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Does sense of coherence affect the relationship between self-rated health and health status in a sample of community-dwelling frail elderly people?
- Authors:
- SAEVAREID H. I., et al
- Journal article citation:
- Aging and Mental Health, 11(6), November 2007, pp.658-667.
- Publisher:
- Taylor and Francis
The objective of this Norwegian study was to examine the association between self-rated health (SRH) and physical, functional, social and mental health measures in community dwelling elderly people needing nursing care. Of special interest was how coping resources (SOC) influenced this relationship. Self-rated health is a good predictor of future health status as measured by mortality and morbidity, decline of functional abilities, use of healthcare, and nursing home placement. The high mean age and the relatively high level of care-dependency in this sample, make this investigation important. A hierarchical regression analysis was applied in a cross sectional sample of 242 elderly (mean age 84.6 years). Results found subjective health complaints (SHC) in both sexes, and psychological distress (only in men), was associated directly with SRH. Coping resources associated with SRH directly, and indirectly through subjective perceived health (SHC and GHQ) but only in men. The influence of registered illness was mediated through the effects of subjectively perceived health in both women and men. Sex differences moderated the effects of SOC on SRH. Subjectively perceived health was more important in the perception of SRH than objective health measures. Men, in contrast to women, tend to convert physical illness into emotional distress.
Home care: using direct payments
- Author:
- COUNSEL AND CARE
- Publisher:
- Counsel and Care
- Publication year:
- 2007
- Pagination:
- 41p.
- Place of publication:
- London
User-friendly factsheet intended for enquirers, and directly relevant to older people, their families and carers. This item deals with using direct payments.
Prospects and pitfalls: use of the RAI-HC assessment by the Department of Veterans Affairs for home care clients
- Authors:
- HAWES Catherine, et al
- Journal article citation:
- Gerontologist, 47(3), June 2007, pp.378-387.
- Publisher:
- Oxford University Press
The U.S. Department of Veterans Affairs has adopted two functional assessment systems that guide care planning: one for nursing home residents (the Resident Assessment Instrument [RAI]) and a compatible one for home care clients (RAI-HC). The purpose of this article is to describe the RAI-HC (often referred to as the Minimum Data Set–Home Care or MDS-HC) and its uses and offer lessons learned from implementation experiences in other settings. The study reviewed implementation challenges associated both with the RAI and the RAI-HC in the United States, Canada, and other adopter countries, and drew on these to suggest lessons for the Department of Veterans Affairs as well as other entities implementing the RAI-HC. Beyond its clinical utility, there are a number of evidence-based uses for the assessment system. The resident-level data can be aggregated and analyzed, and scales identify clinical conditions and risk for various types of negative outcomes. In addition, the data can be used for other programmatic and research purposes, such as determining eligibility, setting payment rates for contract care, and evaluating clinical interventions. At the same time, there are a number of implementation challenges the Department of Veterans Affairs and other organizations may face. Policy makers and program managers in any setting, including state long-term-care programs, who wish to implement an assessment system must anticipate and address a variety of implementation problems with a clear and consistent message from key leadership, adequate training and clinical support for assessors, and appropriate planning and resources for data systems.
Using survey data to measure changes in the quality of home care: analysis of the older people's user experience survey 2006
- Authors:
- MALLEY Juliette, NETTEN Ann, JONES Karen
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2007
- Pagination:
- 110p., bibliog.
- Place of publication:
- Canterbury
The development of the User experience Survey (UES) and the inclusion of the user’s perspective in the Performance Assessment Framework (PAF) were novel and important steps forward in the world of performance assessment and monitoring of social services. Commentators had previously criticised the lack of connectedness between the performance/quality and user involvement agendas and these developments represented real steps forward in meeting this goal. Analysis from the 2003 extension to the UES for older people has demonstrated that user experience measures can usefully discriminate between Local Authorities (LAs). While his new research raises some important questions, this type of approach is clearly an improvement on performance measurement based on processes and inputs. Fifty authorities took part with representation from all Government Office Regions and LA types. Analysis of responses to the compulsory questions and comparison with responses to these questions nationally revealed very similar proportions responding to each category. We can assume from these findings that the sample of authorities is broadly representative of the views of service users across England.
Constructions of frailty in the English language, care practice and the lived experience
- Author:
- GRENIER Amanda
- Journal article citation:
- Ageing and Society, 27(3), May 2007, pp.425-445.
- Publisher:
- Cambridge University Press
The way frailty is conceptualised and interpreted has profound implications for social responses, care practice and the personal experience of care. This paper begins with an exegesis of the concept of frailty, and then examines the dominant notions of frailty, including how ‘frailty’ operates as a ‘dividing-practice’ through the classification of those eligible for care. The definitions and uses of ‘frailty’ in three discursive locations are explored in: (a) the Oxford English Dictionary, (b) the international research literature, and (c) older women's accounts of their lived experience. Three distinctive discourses are found, and applying a Foucauldian analysis, it is shown that the differences reflect overlaps and tensions between biomedical concepts and lived experiences, as well as negative underlying assumptions and ‘subjugated knowledge’. The concept of frailty represents and orders the context, organisational practices, social representations and lived experiences of care for older people. The evidence suggests that if, as the older women's accounts recommended, socially- and emotionally-located expressions of frailty were recognised in addition to the existing conceptions of risk of the body, frailty might no longer be thought of primarily as a negative experience of rupture and decline. To encourage this change, it is suggested that practice focuses on the prevention of frailty and associated feelings of loss, rather than reinforcing the feelings and experiences which render a person ‘frail’.
A recipe for care: not a single ingredient: clinical case for change
- Author:
- PHILP Ian
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2007
- Pagination:
- 8p.
- Place of publication:
- London
The reconfiguring specialist services to bring care closer to home will make a big difference to the lives of older people and their families, according to Professor Ian Philp, National Director for Older People.
Modelling an entitlement to long-term care services for older people in Europe: projections for long-term care expenditure to 2050
- Authors:
- PICKARD Linda, et al
- Journal article citation:
- Journal of European Social Policy, 17(1), February 2007, pp.33-48.
- Publisher:
- Sage
As the numbers of older people rise in Europe, the importance of long-term care services in terms of numbers of users and expenditures can be expected to grow. This article examines the implications for expenditure in four countries of a national entitlement to long-tem care services for all older people, based on assessed dependency. It is based on a European Commission-funded cross-national study, which makes projections to 2050 of long-term care expenditure in Germany, Italy, Spain and the UK. The policy option investigated is based on the German long-term care insurance scheme, which embodies the principle of an entitlement on uniform national criteria to long-term care benefits. The research models this key principle of the German system in the other three participating countries, with respect to home care services. The study finds that, if all moderately/severely dependent older people receive an entitlement to formal (in-kind) home care, the impact on expenditure could be considerable, but would vary greatly between countries. The impact on long-term care expenditure is found to be the least in Germany, where there is already an entitlement to benefits; and the greatest in Spain, where reliance on informal care is widespread. This article discusses the policy implications of these results.
Care at home for people with dementia: as in a total institution?
- Authors:
- ASKHAM Janet, et al
- Journal article citation:
- Ageing and Society, 27(1), January 2007, pp.3-24.
- Publisher:
- Cambridge University Press
This article examines three kinds of social relationship likely to be present when people with dementia are cared for at home by relatives or friends: custodial care, an intimate relationship, and home-life. Using Goffman's three defining aspects of custodial care – routinisation, surveillance and mortification of the self – the paper examines whether these characterised the care of people with dementia at home and, if so, whether they conflicted with the intimate relationship and with home-life. The study involved sustained observations and interviews with 20 people with dementia and their carers in and around London, and qualitative analysis of the data. It was found that all three aspects of custodial care were present although not fully realised, and that they led to difficulties, many of which were associated with the concurrent pursuit of an intimate relationship and home-life. In all cases, daily life was routinised partly to help accomplish care tasks but was found monotonous, while surveillance was usual but restrictive, and prevented both the carers and those with dementia from doing things that they wished to do. Those with dementia were distressed by the denial of their former identities, such as car-driver or home-maker, and by being treated like children. Both the carers and the people with dementia had various ways of balancing custodial care, their intimate relationships and home-life, such as combining routines with other activities, evading surveillance or carrying it out by indirect means, and there were many attempts to maintain some semblance of former identities.
Home care for ageing populations: a comparative analysis of domiciliary care in Denmark, the United States and Germany
- Authors:
- DOYLE Martha, TIMONEN Virpi
- Publisher:
- Edward Elgar
- Publication year:
- 2007
- Pagination:
- 154p., bibliog.
- Place of publication:
- Cheltenham
At a time when the desire to “age in place” has emerged as a rallying cry among elderly and disabled adults and their advocates, this book provides an important new analysis of the ways in which three countries are facing the challenge of assuring the adequacy and quality of in-home care. Drawing on both primary and secondary sources, the book examines the ways in which home care is organized, financed, and delivered in Denmark, Germany, and the United States, countries that represent three different types of long-term care systems.
Anticipating future needs
- Author:
- OXFORD BROOKES UNIVERSITY. Institute of Public Care
- Publisher:
- Care Services Improvement Partnership. Care Services Efficiency Delivery Programme
- Publication year:
- 2007
- Pagination:
- 42p.
- Place of publication:
- London
Increasing the current service provision in line with the projected population growth is unaffordable and early evidence from the Anticipating Future Needs studies shows that it would not meet the changing expectations of older people. Configuring Future Services explores service configuration options to support people's preferred lifestyle, in their own homes, as long as possible. These exist at the health and social care interface and represent opportunities to build on Joint Strategic Needs Assessment with specific, practical joint projects. This paper provides the evidence for service reconfiguration for 7 conditions based on the current literature and an implementation planning approach. A second paper, in December 2007, will discuss lessons learnt from work with two pilot authorities and make recommendations for wider implementation including the building of a knowledge base for local authorities to access.