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Frail old people at the margins of care:some recent research findings
- Authors:
- CHALLIS David, HUGHES Jane
- Journal article citation:
- British Journal of Psychiatry, 180, February 2002, pp.126-130.
- Publisher:
- Cambridge University Press
Community-based care at the margin is a substitute for institutional care. Three factors are considered critical: definitions of eligibility, assessment procedures and balance of care. This research examines determinants of the margin between institutional and home-based care, reviews current practice, identifies the implications and contributes to planning of integrated long-term care services for frail older people. Findings suggest that greater standardisation of approaches to the determination of eligibility for social care and to assessment of need is required. Providing care at home for some of those currently entering care homes is feasible, but will require different service structures and staff roles, including specialist clinicians.
Developing and implementing a local performance measurement system in older people's services
- Authors:
- CLARKSON Paul, CHALLIS David
- Journal article citation:
- Research Policy and Planning, 20(3), 2002, pp.3-16.
- Publisher:
- Social Services Research Group
Summarises work in developing and implementing a local performance measurement system within older people's services, drawing on work undertaken by the Personal Social Services Research Unit (PSSRU). Difficulties in developing such systems include central government demands for data that are not always appropriate to local concerns, technological problems and problems with interpretation. The work attempted to confront these difficulties by outlining a model of the most important domains for monitoring, devising a suite of indicators to comment on organisational objectives and using comparative analysis to formulate questions concerning key areas of variation. The system offers a number of benefits and focused implementation can overcome difficulties and increase co-operation from staff.
Care management, dementia care and specialist mental health services: and evaluation
- Authors:
- CHALLIS David, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 17(4), April 2002, pp.315-325.
- Publisher:
- Wiley
This article evaluates a model of intensive case management for people with dementia based in a community-based mental health service for older people. Individuals in one community team setting received case management and were compared with those in a similar team without such a service. The impact of the scheme upon placement occurred in the second year at the end of which 51% of the experimental group remained at home compared with 33% of the comparison group. For the experimental group significant improvements in the social contacts of older people were noted; a decrease in the stress of their carers was observed, together with a reduction in their input to the care of the client; and there were significant improvements on ratings of overall need reduction, aspects of daily living and level of risk. Differences between the two groups based on service receipt showed higher costs for the experimental group. Discusses the issues which influence the cost-effectiveness of intensive case management. The benefits of locating this service within a specialist mental health team are explored in the context of promoting greater service integration between health and social services.
Policy, organisation and practice of specialist old age psychiatry in England
- Authors:
- CHALLIS David, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 17(11), November 2002, pp.1018-1026.
- Publisher:
- Wiley
The aim of this article is to describe and compare service arrangements in old age psychiatry across England according to three broad domains: levels of professional autonomy; degree of community orientation (delivery of and links with community services) and degree of integration between health and social care provision. The findings indicate that there is marked variation in the deployment and use of professional staff in old age psychiatry, ranging from open access to multidisciplinary assessment to services only accessible by clinician referral. Patterns of linkage with primary care are likewise variable with only half of services providing the types of support recommended by the Audit Commission. Community orientation was evident to a considerable extent in support to care homes and assessment practices. Links between health and social care appeared strongest in terms of liaison and training. There was less evidence of more formal integration through shared management of staff or for links with intensive home support for those with dementia.