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Consequences of prioritisation within long-term care in Denmark, England and Norway: towards increasing inequalities and poorer quality of care?
- Authors:
- ERVIK Rune, LINDEN Tord Skogedal
- Journal article citation:
- International Journal of Care and Caring, 5(2), 2021, pp.209-227.
- Publisher:
- Policy Press
Prioritisation concerns choosing something before something else, and in a welfare state context, this is about decisions on distribution, redistribution and rationing. This article investigates consequences of prioritisation within long-term care in Denmark, England and Norway. Analysing interviews with policy actors and policy documents, we find that prioritising home care, combined with increasing targeting of help and restricting institutionalised care towards those with the most severe needs, may reduce both service quality and equality for those not being prioritised. Moreover, monitoring and central control of service provision restrict individual discretion of care workers, with implications for service quality. (Edited publisher abstract)
The impact of direct payments on service users requiring care and support at home
- Authors:
- McGUIGAN Karen, et al
- Journal article citation:
- Practice: Social Work in Action, 28(1), 2016, pp.37-54.
- Publisher:
- Taylor and Francis
Background: Direct Payments (DP) is a service user-implemented scheme in which the individuals assessed as needing personal, social or health-related care services are given cash payments, allowing them to ‘buy in’ services they require. Previous research indicates DP offer the user greater control and flexibility over their care. However, the literature highlights problems with the system including user responsibilities, carer recruitment, provision of information and support. Aim: To examine the impact of DP on service users in a large Health and Social Care Trust, in Northern Ireland. Method: Thirty DP users from the Trust area were recruited to the study. The sample consisted of 2 respondents who were in direct receipt of DP, and 28 informal carers who implemented the budget on behalf of an eligible DP service user. Each respondent completed an interview with the study researcher, following an interview schedule devised by the research team. Results: Findings show service users are generally satisfied with most aspects of the scheme; however, difficulties still exist around provision of information, support, user responsibilities and public awareness. Conclusion: The research has led to recommendations that may allow the scheme to function more effectively, whilst ensuring user benefits remain largely unchanged. (Publisher abstract)
Homecare cost of care toolkit
- Author:
- LOCAL GOVERNMENT ASSOCIATION
- Publisher:
- Local Government Association
- Publication year:
- 2022
- Place of publication:
- London
- Edition:
- 4th ed.
This Excel-based toolkit will help councils and partners obtain a shared understanding of the costs of providing home care. The toolkit is open access and so can be freely used by all councils and providers. The intended purpose of the toolkit is to support improvements in the level and quality of information about the costs of delivering home-based care and support. Part A of the toolkit, the Standard (Cost+) Worksheet, utilises a traditional unit costing approach and will help users understand the individual operating costs and variances that make up the cost of homecare, whilst adding additional flexibility and costs that may not usually be considered. The toolkit includes, as far as practical, all expected cost lines that homecare providers incur in delivering services. While additional cost lines may exist within individual homecare providers, feedback from extensive engagement with stakeholders, including care providers, has arrived at those that are included in the toolkit. This part of the toolkit also includes additional blank lines to allow the user to add cost lines that are not already included but should be factored into any cost of care exercise. Part B of the toolkit, the Sensitivity Analysis Worksheet, can be used to generate 'what if' scenarios to see, at-a-glance, the impact of changing costs, volumes and price points on the profitability of the provider / branch / market as a whole. Part C, the Data Output Worksheet, will automatically be populated with key information from Part A and can be amended and copied and pasted elsewhere to allow for further analysis. (Edited publisher abstract)
Under reconstruction: the impact of COVID-19 policies on the lives and support networks of older people living alone
- Authors:
- PFABIGAN Johanna, et al
- Journal article citation:
- International Journal of Care and Caring, 6(1-2), 2022, pp.211-228.
- Publisher:
- Policy Press
In the spring of 2020, the Austrian government introduced COVID-19 containment policies that had various impacts on older people living alone and their care arrangements. Seven qualitative telephone interviews with older people living alone were conducted to explore how they were affected by these policies. The findings show that the management of everyday life and support was challenging for older people living alone, even though they did not perceive the pandemic as a threat. To better address the needs of older people living alone, it would be important to actively negotiate single measures in the area of conflict between protection, safety and assurance of autonomy. (Edited publisher abstract)
Staff vacancies in care services 2020
- Authors:
- SCOTTISH SOCIAL SERVICES COUNCIL, CARE INSPECTORATE
- Publisher:
- Scottish Social Services Council
- Publication year:
- 2021
- Pagination:
- 66
- Place of publication:
- Dundee
This report brings together data on the number of registered care services in Scotland with a vacancy and data on whole time equivalent vacancies reported by services. The data on the number of registered care services with a vacancy lets us see the proportion of services in local authority areas and service types impacted by them. At 31 December 2020, there were just over 12,200 registered services providing care and support for children, young people, adults and older people across Scotland – 36% of services reported having vacancies. The percentage of care services reporting vacancies fell by 3 percentage points over the last year, and by 2 percentage points since Dec 2017. The rate of WTE vacancies for all services was 5.1%, down from 6.2% in 2019. This was higher than the overall vacancy rate across all establishments in Scotland of 1.9% reported in the Scottish Government’s Employer skills Survey 2020. At 31 December 2020, 43% of services with vacancies reported having problems filling them; down 6 percentage points from the previous year. This varied by type of service and geographical area: care at home services (63%), care homes for older people (54%), housing support services (52%) and nurse agency services (57%) were all significantly above the national average for all care services. (Edited publisher abstract)
Changes in commissioning home care: an English survey
- Authors:
- DAVIES Sue, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 21(1), 2020, pp.3-14.
- Publisher:
- Emerald
The purpose of this study is to examine changes in the nature, form and range of commissioning arrangements for home care.Design/methodology/approach: Data from two discrete national surveys of English local authorities with social service responsibilities were used. In the first, undertaken in 2007, responses from 111 of the 151 local authorities (74%) were received; in the second, undertaken in 2017, responses from 109 local authorities (72%) were received. A combined data set of 79 complete cases, 52% of local authorities, was created. Percentage point differences across the two time periods were calculated and tested to identify significant changes and a systematic analysis of the free-text responses regarding intended changes to the commissioning process in each data set was undertaken.Findings: Findings identified substantial changes in some aspects of the commissioning of home care in the 2007-2017 decade. Collaboration between stakeholders had increased, particularly regarding the identification of future needs. Improved conditions of service and remuneration for home care workers were evident within the commissioning process. Standardised charges for home care (regardless of time and day) had also become more widespread. Initiatives to prompt providers to deliver more personalised care were more evident. Originality/value: This paper describes the evolution of commissioning arrangements for home care in localities in response to national policy initiatives. It provides guidance to commissioners in meeting the needs of current service users and emphasises the importance of collaboration with stakeholders, particularly providers, in securing future capacity. (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)
House calls: the impact of home-based care for older adults with Alzheimer’s and dementia
- Authors:
- WILSON Kasey, BACHMAN Sara S.
- Journal article citation:
- Social Work in Health Care, 54(6), 2015, pp.547-558.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Older adults with Alzheimer’s/dementia have high health care costs; they may benefit from home-based care, but few have home visits. This article describes a home-based care programme for frail elders, including those with Alzheimer’s/dementia. Descriptive statistics are provided for Medicare-enrolled programme participants and matched controls with Alzheimer’s/dementia on expenditures along six services: skilled nursing facility, inpatient acute, physician, home health, hospice, and social services. Cases with dementia were significantly more likely to have home health and hospice expenditures than controls, suggesting potential for the program to improve end-of-life care. Very few cases or controls had any social service expenditures. Social workers should advocate for the expanded role of home-based care for older adults with dementia and for increased Medicare reimbursement of social work services. (Edited publisher abstract)
The bigger picture: policy insights and recommendations
- Author:
- LLOYD James
- Publishers:
- Independent Age, Strategic Society Centre
- Publication year:
- 2014
- Pagination:
- 50
- Place of publication:
- London
This report evaluates the performance of government policy on care and support of older people who struggle with day-to-day activities in England during the period 2011 to 2013, using the data and insights from ‘The bigger picture: understanding disability and care in England’s older population’. Part 1 of this report examines the reach of publicly funded support; the unmet need in the older population; and variation and consistency of care and support. Part 2 considers the implications of the Care Act implementation and looks at policy development beyond 2016, focusing on eligible needs after the Act, financial eligibility and the means test after 2016 and mapping, identifying and engaging older population groups. The report concludes that given the feasibility and budget challenges implied by the sheer numbers of older people experiencing difficulties with activities of daily living, a rethink and revolution is required among national and local policymakers around how individuals and families are engaged and supported. This will mean revisiting the balance between consistency and variation in services organised by local authorities, as well as fully integrating and exploiting the different ‘touch points’ and ‘gateways’ available for engaging the older population. It will also mean evaluating which aspects of the vision of the Care Act need to be fulfilled by local authorities directly, or can be devolved to empowered, third-party charities and organisations at a local level. (Edited publisher abstract)
The effect of telecare on the quality of life and psychological well-being of elderly recipients of social care over a 12-month period: the Whole Systems Demonstrator cluster randomised trial
- Authors:
- HIRANI Shashivadan Parbati, et al
- Journal article citation:
- Age and Ageing, 43(3), 2014, pp.334-341.
- Publisher:
- Oxford University Press
Background: Home-based telecare (TC) is utilised to manage risks of independent living and provide prompt emergency responses. This study examined the effect of TC on health-related quality of life (HRQoL), anxiety and depressive symptoms over 12 months in patients receiving social care. Design: A study of participant-reported outcomes [the Whole Systems Demonstrator (WSD) Telecare Questionnaire Study; baseline n = 1,189] was nested in a pragmatic cluster-randomised trial of TC (the WSD Telecare trial), held across three English Local Authorities. General practice (GP) was the unit of randomisation and TC was compared with usual care (UC). Methods: Participant-reported outcome measures were collected at baseline, short-term (4 months) and long-term (12 months) follow-up, assessing generic HRQoL, anxiety and depressive symptoms. Primary intention-to-treat analyses tested treatment effectiveness and were conducted using multilevel models to control for GP clustering and covariates for participants who completed questionnaire measures at baseline assessment plus at least one other assessment (n = 873). Results: Analyses found significant differences between TC and UC on Short Form-12 mental component scores (P < 0.05), with parameter estimates indicating being a member of the TC trial-arm increases mental component scores (UC-adjusted mean = 40.52; TC-adjusted mean = 43.69). Additional significant analyses revealed, time effects on EQ5D (decreasing over time) and depressive symptoms (increasing over time). Conclusions: TC potentially contributes to the amelioration in the decline in users’ mental HRQoL over a 12-month period. TC may not transform the lives of its users, but it may afford small relative benefits on some psychological and HRQOL outcomes relative to users who only receive UC. (Publisher abstract)