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The prioritisation of choice in eldercare: the case of Ireland
- Author:
- LOLICH Luciana
- Journal article citation:
- International Journal of Care and Caring, 3(4), 2019, pp.517-530.
- Publisher:
- Policy Press
In recent decades, there has been a prioritisation of choice in eldercare in many Western countries. In many policy documents, choice is framed as giving older adults the choice to be cared for at home. The article draws on secondary sources to trace the impact of a logic of choice in eldercare in Ireland. It situates the analysis within the re-conceptualisation of care as a commodity and the home-care worker as the most ‘efficient’ option. The article examines the limitations of choice and questions whether choice should be the most important aspect of care in old age. (Publisher abstract)
Choice and quality in home-based and community-based aged care: insights from two rapid evidence reviews
- Authors:
- HUNTER Nicholas J. R., et al
- Journal article citation:
- Ageing and Society, 41(4), 2021, pp.875-916.
- Publisher:
- Cambridge University Press
As consumer-directed care programmes become increasingly common in aged care provision, there is a heightened requirement for literature summarising the experience and perspectives of recipients. We conducted rapid evidence reviews on two components of consumer experience of home- and community-based aged care: (a) drivers of choice when looking for a service (Question 1 (Q1)); and (b) perceptions of quality of services (Question 2 (Q2)). We systematically searched MEDLINE and EMBASE databases, and conducted manual (non-systematic) searches of primary and grey literature (e.g. government reports) across CINAHL, Scopus, PsychINFO, and Web of Science, Trove and OpenGrey databases. Articles deemed eligible after abstract/full-text screening subsequently underwent risk-of-bias assessment to ensure their quality. The final included studies (Q1: N = 21; Q2: N = 19) comprised both quantitative and qualitative articles, which highlighted that consumer choices of services are driven by a combination of: desire for flexibility in service provision; optimising mobility; need for personal assistance, security and safety, interaction, and social/leisure activities; and to target and address previously unmet needs. Similarly, consumer perspectives of quality include control and autonomy, interpersonal interactions, flexibility of choice, and safety and affordability. Our reviews suggest that future model development should take into account consumers’ freedom to choose services in a flexible manner, and the value they place on interpersonal relationships and social interaction. (Edited publisher abstract)
Domiciliary care agency responses to increased user choice
- Author:
- SOCIAL POLICY RESEARCH UNIT
- Publisher:
- University of York, Social Policy Research Unit and Institute of Social and Econ
- Publication year:
- 2008
- Pagination:
- 4p.
- Place of publication:
- York
In December 2007, the Government announced the introduction of personal budgets for everyone eligible for publicly-funded adult social care in England. The capacity of home care agencies to adapt from providing predominantly personal budget holders is not well researched. This study explored the potential impacts on the home care agencies and the wider implications for the home care market of these changes.
Caring relationships and their role in users’ choices: a study of users of Direct Payments in England
- Author:
- RODRIGUES Ricardo
- Journal article citation:
- Ageing and Society, 40(7), 2020, pp.1469-1489.
- Publisher:
- Cambridge University Press
User choice in care for older people has assumed that care is like any other commodity; which is in contrast with the concept of care defined by the feminist and ethics of care literature, which includes a relational component beyond care tasks – caring relationships. This study aims to understand how caring relationships impact the decisions of older users of care and their perceived satisfaction. Semi-structured qualitative interviews were conducted with 24 Direct Payments (DPs) older users, including proxies, in three Local Authorities in the Greater London area. Users fell into three groups according to their use of DPs: those purchasing care from agencies, those employing acquaintances as Personal Assistants (PAs) and those employing strangers as PAs. Decisions on and perceived satisfaction with care were both influenced by caring relationships. All users recognised that caring relationships can have instrumental value in improving care delivery or allowing greater leeway in negotiating tasks. Many users placed intrinsic value on continuity of care and the development of close caring relationships and clearly favoured employing PAs. The latter involved higher levels of uncertainty, emotional investment and reciprocal gift exchanges. Agencies were often chosen due to users’ preference for more detached caring relationships. The findings confirm that caring relationships involving reciprocal emotional investment are an important outcome of care, with salient implications for user behaviour. (Edited publisher abstract)
Care and support at home in Wales. Five-year strategic plan 2017-2022
- Author:
- SOCIAL CARE WALES
- Publisher:
- Social Care Wales
- Publication year:
- 2017
- Pagination:
- 21
- Place of publication:
- Cardiff
This five-year plan, developed by the Care Council for Wales in partnership with local authorities and the social care, health and housing sectors, sets out a vision for change to improve care and support at home for people in Wales. It briefly explores the current provision of home care, looks at why change is needed, and identifies six main areas for action in order to improve care. These are: making sure people who need care and support, and carers, are equal partners in decisions about their support; building care and support around families and communities; providing care that supports personal outcomes and meets different needs; investing in a range of good-quality options that help people stay independent and well in their own homes; ensuring the workforce has the right knowledge, skills and values; and designing care and support at home on the best evidence. The plan is accompanied by a supporting document that features examples from across Wales of the different ways in which care and support at home can work effectively. The plan is published by Social Care Wales, which replaces the Care Council for Wales from 3 April 2017. (Edited publisher abstract)
When the clients can choose: dilemmas of street-level workers in choice-based social services
- Authors:
- COHEN Nissim, BENISH Avishai, SHAMRIZ-ILOUZ Aya
- Journal article citation:
- Social Service Review, 90(4), 2016, pp.620-646.
- Publisher:
- University of Chicago Press
To examine the question of how increased use of choice-based management strategies in social services influences the behaviour of street-level workers, this article provides an analytical framework for understanding street-level logic in choice-based environments. It then looks at home-nursing care in Israel to examine how choice plays out in street-level workers’ day-to-day practices. By relying on 34 interviews with social workers working in home-care agencies, the authors illustrate how street-level workers’ jobs have expanded beyond implementing public policy to include the “new job” of recruiting and retaining clients. The article shows how a choice-based environment gives higher priority to clients’ preferences, while at the same time these preferences are subordinated to the economic interest of the providers. It also demonstrates how market pressures may push street-level workers to develop new practices and coping strategies that go beyond, but often also counter to, formal policy. (Edited publisher abstract)
Choice and control for older people using home care services: how far have council-managed personal budgets helped?
- Authors:
- RABIEE Parvaneh, GLENDINNING Caroline
- Journal article citation:
- Quality in Ageing and Older Adults, 15(4), 2014, pp.210-219.
- Publisher:
- Emerald
Purpose: This paper reports the experiences of older people who use council-managed personal budgets (PBs) to fund home care services and their satisfaction with the level of choice and control they are able to exercise. Design/methodology/approach: Data were collected from 18 older people from eight home care agencies across three councils in England. All interviews were semi-structured and face-to-face. Findings: Areas discussed include choice and flexibility over care agency, care workers, tasks, and timing and duration of visits. Despite some optimism about improvements in choice and flexibility experienced by older people using home care services, the findings from this small study suggest that the gap between the 'ideal' of user choice and the 'reality of practice continues to be significant. The level of choice and control older people felt able to exercise to tailor home care services to their personal needs and preferences was restricted to low level choices. Other choices were constrained by the low levels of older people's PBs and council restrictions on what PBs can be spent on. Older people's understanding of limitations in public funding/pressures on agencies and their reluctance to play an active consumer role including willingness to 'exit' from unsatisfactory care arrangements appeared to further challenge the potential for achieving greater choice and control through council-managed PBs. Originality/value: The English government's policy emphasis on personalisation of care and support and new organisational arrangements for managed PBs aim to promote user choice and control. This is the first study to report the experiences of older people using managed PBs under these new arrangements. The paper highlights areas of interests and concerns that social care staff, support planners and commissioners may need to consider. (Edited publisher abstract)
Food provision for older people receiving home care from the perspectives of home-care workers
- Authors:
- WATKINSON-POWELL Anna, et al
- Journal article citation:
- Health and Social Care in the Community, 22(5), 2014, pp.553-560.
- Publisher:
- Wiley
To examine the barriers and facilitators to food provision for older people receiving home care, semi-structured interviews with nine home-care workers employed by independent agencies in a large city in northern England were conducted in June 2013. Data were analysed thematically, based on the principles of grounded theory. Findings showed that significant time pressures limited home-care workers in their ability to socially engage with service users at mealtimes, or provide them with anything other than ready meals. Enabling choice was considered more important than providing a healthy diet, but choice was limited by food availability and reliance on families for shopping. Home-care workers received little nutritional training and were not involved by healthcare professionals in the management of malnutrition. Despite the rhetoric of individual choice and importance of social engagement and nutrition for health and well-being, nutritional care has been significantly compromised by cuts to social care budgets. The potential role for home-care workers in promoting good nutrition in older people is undervalued and undermined by the lack of recognition, training and time dedicated to food-related care. (Edited publisher abstract)
Bringing care home: the Guinness partnership
- Authors:
- SKILLS FOR CARE, HOUSING LEARNING AND IMPROVEMENT NETWORK
- Publisher:
- Skills for Care
- Publication year:
- 2014
- Pagination:
- 6 mins 3 seconds
- Place of publication:
- Leeds
This short film film looks at how adult care and housing services can integrate their work to improve the quality of life for those with care and support needs. This video focuses on Fitzwilliam Court in Hoyland, South Yorkshire where on site domiciliary care enablers support people who live there to lead independent lives, maximising their choice and control. The film was made by Skills for Care and the Housing Learning and Improvement Network. (Edited publisher abstract)
How far do managed personal budgets offer choice and control for older people using home care services?
- Author:
- UNIVERSITY OF YORK. Social Policy Research Unit
- Publisher:
- NIHR School for Social Care Research
- Publication year:
- 2013
- Pagination:
- 4
- Place of publication:
- London
Research commissioned by the School for Social Care Research from the Social Policy Research Unit at the University of York suggests that many older people may be missing out on the benefits of personal budgets (PBs), because they have limited opportunities to shape services to their personal preferences and circumstances. Older people are often unwilling to take on responsibility for managing a cash direct payment and employing their own carers. Therefore, most older people who used to pay for council-commissioned services ( most commonly home care) have their PB managed by the local council. This in-depth study of three English councils (two unitary boroughs and one shire county) with large older populations and large proportions of people using managed PBs found that the main restriction on older people’s choice and control was the level of the PB, which usually covered only essential personal care needs. The study also found that councils were retaining much of the decision-making power: some restricted the tasks that home care agencies could undertake to personal care only; others required any changes to care plans be approved by them. Flexible options for PBs such as time banking or Individual Service Funds were not fully utilised. Time banking, where time is saved from routine visits to use later on for alternative activities, was restricted in both availability and scope. This was due to fears by some home care agencies and older people that a PB would be reduced if the council perceived there was spare capacity that could be banked. Individual Service Funds, where budgets are held by home care agencies and managed in direct negotiation with users, did not appear to be fully operational in the study councils, as budgets were all still held by councils. (Edited publisher abstract)