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Assessing quality for people living with dementia in residential long-term care: trends and challenges
- Authors:
- McCONNELL Eleanor S., MEYER Julienne
- Journal article citation:
- Gerontology and Geriatric Medicine, 5(January-December), 2019,
- Publisher:
- Sage
The global prevalence of dementia is growing rapidly, driving an increased use of residential long-term care (LTC) services. Performance indicators for residential LTC should support targeting of limited resources to promote person-centered care, health, and well-being for both patients and caregivers (formal and informal), yet many performance indicators remain focused on structure, process, or outcome measures that are only assumed to support personally relevant outcomes for those with dementia, without direct evidence of meaningfulness for these individuals. In this article, two complementary approaches to assessing quality in residential LTC serve as a lens for examining a series of tensions related to assessment in this setting. These include measurement-focused approaches using generic psychometrically valid instruments, often used to monitor quality of services, and meaning-focused approaches using individual subjective assessment of personally relevant outcomes, often used to monitor care planning. Examples from the European and U.S. literature suggest an opportunity to strengthen an emphasis on personally meaning-focused outcomes in quality assessment. (Edited publisher abstract)
My home life: promoting quality of life in care homes: report
- Authors:
- OWEN Tom, MEYER Julienne
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2012
- Pagination:
- 81p.
- Place of publication:
- York
Older people have identified the importance of having control over how they lead their lives and the care that they receive. This is also echoed in government policy across all four nations of the UK. However, there remains a lack of real understanding of what this looks like in care homes and how to make it happen. This report summarises lessons from best practice in care homes, particularly regarding the promotion of “voice, choice and control” for older people and concerning the development of leadership in the care home sector. Key messages from over 100 examples of good practice submitted by care homes were explored with the sector. This study indicates that positive relationships in care homes enable staff to listen to older people, appreciate individual needs and promote greater voice, choice and control. Relationship-centred care was often central to examples of best practice. Care home managers were pivotal in promoting relationships between older people, staff and relatives. Care home providers and statutory agencies need to consider how their attitudes, practices and policies influence practice on the ground. Inappropriate policy can create undue pressure and unnecessary paperwork; ultimately reducing the capacity of care homes to respond to the needs of older people, it is alleged. Also, negative stereotypes of care homes can impact adversely on the confidence of staff and managers.
My home life: promoting quality of life in care homes: summary
- Authors:
- OWEN Tom, MEYER Julienne
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2012
- Pagination:
- 8p.
- Place of publication:
- York
Older people have identified the importance of having control over how they lead their lives and the care that they receive. This is also echoed in government policy across all four nations of the UK. However, there remains a lack of real understanding of what this looks like in care homes and how to make it happen. This report summarises lessons from best practice in care homes, particularly regarding the promotion of “voice, choice and control” for older people and concerning the development of leadership in the care home sector. Key messages from over 100 examples of good practice submitted by care homes were explored with the sector. This study indicates that positive relationships in care homes enable staff to listen to older people, appreciate individual needs and promote greater voice, choice and control. Relationship-centred care was often central to examples of best practice. Care home managers were pivotal in promoting relationships between older people, staff and relatives. Care home providers and statutory agencies need to consider how their attitudes, practices and policies influence practice on the ground. Inappropriate policy can create undue pressure and unnecessary paperwork; ultimately reducing the capacity of care homes to respond to the needs of older people, it is alleged. Also, negative stereotypes of care homes can impact adversely on the confidence of staff and managers.
My Home Life: a new vision for care home practice
- Authors:
- OWEN Tom, MEYER Julienne
- Journal article citation:
- Journal of Dementia Care, 15(5), September 2007, pp.28-30.
- Publisher:
- Hawker
The My Home Life programme aims to improve the quality of life for everyone involved in care homes - residents, staff and visitors. This article outlines the vision of My Home Life and discusses the eight best practice themes identified: managing transitions; maintaining identity; creating community; sharing decision-making; improving health and healthcare; supporting good end-of-life care; keeping workforce fit for purpose; and promoting positive culture.
Moving from a victim blaming to an appreciative inquiry: exploring quality of life in care homes
- Authors:
- MEYER Julienne, et al
- Journal article citation:
- Quality in Ageing, 7(4), December 2006, pp.27-36.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
This article highlights the need for researchers to work across disciplinary boundaries in order to capture the complexity that care practitioners have to engage with everyday in care home settings. Drawing on findings from a literature review on the complexity of loss in continuing care institutions for older people, the case is made for less victim blaming and more appreciative approaches to research. The way this thinking informed the development of a further literature review on quality of life in care homes is discussed. Findings from this second study are shared by illustrating key messages with quotes from older residents, relatives and staff living, visiting and working in care homes. These best practice messages focus on: transition into a care home; working to help residents maintain their identity; creating community within care homes; shared decision-making; health and health services; end-of-life care; keeping the workforce fit for purpose, and promoting positive culture. The importance of collaborative working in both research and practice is discussed.
Assessing the built environment in care homes
- Authors:
- ABBOTT Stephen, BIRKEN Mary, MEYER Julienne
- Journal article citation:
- Journal of Dementia Care, 25(3), 2017, pp.32-34.
- Publisher:
- Hawker
This article discusses different approaches of assessing the built environment in care homes for people with dementia. It compares using routinely collected data about incidents and behaviours that might reflect the physical environment; using existing environmental assessment tools; interviews with staff, residents and visitors about the quality of the environment as a place to live, work or visit; and observational methods of assessment. (Edited publisher abstract)
The impact of improved environment in a care home
- Authors:
- ABBOTT Stephen, BIRKEN Mary, MEYER Julienne
- Journal article citation:
- Journal of Dementia Care, 24(6), 2016, pp.23-25.
- Publisher:
- Hawker
This article summarises the findings of an evaluation of environmental improvements carried out in a care home for people with dementia, looking in detail at the views of care staff. Semi-structured interviews were carried out with 25 staff about the post-refurbishment environment as a place to live, work or visit. Three themes emerged from the data: impacts on residents and staff; differing views on 'homeliness'; and that environmental design alone is not enough. The data found that the refurbishment had created a better general atmosphere, which made it easier to care for residents with dementia. The article concludes that a high quality physical environment is a necessary, but not sufficient condition for good care for people with dementia. Other factors identified included a flexible approach to the social environment, fully accessible social spaces and an emphasis on homeliness in all its aspects. (Edited publisher abstract)
Care homes
- Authors:
- LUFF Rebekah, FERREIRA Zara, MEYER Julienne
- Publisher:
- NIHR School for Social Care Research
- Publication year:
- 2011
- Pagination:
- 40p., bibliog.
- Place of publication:
- London
The main aim of this evidence-based guide, which draws on illustrative examples from a range of studies, is to help those new to the field of research in care homes to learn from the experience of others. It focuses on care homes for older people and on 3 broad methodologies as applied in care home research: qualitative, quantitative, and participative research. It covers the context and culture of UK care homes, preparing to do research and development in care homes, research funding, ethics in care home research, gaining access and working with care home management and staff, special considerations for different methods, good practice, reflections on analysis, and disseminating findings. It includes recommendations for research on adult social care practice.
Psychoanalytical informed research in an NHS continuing care unit for older people: exploring and developing staff's work with complex loss and grief
- Authors:
- HOLMAN Cheryl, MEYER Julienne, DAVENHILL Rachael
- Journal article citation:
- Journal of Social Work Practice, 20(3), November 2006, pp.315-328.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
There are studies about the emotional and social aspects of loss and grief in continuing care environments such as care homes and hospital wards, but researchers have tended to focus on either the cultural aspect of the organisation or the emotional response of individuals. This splitting in the body of knowledge misses the opportunity to examine the link between the personal and the broader public domain. This paper concerns the methodology and initial findings from a psychoanalytically informed research study. It was aimed deliberately at exploring the juncture between the psychological and social domains that care staff have to negotiate in order to provide care related to loss and grief in an NHS continuing care ward in London. The method draws heavily on the Tavistock approach to learning about emotions but also adopts participant observation methods rooted in the ethnographic tradition. The study identifies the emotional demand of caring for people experiencing loss and grief in a continuing care unit and the development of a reflective group that supported practice developments in meeting these tasks. The paper will argue that research that develops an understanding of social practices underpinned by psychoanalytic perspectives can inform development in areas where staff are expected to cope with high levels of anxiety and stress.
Assessing the outcomes of day hospital care for older people: a review of the literature
- Authors:
- BENTLEY Jane, MEYER Julienne, KAFETZ Kalman
- Journal article citation:
- Quality in Ageing, 2(4), December 2001, pp.33-41.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
The current policy context demands that health service providers demonstrate that services are effective, efficient, value for money and of good quality. Recent government interest in intermediate care has increased pressure on day hospitals in particular to supply such evidence, because they face competition for their core services (such as rehabilitation care) from the other community-based providers. This review was conducted as part of a small study to evaluate a day hospital service in North London. Findings suggest that the outcomes of day hospital are especially difficult to appraise because of the highly variable nature of both individual facilities and the needs and capabilities of patients attending. Traditional quantitative methods, such as randomised controlled trials or the use of standardised tools to assess treatment outcomes, face severe methodological problems owing to this variability. The review suggests that future researcher take a more user-focused and qualitative research approach to the evaluation of day hospital care, such as by evaluating joint care plans with patients and staff, by assessing costs, by following small numbers of users through treatment and by studying users' and carer' views of (and preference for) care.