importance of collecting data on informal carer time and also demonstrate the viability of collecting resource use data direct from service users. The study demonstrates challenges, and value, of including self‐report outcome and resource use measures in evaluations of reablement. (Edited publisher abstract)
Does older adults’ use of social care influence their healthcare utilisation? A systematic review of international evidence
- Authors:
- SPIERS Gemma, et al
- Journal article citation:
- Health and Social Care in the Community, 27(5), 2019, pp.e651-e662.
- Publisher:
- Wiley
This systematic review aimed to synthesise evidence on the relationship between older adults’ use of social care and their healthcare utilisation. Ten databases were searched for international literature on social care (exposure), healthcare use (outcome) and older adults (population). Searches were carried out in October 2016, and updated May 2018. Studies were eligible if they were published after 2000 in a high income country, examined the relationship between use of social care and healthcare utilisation by older adults (aged ≥60 years), and controlled for an indicator of need. Study quality and bias were rated using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. Study data were extracted and a narrative synthesis was conducted. Data were not suitable for quantitative synthesis. Thirteen studies were identified from 12,065 citations. Overall, the quality and volume of evidence was low. There was limited evidence to suggest that longer lengths of stay in care homes were associated with a lower risk of inpatient admissions. Residents of care homes with onsite nursing had fewer than expected admissions to hospital, compared to people in care homes without nursing, and adjusting for need. Evidence for other healthcare use outcomes was even more limited and heterogeneous, with notable gaps in primary care. The authors conclude that older adults’ use of care homes may moderate inpatient admissions. In particular, the presence of registered nurses in care homes may reduce the need to transfer residents to hospital. However, further evidence is needed to add weight to this conclusion. Future research should build on this evidence and address gaps regarding the influence of community based social care on older adults’ healthcare use. A greater focus on primary care outcomes is imperative. (Edited publisher abstract)
What is (Adult) Social Care in England? Its origins and meaning
- Authors:
- SMITH Randall, et al
- Journal article citation:
- Research Policy and Planning, 33(2), 2018/19, pp.45-56.
- Publisher:
- Social Services Research Group
The term ‘social care’ emerged in both official and academic publications in England in the 1990s but has not been defined in legislation. How the phrase has varied in usage over the last 20 plus years is outlined in this article. Whilst the element of ‘personal care’ has been present in the range of descriptions of ‘social care’, the policy context has changed dramatically, affecting the broader debate about priorities in public support for vulnerable adults. What ‘social care’ means as a policy rather than a practice has changed over time. The notion of indeterminacy provides a plausible explanation of changes in terminology and meaning in policies and practices. (Edited publisher abstract)
Elderly and end of life care for Muslims in the UK
- Authors:
- SULEMAN Mehrunisha, et al
- Publisher:
- Muslim Council of Britain
- Publication year:
- 2019
- Pagination:
- 80
- Place of publication:
- London
This report draws together into one document themes relating to the care of older people, end of life care and after-death considerations in the Muslim community. It seeks to present a Muslim voice in the health and social care policy discussions, offering evidence of needs and experiences collated through interviews and focus groups. It also draws on Census and statistical information to provide population forecasts of Muslim older people and their health status. A key theme in this report is the importance of collaboration between the health and social care organisations bodies and faith-based organisations. Sections cover: health of the elderly; elderly care needs; end of life care needs; forecasts of care needs in 2036. The final section provides a summary of actions arising. (Edited publisher abstract)