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Report of research into domiciliary care services
- Author:
- WOLVERHAMPTON. Social Services Department
- Publisher:
- Wolverhampton. Social Services Department
- Publication year:
- 1987
- Pagination:
- 57p., tables. illus.
- Place of publication:
- Wolverhampton
-
The challenges of commissioning home care for older people in England: commissioners’ perspectives
- Authors:
- DAVIES Karen, et al
- Journal article citation:
- Ageing and Society, 41(8), 2021, pp.1858-1877.
- Publisher:
- Cambridge University Press
Home care for older people in England is commissioned through local authorities working predominantly with independent providers of care. Commissioners operate in a market model, planning and procuring home care services for local populations. Their role involves ‘managing’ and ‘shaping’ the market to ensure an adequate supply of care providers. Another imperative, emerging from the principles of personalisation, is the drive to achieve user outcomes rather than ‘time and task’ objectives. Little formal research has investigated the way commissioners reconcile these different requirements and organise commissioning. This study investigated commissioning approaches using qualitative telephone interviews with ten commissioners from different local authorities in England. The characteristics of commissioning were analysed thematically. Findings indicated (a) commissioning involved complex systems and processes, uniquely shaped for the local context, but frequently changed, suggesting a constant need for reframing commissioning arrangements; (b) partnerships with providers were mainly transactional, with occasional examples of collaborative models, that were considered to facilitate flexible services more appropriate for commissioning for personalised outcomes; and (c) only a small number of commissioners had attempted to reconcile the competing and incompatible goals of tightly prescribed contracting and working collaboratively with providers. A better understanding of flexible contracting arrangements and the hallmarks of a trusting collaboration is required to move beyond the procedural elements of contracting and commissioning. (Edited publisher abstract)
Manoeuvring challenging demands: care managers, the Free Choice System and older users of home care services with reduced decision-making capacity
- Authors:
- DUNER Anna, GUSTAFSSON Gerd
- Journal article citation:
- International Journal of Care and Caring, 4(4), 2020, pp.479-495.
- Publisher:
- Policy Press
The aim of this article is to describe and analyse how care managers experience and manage the Swedish Free Choice System in relation to older users of home care services with reduced decision-making capacity. The empirical data were generated by focus group interviews with care managers working in local eldercare authorities that had implemented the Free Choice System. The findings reveal that care managers used various strategies, and justifications for them, based on various coexisting logics: the market logic; the logic of public administration; and the logic of care. (Edited publisher abstract)
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)
St. Monica Trust: domiciliary care services report
- Author:
- OXFORD BROOKES UNIVERSITY. Institute of Public Care
- Publisher:
- Oxford Brookes University. Institute of Public Care
- Publication year:
- 2011
- Pagination:
- 55p.
- Place of publication:
- Oxford
Demand for domiciliary based services for older people is growing in response to population demand and to policy demands for effective alternatives to residential and hospital based care. In addition, the client-provider relationship is changing, with local authorities and, to some extent, health authorities being removed from the contracting transaction, and more direct choice and control for service users. This report was prepared for St Monica Trust with the aim of: identifying the different forms of domiciliary service which can be provided, from home help to intensive rehabilitative services and end of life care; describing key approaches and business models, and consideration of their cost and business development implications; and identifying examples of existing services. The research comprised an analysis of existing published materials, and telephone conversations with a few existing services to explore the financial costing and employment issues. The report concludes by considering future marketing and business strategies, especially in relation to: local authority and GP consortia; personal budget and individual budget holders; and self-funders.
The inter-relationship between formal and informal care: a study in France and Israel
- Authors:
- LITWIN Howard, ATTIAS-DONFUT Claudine
- Journal article citation:
- Ageing and Society, 29(1), January 2009, pp.71-91.
- Publisher:
- Cambridge University Press
This study examined whether formal care services delivered to frail older people's homes in France and Israel substitute for or complement informal support. The two countries have comparable family welfare systems but many historical, cultural and religious differences. Data for the respondents aged 75 or more years at the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) were analysed. Regressions were examined of three patterns of care from outside the household: informal support only, formal support only and both formal and informal care, with the predictor variables including whether informal help was provided by a family member living in the household. The results revealed that about one-half of the respondents received no help at all (France 51%, Israel 55%), about one-tenth received care from a household member (France 8%, Israel 10%), and one-third were helped by informal carers from outside the household (France 34%, Israel 33%). More French respondents (35%) received formal care services at home than Israelis (27%). Most predictors of the care patterns were similar in the two countries. The analysis showed that complementarity is a common outcome of the co-existence of formal and informal care, and that mixed provision occurs more frequently in situations of greater need. It is also shown that spouse care-givers had less formal home-care supports than either co-resident children or other family care-givers. Even so, spouses, children and other family care-givers all had considerable support from formal home-delivered care.
Potentially inappropriate management of depressive symptoms among Ontario home care clients
- Authors:
- DALBY Dawn M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(6), June 2008, pp.650-659.
- Publisher:
- Wiley
The authors' objective was to examine the prevalence and correlates of potentially inappropriate pharmacotherapy (including potential under-treatment) for depression in adult home care clients by means of a cross-sectional study of clients receiving services from Community Care Access Centres in Ontario, 3,321 of whom were assessed with the Resident Assessment Instrument for Home Care (RAI-HC). A score of 3 or greater on the Depression Rating Scale, a validated scale embedded within the RAI-HC, indicates the presence of symptoms of depression. Medications listed on the RAI-HC were used to categorise treatment into two groups: potentially appropriate and potentially inappropriate antidepressant drug therapy. Adjusted logistic regression models were used to explore relevant predictors of potentially inappropriate pharmacotherapy. The results showed 414 (12.5%) had symptoms of depression and 17% received an appropriate antidepressant. Over half (64.5%) received potentially inappropriate pharmacotherapy (including potential under-treatment). At age 75 or older, higher levels of caregiver stress and the presence of greater comorbidity were associated with a higher risk of potentially inappropriate pharmacotherapy in multivariate analyses. Documentation of any psychiatric diagnosis on the RAI-HC and receiving more medications were significantly associated with a greater likelihood of appropriate drug treatment. It was concluded that most clients with significant depressive symptoms were not receiving appropriate pharmacotherapy. Having a documented diagnosis of a psychiatric condition on the RAI-HC predicted appropriate pharmacotherapy. By increasing recognition of psychiatric conditions, the use of standardised, comprehensive assessment instruments in home care may represent an opportunity to improve mental health care in these settings.
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.
Extra care housing
- Author:
- COUNSEL AND CARE
- Publisher:
- Counsel and Care
- Publication year:
- 2009
- Pagination:
- 27p.
- Place of publication:
- London
Extra care housing is part of the provision of support which is available to more frail older people to enable them to continue living independently for as long as possible. Extra care housing may suit older people who need a high level of personal care, but who are otherwise able to live independently on their own. This factsheet gives information about extra care housing provision, how to access it, and how to fund a place in such a scheme.
Client satisfaction with home care services in rural Russia
- Authors:
- STRUYK Raymond, et al
- Journal article citation:
- Journal of Aging and Social Policy, 18(1), 2006, pp.87-105.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
This study explores the satisfaction of a sample of 300 frail elders living in a rural Russian area with the support services provided by social service agency staff. The client population lives in extremely difficult conditions in terms of housing and associated communal services. They reported very high levels of satisfaction with the agency-provided services, both general satisfaction and their satisfaction with the specific services received during the reference visit inquired about by the interviewer. The degree of satisfaction is likely related to the difficulty of their living environment and their probable poverty, as well as the quality of services received. Attempts to relate the variance in the satisfaction ratings to the extent of activity limitations and the volume of formal and informal care using multivariate analysis met with limited success, owing in part, at least, to the limited variance in the dependent variables. Nevertheless, the patterns identified are broadly consistent with expectations based on modelling previously done for the U.S. populations receiving at-home care. The results clearly indicate the value of providing such services to frail elders in such circumstances.