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Lessons from the Arkansas cash and counseling program: how the experiences of diverse older consumers and their caregivers address family policy concerns
- Authors:
- SAN ANTONIO Patricia, et al
- Journal article citation:
- Journal of Aging and Social Policy, 22(1), January 2010, pp.1-17.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
The Cash and Counseling Demonstration and Evaluation (CCDE) program was a trial of an unfettered consumer directed service offering Medicaid recipients in three states a cash allowance and information services in lieu of agency delivered care. Based on this experience the concerns of policy makers were drawn together into four family policy questions often asked about consumer-directed services and examining issues such as quality, suitability, and fraud and abuse. The data reported are drawn from in-home interviews with 19 adults with diverse disabilities over 50 years of age and their care unit members who participated in IndependentChoices, the Arkansas implementation of CCDE. Building on other CCDE evaluation survey data, this analysis discusses recipient and care givers’ experiences of receiving, giving, and managing care. It demonstrates how the program allows consumers choice, so that they receive the services they want, but at the same time the programme’s flexibility allows policy makers to safeguard both consumers and programme resources through the use of representatives, state consultants, and fiscal intermediaries. The authors conclude that overall the experience with Arkansas CCDE has been quite positive and that it might act as a model to help address the needs of both consumers with diverse disabilities and policy makers in other states.
Housing issues for older people in rural areas
- Authors:
- BEVAN Mark, CROUCHER Karen
- Publisher:
- Scotland. Scottish Government Social Research
- Publication year:
- 2008
- Pagination:
- 26p.
- Place of publication:
- Edinburgh
This paper or ‘think-piece’ has been commissioned by the Scottish Executive Development Department. Its aim is to offer expert reflections on the policy actions that might be inferred from the evidence base on older people’s housing and support needs in rural Scotland. Topics covered included: types of tenure and household size for older people in rural areas, housing and support service aspirations of older people in rural areas, information needs of older people in rural areas, relative cost of providing housing services for older people in rural areas, exploration of the barriers to delivering services for older people in rural areas, consideration of any potentially useful alternative approaches to service delivery that have been put in place, and consideration of the different ‘ruralities’ in Scotland. Suggestions for policy and practice for consideration by the Scottish Executive are outlined.
A sea of change in the teacup!
- Author:
- JONES Ray
- Journal article citation:
- Journal of Integrated Care, 13(4), August 2005, pp.2-5.
- Publisher:
- Emerald
Considers five reports produced by the Government, which focus on disabled and older people, and which stretch across a wide continuum of perspectives and policy.
Implementing the Single Assessment Process (SAP): opportunities and challenges
- Author:
- DICKINSON Angela
- Journal article citation:
- Journal of Interprofessional Care, 20(4), August 2006, pp.365-379.
- Publisher:
- Taylor and Francis
The Single Assessment Process (SAP) has been introduced as part of the National Service Framework for Older People and has major implications for health and social care. The aim of this study was to evaluate a pilot introduction of the Single Assessment Process in the South-East of England. A qualitative case study design incorporating observation and semi-structured interviews were used to collect data. Assessment visits were observed and recorded, and interviews were carried out with older people and their carers (n = 9), health and social care practitioners, operational managers, and other key individuals involved in the pilot (n = 26). Overall the evaluation found three major themes that had an impact on the implementation of the Single Assessment Process. These were: the process of implementing policy and change, the health and social care boundary, and communication and sharing of assessments. Front-line practitioners (street-level bureaucrats) had a major impact on the SAP implementation, particularly through their reluctance to engage with the process, work together and share assessments. Success of the national SAP implementation will depend on the extent to which those working directly with older people can be engaged in the policy process.
Commentary: COVID in care homes- challenges and dilemmas in healthcare delivery
- Journal article citation:
- Age and Ageing, 49(5), 2020, pp.701-705.
- Publisher:
- Oxford University Press
The COVID-19 pandemic has disproportionately affected care home residents internationally, with 19–72% of COVID-19 deaths occurring in care homes. COVID-19 presents atypically in care home residents and up to 56% of residents may test positive whilst pre-symptomatic. In this article, the authors provide a commentary on challenges and dilemmas identified in the response to COVID-19 for care homes and their residents. The authors highlight the low sensitivity of polymerase chain reaction testing and the difficulties this poses for blanket screening and isolation of residents. They discuss quarantine of residents and the potential harms associated with this. Personal protective equipment supply for care homes during the pandemic has been suboptimal and they suggest that better integration of procurement and supply is required. Advance care planning has been challenged by the pandemic and the authors say there is a need to for healthcare staff to provide support to care homes with this. Finally, the authors discuss measures to implement augmented care in care homes, including treatment with oxygen and subcutaneous fluids, and the frameworks which will be required if these are to be sustainable. The authors say that all of these challenges must be met by healthcare, social care and government agencies if care home residents and staff are to be physically and psychologically supported during this time of crisis for care homes. (Edited publisher abstract)
Reading between the lines: the role discourse in shaping responses to safeguarding older people
- Author:
- GALPIN Diane
- Journal article citation:
- Journal of Adult Protection, 16(6), 2014, pp.399-410.
- Publisher:
- Emerald
Purpose: This paper reports on findings from research into the role of language and discourse in shaping responses to older people at risk of abuse in England. Design/methodology/approach: The study comprised of a critical discourse analysis (CDA) of the coalition governments underpinning policy statement outlining its approach to safeguarding adults in 'A Vision for Adult Social Care: Capable Communities and Active Citizens.' Critical discourse analysis is used to deconstruct policy to identify hidden meaning. Findings: The results suggest ideological, philosophical and economic discourses underpinning policy may promote 'Big Society' rather than address the abuse of older people, and that this might leave some older people vulnerable and at risk. Research limitations/implications: It is acknowledged the qualitative approach of CDA has its limitations as issues of subjectivity and interpretation exist. Practical implications: Drawing on this analysis may provide a heightened awareness of the use of discourse to expose potentially hidden motivations in others, and ourselves, by seeking out the ideological, philosophical and theoretical hiding places which enable specific discourses to become taken for granted. Originality/value: This paper explores practice in safeguarding adults from an ideological, economic and philosophical perspective. (Edited publisher abstract)
Future health trends in the North East and how they might be supported or disrupted by policy changes: future of ageing: think piece
- Author:
- JAGGER Carol
- Publisher:
- Great Britain. Government Office for Science
- Publication year:
- 2014
- Pagination:
- 15
- Place of publication:
- London
This paper discusses the expected future trends in health in the North East, looking in particular to 2025 and 2040, and how policy changes might impact positively or negatively. Although life and health expectancies in the North East have risen in the last decade, values are still well below the average for England. The paper argues that inequalities in disability free life expectancy across England are wider than those in life expectancy and therefore the continued inclusion of life expectancy (SMR) in the NHS resources allocation formula disadvantages areas such as the North East. Extending the state pension age will be challenging in the North East since most areas have DFLE at birth below 65. Employers will therefore have to accommodate substantial numbers of workers who are already limited before 65. Net decreases in the numbers of people pre-retirement (55-64 years) compared to England, but similar doubling of the next generation of the very old who will be reliant upon them for care, may also impact on employers. Trends in diabetes, overweight and excess alcohol consumption are increasing in the North East and the region currently ranks amongst the highest on diabetes, CVD, IHD, stroke, excess alcohol consumption, and obesity as well as mental ill health in women. All of these are likely to impact on DFLE, potentially to a greater extent than life expectancy. (Edited publisher abstract)
The role of pets in the lives of older people: a review
- Author:
- McNICHOLAS June
- Journal article citation:
- Working with Older People, 18(3), 2014, pp.128-133.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to summarise some of the major scientific research projects that identify the value of pet ownership and pet interaction to older people with a view to disseminating such findings to health professionals and care workers engaged in the welfare of older people. Design/methodology/approach: A review of findings from major international studies across a number of health related disciplines. Findings: Pets may serve significant functions that enhance the physical, emotional and social well-being of older people. With recognition from health professionals, pet ownership may rank highly amongst those elements which should be preserved wherever possible. Originality/value: The dissemination of the importance of pet ownership to the health and well-being of older people, with special implications for policy development amongst care providers. (Publisher abstract)
Delivering Dilnot: paying for elderly care
- Authors:
- BURSTOW Paul, (ed.)
- Publisher:
- CentreForum
- Publication year:
- 2013
- Pagination:
- 55p.
- Place of publication:
- London
The aim of this report is to stimulate debate and draw attention to issues around funding care for the elderly. It takes the view that the Dilnot Commission’s proposals are “our best hope of reforming care financing in at least a decade”. and considers how Dilnot could and should be paid for in the fairest and most progressive way. The paper includes the voices of older people and carers directly affected by these issues. Also included are contributions from Lord Sutherland who offers a long term overview; Yvonne Braun, on behalf the Association of British Insurers, who sets out the crucial role that good financial advice can play in helping people to secure peace of mind for the future; and former Care Services Minister Paul Burstow provides detailed analysis on what level Dilnot’s cap should be set at, and how it should be paid for. Original research found that the argument for introducing a £50,000 cap for those with modest assets is overwhelming. The authors suggest that an additional annual pot of money, around £600 million, could be raised by establishing capital gains tax at death. In total the Treasury could save over £2 billion a year to pay for a Dilnot care system at a cap that would still protect those who desperately need it.
Involving specialist clinicians in policies for integrated care
- Authors:
- CLARKSON Paul, et al
- Journal article citation:
- Journal of Integrated Care, 19(6), 2011, pp.14-22.
- Publisher:
- Emerald
Drawing on a survey examining the impact of the Single Assessment Process for Older People, a policy aimed at integrating assessments, this article discusses issues concerning the involvement of clinicians in integrated approaches to assessment. Cross-sectional surveys of specialist clinicians (geriatricians and old age psychiatrists) were undertaken in 2004 and 2005 as part of a study examining the initial impact of the single assessment process. This article presents a review of the data, exploring the involvement of specialist clinicians in assessment practice. It reports that clinician involvement was limited, with changes to assessment predominantly related to paperwork, and little involvement of older people. The authors suggest that clinicians have previously not been engaged in policies around integrated assessments, that factors that can help engagement include development of a shared vision and appropriate systems to promote information sharing, and that there are lessons to learn in terms of the factors that may help or hinder the achievement of integrated practice.