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Understanding and improving transitions of older people: a user and carer centred approach

Authors:
ELLINS Jo, et al
Publisher:
National Institute for Health Research
Publication year:
2012
Pagination:
169p.
Place of publication:
London

This project focuses on older people and their transition between different services and agencies in health and social care. Research studies and reports from inspectors have shown that older people experience many problems before, during and after transitions. This project had two key aims. First, it explored what information, support and care is needed by older people and their carers as they go through a transition. Second, the project team worked with people and organisations in four local areas to put the findings into practice. Care transitions involve far more than a move across services or settings. Participants in this study experienced transitions on a number of different levels: physical, including bodily changes as well as use of services; psychological, with changes in their identity or sense of self; and social, with changes in their relationships with partners, family and friends. These different transitions often happened simultaneously and if circumstances made coping difficult in one type of transition then it was likely to have an effect on others. Most of the suggestions participants made for improving services called for ‘micro-changes’ in the care environment and in interpersonal relationships. There was little suggestion that what was needed was new or different services; easier and earlier access to existing services emerged as a far greater priority. While these micro-changes may not cost large amounts of money, they do require committed and sustained effort to challenge existing ways of working that may be deeply ingrained in organisational and professional cultures.

Journal article

B J Spitler: geriatric care management pioneer

Author:
FRATES Janice
Journal article citation:
Journal of Gerontological Social Work, 50(3/4), 2008, pp.133-141.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

B. J. Curry Spitler, who died in 2004, pioneered a geriatric care management model that combined care management with home health services, and emphasised high levels of training and professionalism for all members of the care team. This assessment of her life is provided by someone who both worked with Spitler (to produce a marketing plan for her agency, Age Concerns) and used her services to care for her mother. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street,  Binghamton, NY 13904-1580).

Journal article

The discretion and power of street-level bureaucrats: an example from Swedish municipal eldercare

Authors:
DUNER Anna, NORDSTROM Monica
Journal article citation:
European Journal of Social Work, 9(4), December 2006, pp.425-444.
Publisher:
Taylor and Francis

This paper focuses on discretion in the frontline practice of social work with elderly people in Sweden. The aim is to describe and analyse how care managers in municipal eldercare use discretion and power in needs assessment and decision-making. Emanating from Lipsky's concept of discretion, we identify the conditions of decision-making, which along with the concepts of structural power and intentional power constitute the theoretical framework of this analysis. Eight care managers from four Swedish municipalities were observed and interviewed. The researchers carried out 38 observations and nine in-depth interviews. The analysis led to the identification of four techniques in the decision-making process of care managers: reject, execute, transform needs and control. The consequences of these practices are discussed at the end of the paper.

Journal article

Predicting transitions in the use of informal and professional care by older adults

Authors:
GEERLINGS Sandra, et al
Journal article citation:
Ageing and Society, 25(1), January 2005, pp.111-130.
Publisher:
Cambridge University Press

To prepare the care system for a rising population of older people it is important to understand what factors predict the use of care. This paper reports a study of transitions in use of informal and professional care using Andersen-Newman models of the predictive predisposing, enabling and need factors. It draws on Longitudinal Ageing Study Amsterdam data on care use and contextual factors. Data were collected at 3-yearly intervals from a random sex- and age-stratified population-based sample of adults aged 55-85. In summary, findings for those who initially did not receive care were that almost one-third received some kind 3 years later, most provided by informal carers. Need factors were important predictors of most transitions, and predisposing and enabling factors, such as age, partner status and income also played a role. On the relationship between informal and professional care, evidence was found for both 'compensatory processes (informal substitutes for professional care) and 'bridging processes' (informal care facilitates professional care). In view of the increasing discrepancy between the demand for professional care and supply, the significant impact of predisposing and enabling factors offers opportunities for intervention.

Journal article

Informal caregivers' experiences of formal support in a changing context

Author:
WILES Janine
Journal article citation:
Health and Social Care in the Community, 11(3), May 2003, pp.189-207.
Publisher:
Wiley-Blackwell

As the location of long-term care of elderly people moves to homes and communities, and responsibility shifts to families, understanding the experience of people in this situation is necessary to ensure that support is appropriate, accessible and effective. This paper explores informal caregivers' and recipients' relationships with formal support, drawing on thematic and narrative analysis of 30 in-depth interviews with self-identified family caregivers over a year in a mid-size city in Ontario, Canada. All but 6 had some interaction with formal support. The semistructured interviews explored caregivers' knowledge about and perceptions and experiences of accessing and using formal support. Interpretation reveals how confusion and lack of knowledge about services, inflexibility and lack of availability, and increasing pressure on the quantity and quality of publicly funded community-based resources combine to impact negatively on the experience of accessing and using formal support. Different ideas about relative roles and responsibilities of seniors, informal caregivers and 'family' in general, and the state both shape and are shaped by policies and the situated realities of formal support provision. Providing home care creates both opportunities and constraints for caregivers in interactions with formal support. Highlights the difficulties of interacting with publicly funded formal support as the costs of care are moved away from the state and onto families and individuals.

Book

Inspection of the care management of services for older people in the county borough of Bridgend, December 1999

Author:
WALES. Social Services Inspectorate for Wales
Publisher:
WALES. Social Services Inspectorate for Wales
Publication year:
2002
Pagination:
45p.
Place of publication:
Cardiff
Book

Inspection of the care management of services for older people in Newport County Borough: February 1999

Author:
WALES. Social Services Inspectorate for Wales
Publisher:
WALES. Social Services Inspectorate for Wales
Publication year:
2000
Pagination:
47p.
Place of publication:
Cardiff

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Book

Inspection of care management services for older people living in Monmouthshire: inspected June 1999

Author:
WALES. Social Services Inspectorate for Wales
Publisher:
WALES. Social Services Inspectorate for Wales
Publication year:
2000
Pagination:
47p.
Place of publication:
Cardiff
Book

Inspection of care management for older people in the county of Flintshire; inspected April 1999

Author:
WALES. Social Services Inspectorate for Wales
Publisher:
WALES. Social Services Inspectorate for Wales
Publication year:
2000
Pagination:
45p.
Place of publication:
Cardiff
Book

Inspection of care management for older people living in Gwynedd: March 1999

Author:
WALES. Social Services Inspectorate for Wales
Publisher:
WALES. Social Services Inspectorate for Wales
Publication year:
2000
Pagination:
45p.
Place of publication:
Cardiff

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