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Systematic review: effective home support in dementia care, components and impacts - Stage 2, effectiveness of home support interventions
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Journal of Advanced Nursing, 74(3), 2018, pp.507-527.
- Publisher:
- Blackwells Publishing
AIM: The aim of this study was to explicate the outcomes of home support interventions for older people with dementia and/or their carers to inform clinical practice, policy and research. BACKGROUND: Most people with dementia receive support at home. However, components and effectiveness of home support interventions have been little explored. DESIGN: Systematic review with narrative summary. DATA SOURCES: Electronic searches of published studies in English using PubMed, Cochrane Central Register of Controlled Trials, PsychINFO, CINAHL, Applied Social Science Index and CSA Social Services Abstracts. Databases and sources were searched from inception to April 2014 with no date restrictions to locate studies. REVIEW METHODS: The PRISMA statement was followed and established systematic review methods used. Using 14 components of care for people with dementia and their carers, identified previously, data across studies were synthesized. Interventions were grouped and described and effectiveness ratings applied. Qualitative studies were synthesized using key themes. RESULTS: Seventy studies (four qualitative) were included. Most were directed to carers and of high quality. Seven interventions for carers and two for people with dementia were identified, covering 81% of studies. Those relating to daily living, cognitive training and physical activity for people with dementia were absent. Measures of effectiveness were influenced mainly by the intensity (duration and frequency) of interventions. Those containing education, social support and behaviour management appeared most effective. CONCLUSION: These interventions reflect emergent patterns of home support. Research is required to identify effective interventions linked to the stage of dementia, which can be applied as part of routine clinical care. (Edited publisher abstract)
The potential impact of changes in public funding for residential and nursing-home care in the United Kingdom: the Residential Allowance
- Authors:
- CLARKSON Paul, HUGHES Jane, CHALLIS David
- Journal article citation:
- Ageing and Society, 25(2), March 2005, pp.159-180.
- Publisher:
- Cambridge University Press
The pursuit of independence and avoidance of unnecessary care-home admissions are key elements of British government policy for the care of older people. The present government's objective to maintain independence has been compromised by the ‘Residential Allowance’ which, as a component of social security payable to residents in independent-sector homes, could be seen as an incentive to place people in care-homes rather than seek care-at-home. In order to remove this incentive, the government proposed to abolish the allowance and instead transfer resources by a grant to local authorities. This was intended to promote independence by making available funds with which social services departments could support domiciliary care. This paper examines the potential impact of the proposal from the perspective of front line practitioners and managers. Calculations of the proposal's likely effects in five authorities were made from a simulation of their usual decision-making processes. The results, applied to the national picture, showed only a marginal effect of the change upon admissions to care homes. The potential effect of the change in diverting admissions from care homes was seen to be hampered by organisational influences which vary between authorities.
Public funding for residential and nursing home care: projection of the potential impact of proposals to change the residential allowance in services for older people
- Authors:
- CLARKSON Paul, HUGHES Jane, CHALLIS David
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(3), March 2003, pp.211-216.
- Publisher:
- Wiley
This article investigates the potential effects of a policy change in the funding of UK residential care. The White Paper "Modernising Social Services " outlined plans to change the distribution of the Residential Allowance (RA), payable in support of residents in independent residential or nursing home care, from a component of income support paid direct to establishments to a grant to local authorities. This change was intended to remove the incentive in accessing independent residential care more favourably than local authority care. A further objective was to encourage local authorities to use the grant to support home-based alternatives to residential care. The policy rests on a model in which price signals dictate the choice of care for an older person. By, in effect, raising the price of independent residential and nursing home care, the policy provides an incentive for authorities to seek alternatives to institutional care. The study indicated that wider organisational factors other than price are likely to play a greater role in deciding whether an older person is admitted to care. Changes in public funding alone do not reflect the complexities involved in decision-making concerning the residential placement of older people.