Journal of Long-Term Care, November 2019, pp.176-193. Online only
Publisher:
King's College London
Place of publication:
London
Context: In the UK, local authorities (England, Wales and Scotland) and Health and Social Care Trusts (Northern Ireland) commission support services from home care providers to enable people over the age of 65 them to continue to live at home. However, little is known about these arrangements. Objectives: To address this knowledge gap through identifying the lessons from research for commissioners of home care for older people. Method: A scoping review was undertaken to extrapolate the lessons from research for future practice. Searches were conducted in 2016/17 and the analysis was completed 2017/18. Electronic and manual searches of UK literature were undertaken using distinct terms to investigate the people, organisations and processes intrinsic to commissioning home care for older people. Findings: From a total of 1,819 papers and government reports, 22 met the inclusion criteria, indicative of a limited body of knowledge. A variety of research methods and designs were included with mixed methods most frequently used. Four lessons were identified relating to: the marketisation of home care; the future of care at home; promoting integration with local partners in commissioning home care; and areas for future research. Limitations: The focus on research evidence may have meant that potentially interesting insights to inform future commissioning strategies from conceptual articles were omitted from the review. Implications: Understanding the complexities of market management in commissioning home care for older people is still at an early stage of development. This review provides evidence to inform its future development of value to policy makers and practitioners.
(Edited publisher abstract)
Context: In the UK, local authorities (England, Wales and Scotland) and Health and Social Care Trusts (Northern Ireland) commission support services from home care providers to enable people over the age of 65 them to continue to live at home. However, little is known about these arrangements. Objectives: To address this knowledge gap through identifying the lessons from research for commissioners of home care for older people. Method: A scoping review was undertaken to extrapolate the lessons from research for future practice. Searches were conducted in 2016/17 and the analysis was completed 2017/18. Electronic and manual searches of UK literature were undertaken using distinct terms to investigate the people, organisations and processes intrinsic to commissioning home care for older people. Findings: From a total of 1,819 papers and government reports, 22 met the inclusion criteria, indicative of a limited body of knowledge. A variety of research methods and designs were included with mixed methods most frequently used. Four lessons were identified relating to: the marketisation of home care; the future of care at home; promoting integration with local partners in commissioning home care; and areas for future research. Limitations: The focus on research evidence may have meant that potentially interesting insights to inform future commissioning strategies from conceptual articles were omitted from the review. Implications: Understanding the complexities of market management in commissioning home care for older people is still at an early stage of development. This review provides evidence to inform its future development of value to policy makers and practitioners.
(Edited publisher abstract)
Subject terms:
home care, older people, commissioning, literature reviews, local authorities;
Journal of Social Work in Long-Term Care, 3(3/4), 2005, pp.103-120.
Publisher:
Taylor and Francis
Place of publication:
London
This American study reviews the conceptualization and measurement issues related to unmet service needs of older adults receiving home and community-based services. The authors summarize and synthesize the recent literature on unmet service needs to examine (1) how this concept is conceptualized and measured and (2) how this concept could be used to advance the provision of home and community-based services. The findings suggest that measures of unmet needs varied in terms of their focus (e.g., function-specific or service-specific) and sources of information (e.g., care receivers, caregivers, or professions). The findings underscore the need to further refine the conceptualization and measurement of unmet service needs and to assure the proper use of existing measures by social service providers. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
This American study reviews the conceptualization and measurement issues related to unmet service needs of older adults receiving home and community-based services. The authors summarize and synthesize the recent literature on unmet service needs to examine (1) how this concept is conceptualized and measured and (2) how this concept could be used to advance the provision of home and community-based services. The findings suggest that measures of unmet needs varied in terms of their focus (e.g., function-specific or service-specific) and sources of information (e.g., care receivers, caregivers, or professions). The findings underscore the need to further refine the conceptualization and measurement of unmet service needs and to assure the proper use of existing measures by social service providers. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Subject terms:
home care, literature reviews, older people, unmet need, assessment;
European Journal of Social Work, 22(6), 2019, pp.974-986.
Publisher:
Taylor and Francis
Professional caregivers are expected to facilitate user participation for people with dementia. At the same time, an increasing number of elderly people with dementia are now being cared for at their homes. Research is scarce on user participation for people with dementia, especially for people with dementia who live at home. This article aims to systematically and critically review the factors affecting user participation for elderly people with dementia living at home from the viewpoint of the patients, family caregivers, professional caregivers and researchers. A systematic literature search and critical interpretive synthesis were conducted. The search yielded 1,957 articles. In total, 112 full-text articles were retrieved, of which 27 met the inclusion criteria. Five broad analytical themes were identified during the analysis: individual characteristics, professional caregiver characteristics, decision characteristics, relational characteristics and organisational characteristics. The results show that the value placed on user participation can differ between family caregivers and professional caregivers. People with dementia still experience stigmatisation, preventing user participation, and relations with both family and professional caregivers play a key role in enabling user participation for people with dementia.
(Edited publisher abstract)
Professional caregivers are expected to facilitate user participation for people with dementia. At the same time, an increasing number of elderly people with dementia are now being cared for at their homes. Research is scarce on user participation for people with dementia, especially for people with dementia who live at home. This article aims to systematically and critically review the factors affecting user participation for elderly people with dementia living at home from the viewpoint of the patients, family caregivers, professional caregivers and researchers. A systematic literature search and critical interpretive synthesis were conducted. The search yielded 1,957 articles. In total, 112 full-text articles were retrieved, of which 27 met the inclusion criteria. Five broad analytical themes were identified during the analysis: individual characteristics, professional caregiver characteristics, decision characteristics, relational characteristics and organisational characteristics. The results show that the value placed on user participation can differ between family caregivers and professional caregivers. People with dementia still experience stigmatisation, preventing user participation, and relations with both family and professional caregivers play a key role in enabling user participation for people with dementia.
(Edited publisher abstract)
Subject terms:
dementia, literature reviews, home care, independent living, user participation, older people, decision making;
Background: The increasing number of people with dementia means more demand for both informal and formal sources of care. Developing interventions such as case management, which enhances the co-ordination between different agencies involved in community care, might offer the support necessary to cover some of the needs of people with dementia and their carers. Case management has been tested in people with dementia and in carers in a number of countries and healthcare systems, but it is not clear whether current evidence supports its effectiveness. Study characteristics: 13 randomised controlled trials (RCTs) were identified, including 9615 participants with dementia worldwide. Eleven RCTs also included carers. Studies were conducted in different countries, varied in size and healthcare systems and compared various types of case management interventions with usual care or augmented usual care. Key findings: Some studies examined the benefit of case management in reducing admissions to residential or nursing homes (institutionalisation). The review found benefits at six months and 18 months but not at 12 and 24 months. However, when only studies which were clearly focused upon delaying institutionalisation or prolonging the period of community care were included we found a reduction in institutionalisation at 12 months. Some studies examined the benefits of case management in terms of reduced hospital length of stay, and there was evidence to suggest that it might increase at six months. Some studies indicated that case management was more effective at reducing behaviour disturbance at 18 months, reducing carer burden and depression and improving carer well-being at six months and social support at 12 months. Case management increases the use of community services but there was some indication that overall healthcare costs may be reduced in the first year. Some studies reported that case management was no more effective than usual care in improving patient depression, functional abilities or cognition. There was not enough evidence to clearly assess whether case management could reduce the length of time until people with dementia were admitted to care homes.
(Edited publisher abstract)
Background: The increasing number of people with dementia means more demand for both informal and formal sources of care. Developing interventions such as case management, which enhances the co-ordination between different agencies involved in community care, might offer the support necessary to cover some of the needs of people with dementia and their carers. Case management has been tested in people with dementia and in carers in a number of countries and healthcare systems, but it is not clear whether current evidence supports its effectiveness. Study characteristics: 13 randomised controlled trials (RCTs) were identified, including 9615 participants with dementia worldwide. Eleven RCTs also included carers. Studies were conducted in different countries, varied in size and healthcare systems and compared various types of case management interventions with usual care or augmented usual care. Key findings: Some studies examined the benefit of case management in reducing admissions to residential or nursing homes (institutionalisation). The review found benefits at six months and 18 months but not at 12 and 24 months. However, when only studies which were clearly focused upon delaying institutionalisation or prolonging the period of community care were included we found a reduction in institutionalisation at 12 months. Some studies examined the benefits of case management in terms of reduced hospital length of stay, and there was evidence to suggest that it might increase at six months. Some studies indicated that case management was more effective at reducing behaviour disturbance at 18 months, reducing carer burden and depression and improving carer well-being at six months and social support at 12 months. Case management increases the use of community services but there was some indication that overall healthcare costs may be reduced in the first year. Some studies reported that case management was no more effective than usual care in improving patient depression, functional abilities or cognition. There was not enough evidence to clearly assess whether case management could reduce the length of time until people with dementia were admitted to care homes.
(Edited publisher abstract)
Subject terms:
case management, literature reviews, home care, dementia, older people, care planning;
UK studies consistently demonstrated that it is the combination of independence and security that residents value. However, residents and providers do not always seem to have a shared understanding of what constitutes ‘independence’. Housing with care offers opportunities for social interaction and companionship, and there is much evidence of mutual support and neighbourliness. However, people who are very frail or who have sensory and cognitive impairments are consistently reported to be on the margins of social groups and networks. In some circumstances housing with care can provide an alternative to residential care, but the evidence suggests that it is not always a substitute for these settings. Residents moved to residential or nursing home care for a number of reasons, including increasing care needs and their own or their relatives’ preferences for something different, or perhaps something more. Evidence suggests that housing with care can have a positive impact on the health and well-being of residents, and that it is beneficial to their quality of life. However, studies relied heavily on expressions of resident satisfaction/contentment in arriving at their assessments; more robust quality of life measures were lacking in the evidence base. The evidence on the cost-effectiveness of housing with care is particularly limited and sometimes contradictory. Such as there is seems to indicate that housing with care may be more expensive than residential care, but may be cheaper than care delivered into ‘ordinary’ housing settings
UK studies consistently demonstrated that it is the combination of independence and security that residents value. However, residents and providers do not always seem to have a shared understanding of what constitutes ‘independence’. Housing with care offers opportunities for social interaction and companionship, and there is much evidence of mutual support and neighbourliness. However, people who are very frail or who have sensory and cognitive impairments are consistently reported to be on the margins of social groups and networks. In some circumstances housing with care can provide an alternative to residential care, but the evidence suggests that it is not always a substitute for these settings. Residents moved to residential or nursing home care for a number of reasons, including increasing care needs and their own or their relatives’ preferences for something different, or perhaps something more. Evidence suggests that housing with care can have a positive impact on the health and well-being of residents, and that it is beneficial to their quality of life. However, studies relied heavily on expressions of resident satisfaction/contentment in arriving at their assessments; more robust quality of life measures were lacking in the evidence base. The evidence on the cost-effectiveness of housing with care is particularly limited and sometimes contradictory. Such as there is seems to indicate that housing with care may be more expensive than residential care, but may be cheaper than care delivered into ‘ordinary’ housing settings
Extended abstract:
Author
CROUCHER Karen; HICKS Leslie; JACKSON Karen;
Title
Housing with care for later life: a literature review.
Publisher
Joseph Rowntree Foundation, 2006
Summary
This report presents a comprehensive overview of the most recent evidence related to new and emerging models of housing with care for later life.
Context
An introduction gives the a ims of the review , methods, an overview of retrieved studies and the structure of the review. Definitions, models and typologies discusses d efinitions in the UK , asking What's in a name?; housing with care in the UK : variations on a theme, and models outside the UK . D ominant themes from the wider literature include m oving to live in retirement communities, social integration, use of care services and facilities, and assisted living facilities. What do we know? Evaluations of UK models of
housing with care discusses t he evidence base, promoting independence?, health, well-being and quality of life, social integration, home for life?, alternative to residential care?, cost-effectiveness and affordability. Reflecting on the evidence: meeting expectations? covers messages for providers from t he UK evidence base for providers and the evidence base from outside the UK : messages; retirement communities as a positive choice for later life; and current and future research in the UK . Appendices give search strategies, databases searched, a list of contacts and websites searched.
Contents
UK studies consistently demonstrated that it is the combination of independence and security that residents value. However, residents and providers do not always seem to have a shared understanding of what constitutes 'independence'. Housing with care offers opportunities for social interaction and companionship, and there is much evidence of mutual support and neighbourliness. However, people who are very frail or who have sensory and cognitive impairments are consistently reported to be on the margins of social groups and networks. In some circumstances housing with care can provide an alternative to residential care, but the evidence suggests that it is not always a substitute for these settings. Residents moved to residential or nursing home care for a number of reasons, including increasing care needs and their own or their relatives' preferences for something different, or perhaps something more. Evidence suggests that housing with care can have a positive impact on the health and well-being of residents, and that it is beneficial to their quality of life. However, studies relied heavily on expressions of resident satisfaction/contentment in arriving at their assessments; more robust quality of life measures were lacking in the evidence base. The evidence on the cost-effectiveness of housing with care is particularly limited and sometimes contradictory. Such as there is seems to indicate that housing with care may be more expensive than residential care, but may be cheaper than care delivered into 'ordinary' housing settings.
154 references
ISBN 1 85935 433 5
Subject terms:
home care, independent living, housing, literature reviews, older people, cost effectiveness;
UK studies consistently demonstrated that it is the combination of independence and security that residents value. However, residents and providers do not always seem to have a shared understanding of what constitutes ‘independence’. Housing with care offers opportunities for social interaction and companionship, and there is much evidence of mutual support and neighbourliness. However, people who are very frail or who have sensory and cognitive impairments are consistently reported to be on the margins of social groups and networks. In some circumstances housing with care can provide an alternative to residential care, but the evidence suggests that it is not always a substitute for these settings. Residents moved to residential or nursing home care for a number of reasons, including increasing care needs and their own or their relatives’ preferences for something different, or perhaps something more. Evidence suggests that housing with care can have a positive impact on the health and well-being of residents, and that it is beneficial to their quality of life. However, studies relied heavily on expressions of resident satisfaction/contentment in arriving at their assessments; more robust quality of life measures were lacking in the evidence base. The evidence on the cost-effectiveness of housing with care is particularly limited and sometimes contradictory. Such as there is seems to indicate that housing with care may be more expensive than residential care, but may be cheaper than care delivered into ‘ordinary’ housing settings.
UK studies consistently demonstrated that it is the combination of independence and security that residents value. However, residents and providers do not always seem to have a shared understanding of what constitutes ‘independence’. Housing with care offers opportunities for social interaction and companionship, and there is much evidence of mutual support and neighbourliness. However, people who are very frail or who have sensory and cognitive impairments are consistently reported to be on the margins of social groups and networks. In some circumstances housing with care can provide an alternative to residential care, but the evidence suggests that it is not always a substitute for these settings. Residents moved to residential or nursing home care for a number of reasons, including increasing care needs and their own or their relatives’ preferences for something different, or perhaps something more. Evidence suggests that housing with care can have a positive impact on the health and well-being of residents, and that it is beneficial to their quality of life. However, studies relied heavily on expressions of resident satisfaction/contentment in arriving at their assessments; more robust quality of life measures were lacking in the evidence base. The evidence on the cost-effectiveness of housing with care is particularly limited and sometimes contradictory. Such as there is seems to indicate that housing with care may be more expensive than residential care, but may be cheaper than care delivered into ‘ordinary’ housing settings.
Subject terms:
home care, independent living, housing, literature reviews, older people, cost effectiveness;
Health and Social Work, 29(3), August 2004, pp.219-244.
Publisher:
Oxford University Press
Presents a literature review to identify the variables associated with home health care utilisation using the Andersen-Newman model as a framework for analysis. Sixty-four studies published 1985-2000 were identified through PUBMED, Sociofile and PsycINFO databases. Home health care was defined as in-home skilled nursing, homemaker, mobile meals, home health aid, physical therapy, or social work services. Indicates that the client most likely to use home health care is elderly, has a high number of ADL/IADL impairments, lives alone, has a low level of informal support, and has Medicaid coverage. In the presence of informal support or when care recipients live with others, the initiation of formal services may be delayed until physical impairment is severe or caregiver burden is high. Implications for social work practice and research are discussed.
Presents a literature review to identify the variables associated with home health care utilisation using the Andersen-Newman model as a framework for analysis. Sixty-four studies published 1985-2000 were identified through PUBMED, Sociofile and PsycINFO databases. Home health care was defined as in-home skilled nursing, homemaker, mobile meals, home health aid, physical therapy, or social work services. Indicates that the client most likely to use home health care is elderly, has a high number of ADL/IADL impairments, lives alone, has a low level of informal support, and has Medicaid coverage. In the presence of informal support or when care recipients live with others, the initiation of formal services may be delayed until physical impairment is severe or caregiver burden is high. Implications for social work practice and research are discussed.
Subject terms:
home care, literature reviews, older people, research implementation, social work methods, carers;
Health and Social Care in the Community, 30(4), 2022, pp.1286-1306.
Publisher:
Wiley
Despite apparent need, many older people with cognitive impairment and/or mental health needs do not fully engage with social care. This can manifest in different ways, including passive or aggressive attempts to avoid or repel care workers. However, little is known about how to support such individuals in their own homes and deliver effective care. Against this background, the researchers undertook a scoping review with a view to developing a preliminary theory of change suggesting how care might be modified to engage this client group. The most recent search was conducted on 21/04/21. Papers were included if they (i) focused on older people (65+) living at home with social care needs and (ii) described difficulties/problems with the provision/receipt of social care associated with individuals’ mental health needs. Twenty-six citations were identified through electronic database searches and reference screening, and the results were charted according to key theory of change concepts (long-term outcomes, preconditions, interventions, rationale and assumptions). All the included papers were related to people with dementia. Four subgroups of papers were identified. The first highlights those external conditions that make it more likely an intervention will be successful; the second describes specific interventions to engage older people who by virtue of their mental health needs have not engaged with social care; the third explores what services can be done to increase service uptake by older people with mental health needs and their caregivers more generally; and the fourth details theoretical approaches to explaining the behaviour of people with dementia. Each provides information that could be used to inform care delivery and the development of interventions to improve engagement with health and social care for these individuals. The study concludes that different framing of engagement difficulties, such as that offered through positioning theory, may assist in future service design.
(Edited publisher abstract)
Despite apparent need, many older people with cognitive impairment and/or mental health needs do not fully engage with social care. This can manifest in different ways, including passive or aggressive attempts to avoid or repel care workers. However, little is known about how to support such individuals in their own homes and deliver effective care. Against this background, the researchers undertook a scoping review with a view to developing a preliminary theory of change suggesting how care might be modified to engage this client group. The most recent search was conducted on 21/04/21. Papers were included if they (i) focused on older people (65+) living at home with social care needs and (ii) described difficulties/problems with the provision/receipt of social care associated with individuals’ mental health needs. Twenty-six citations were identified through electronic database searches and reference screening, and the results were charted according to key theory of change concepts (long-term outcomes, preconditions, interventions, rationale and assumptions). All the included papers were related to people with dementia. Four subgroups of papers were identified. The first highlights those external conditions that make it more likely an intervention will be successful; the second describes specific interventions to engage older people who by virtue of their mental health needs have not engaged with social care; the third explores what services can be done to increase service uptake by older people with mental health needs and their caregivers more generally; and the fourth details theoretical approaches to explaining the behaviour of people with dementia. Each provides information that could be used to inform care delivery and the development of interventions to improve engagement with health and social care for these individuals. The study concludes that different framing of engagement difficulties, such as that offered through positioning theory, may assist in future service design.
(Edited publisher abstract)
Subject terms:
service uptake, older people, cognitive impairment, community care, health needs, home care, intervention, literature reviews, mental health problems, service provision;
Background: Informal caregivers are an essential pillar for ensuring and maintaining the outpatient care of the frail elderly. Due to demographic changes, including an increase in the number of people in need of care as well as changing social structures (full-time employment of women, increasing number of single households, etc.) these informal care structures are fraught by considerable challenges. To support and facilitate informal caregivers in their role of nursing, it is important to identify their preferences, needs, and thus create a preference-oriented system. Methods: A systematic review was conducted to identify preferences and needs regarding the organization of informal care. The database searches were performed by using EMBASE, Scopus and Dimdi. Results: A total of 44 studies were included in the present review. Studies from 17 different countries provide broad international perspectives. Besides the preferences for long-term care structure, the following four principal topics were identified: (1) informational needs; (2) support needs; (3) organizational needs, and (4) needs for societal recognition. Conclusion: To meet the current challenges in the outpatient or home-based care of elders, it is essential to strengthen the role of informal caregivers. Therefore, it is necessary to adopt and further develop informal care structures according to the needs of informal caregivers. However, demographic, financial and cultural aspects of each country need to be considered as these may influence the preferences and needs of informal caregivers.
(Edited publisher abstract)
Background: Informal caregivers are an essential pillar for ensuring and maintaining the outpatient care of the frail elderly. Due to demographic changes, including an increase in the number of people in need of care as well as changing social structures (full-time employment of women, increasing number of single households, etc.) these informal care structures are fraught by considerable challenges. To support and facilitate informal caregivers in their role of nursing, it is important to identify their preferences, needs, and thus create a preference-oriented system. Methods: A systematic review was conducted to identify preferences and needs regarding the organization of informal care. The database searches were performed by using EMBASE, Scopus and Dimdi. Results: A total of 44 studies were included in the present review. Studies from 17 different countries provide broad international perspectives. Besides the preferences for long-term care structure, the following four principal topics were identified: (1) informational needs; (2) support needs; (3) organizational needs, and (4) needs for societal recognition. Conclusion: To meet the current challenges in the outpatient or home-based care of elders, it is essential to strengthen the role of informal caregivers. Therefore, it is necessary to adopt and further develop informal care structures according to the needs of informal caregivers. However, demographic, financial and cultural aspects of each country need to be considered as these may influence the preferences and needs of informal caregivers.
(Edited publisher abstract)
Subject terms:
systematic reviews, literature reviews, needs, older people, carers, user views, informal care, access to information, home care, community care;
University of Birmingham. Health Services Management Centre
Publication year:
2019
Pagination:
59
Place of publication:
Birmingham
This interim report provides analysis of the estimated numbers of people who are self-funding their social care and support, and reflections from a realist literature review on self-funders and their experience of engaging with care markets. The report is part of a programme of NIHR funded research at the University of Birmingham, exploring how local authorities are meeting the requirements of the 2014 Care Act to shape markets and deliver better personalisation of care. The report found a scarcity of literature about self-funders, with much either pre-dating the 2014 Care Act, or produced soon after. Estimates of the numbers of people paying for care varied considerably. Also, it found the experiences of self-funders are not routinely captured through large data sets. In total 85 items were included in the literature review. The analysis focuses on the following aspects: market limitations; personalisation; constraints on local authority market shaping; and lack of tools for people to make effective choices. The analysis was unable to provide any definitive conclusions on whether market shaping and personalisation have been effective in achieving better outcomes for self-funders. However, it highlights the challenges and tensions in bringing about the transformation of care and support.
(Edited publisher abstract)
This interim report provides analysis of the estimated numbers of people who are self-funding their social care and support, and reflections from a realist literature review on self-funders and their experience of engaging with care markets. The report is part of a programme of NIHR funded research at the University of Birmingham, exploring how local authorities are meeting the requirements of the 2014 Care Act to shape markets and deliver better personalisation of care. The report found a scarcity of literature about self-funders, with much either pre-dating the 2014 Care Act, or produced soon after. Estimates of the numbers of people paying for care varied considerably. Also, it found the experiences of self-funders are not routinely captured through large data sets. In total 85 items were included in the literature review. The analysis focuses on the following aspects: market limitations; personalisation; constraints on local authority market shaping; and lack of tools for people to make effective choices. The analysis was unable to provide any definitive conclusions on whether market shaping and personalisation have been effective in achieving better outcomes for self-funders. However, it highlights the challenges and tensions in bringing about the transformation of care and support.
(Edited publisher abstract)
Subject terms:
literature reviews, self-funders, local authorities, market development, choice, personalisation, older people, home care, care homes, social care provision;