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When the clients can choose: dilemmas of street-level workers in choice-based social services
- Authors:
- COHEN Nissim, BENISH Avishai, SHAMRIZ-ILOUZ Aya
- Journal article citation:
- Social Service Review, 90(4), 2016, pp.620-646.
- Publisher:
- University of Chicago Press
To examine the question of how increased use of choice-based management strategies in social services influences the behaviour of street-level workers, this article provides an analytical framework for understanding street-level logic in choice-based environments. It then looks at home-nursing care in Israel to examine how choice plays out in street-level workers’ day-to-day practices. By relying on 34 interviews with social workers working in home-care agencies, the authors illustrate how street-level workers’ jobs have expanded beyond implementing public policy to include the “new job” of recruiting and retaining clients. The article shows how a choice-based environment gives higher priority to clients’ preferences, while at the same time these preferences are subordinated to the economic interest of the providers. It also demonstrates how market pressures may push street-level workers to develop new practices and coping strategies that go beyond, but often also counter to, formal policy. (Edited publisher abstract)
Aging gracefully: the PACE approach to caring for frail elders in the community
- Authors:
- HOSTETTER Martha, KLEIN Sarah, McCARTHY Douglas
- Publisher:
- Commonwealth Fund
- Publication year:
- 2016
- Pagination:
- 14
- Place of publication:
- New York
Focusing on the original programme of On Lok operating in one area of the USA, this case study examines the Program of All-Inclusive Care for the Elderly (PACE) model of care and explores the potential for the model to be adapted for use with a wider population. The PACE model serves a target population of people age 55 and older, who need long-term care but are able to safely live at home. Key features of the programme include: comprehensive medical and social services delivered in community day centres and people’s homes; care coordination by interdisciplinary teams, and integrated care through to end of life. The service promotes socialisation, activity, and independence, while lessening burden on family caregivers. Evaluation estimates that the service improves some aspects of care quality and reduces need for acute care, while achieving costs comparable to traditional Medicare. Challenges identified include that it is operationally complex and also requires large care teams. It also may need some adaptation to reach larger share of population. This is one of a series of case studies examining programs in the United States that aim to improve outcomes and reduce costs of care for patients with complex needs. (Edited publisher abstract)
The social work role in reducing 30-day readmissions: the effectiveness of the Bridge Model of transitional care
- Authors:
- ALVAREZ Renae, et al
- Journal article citation:
- Journal of Gerontological Social Work, 59(3), 2016, pp.222-227.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centred, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components - care coordination, case management, and patient engagement - which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment’s emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs. (Edited publisher abstract)
User choice in Swedish eldercare – conditions for informed choice and enhanced service quality
- Authors:
- MOBERG Linda, BLOMQVIST Paula, WINBLAD Ulrika
- Journal article citation:
- Journal of European Social Policy, 26(3), 2016, pp.281-295.
- Publisher:
- Sage
Proponents of user choice argue that this type of policy arrangement improves the quality of public social services since users are expected to select the most highly performing providers. In order for users to make informed choices, however, they need quality information about the services offered by different providers. In this article, we carry out a case study, investigating whether information about service quality was presented to users of home-based elderly care in Sweden. The analysis is based on unique data regarding the information of 223 providers in 10 municipalities. The results suggest that the information was poor and lacking in important quality dimensions. This indicates a lack of real user power since it is virtually impossible for users to make informed choices without relevant information. It also makes it less likely that the general quality level of home-based services will increase as a result of the user choice. (Publisher abstract)
Sustainability processes among Naturally Occurring Retirement Community Supportive Service Programs
- Authors:
- GREENFIELD Emily A., FRANTZ Mandy E.
- Journal article citation:
- Journal of Community Practice, 24(1), 2016, pp.38-55.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philapelphia, USA
Sustainability remains a concern for community models to better support older adults’ ageing in place in their own homes and communities. Based on qualitative data from leaders of 53 Naturally Occurring Retirement Community (NORC) Supportive Service Programs, which is among the most prominent community practice models in ageing, the authors aimed to develop an empirically-grounded framework on sustainability processes. Results indicated that programmes use funding, staff members, interorganisational partnerships, and volunteers to offer services to attract older adults, and that older adults’ participation, in turn, is perceived as influencing the accrual of additional resources. Across themes, respondents discussed the importance of being responsive to the community and facilitating consumer participation. (Edited publisher abstract)
Effects of preventive home visits on older people's use and costs of health care services: a systematic review
- Authors:
- LIMMATTA H., et al
- Journal article citation:
- European Geriatric Medicine, 7(6), 2016, pp.571-580.
- Publisher:
- Elsevier
Introduction: The aim of this study was to systematically review the evidence from randomized controlled trials (RCT) concerning effectiveness of preventive home visit (PHV) programs on older people's use and costs of health and social services. We also evaluated resultant costs-changes achieved with intervention in older people's functioning, quality-of-life (QOL) or mortality. Materials and methods: A systematic review of published RCTs reporting use and/or costs on PHVs on multimorbid older people was performed. The characteristics and methodological quality of studies were assessed. Results: Of the 3219 articles screened, 19 met the inclusion criteria. The methodological quality of the trials was principally moderate (n = 5) or good (n = 10). Of the studies, 12 evaluated the overall costs of health and social services. None of these studies was able to show significant differences in total costs between intervention and control groups. Six studies suggested that PHVs may decrease nursing home admissions and/or hospital days. Seven studies showed some favourable effect on physical functioning, QOL, or mortality, without increasing the total health care costs. Conclusions: Of the high number of studies investigating efficacy of PHVs on older people, only a few studies explore economic effects. PHVs do not provide overall savings to health care costs, but some interventions might offer some cost-neutral positive effects on functioning, QOL and/or mortality. More studies are needed to clarify the effective aspects of the programs and cost-effectiveness of the PHVs. (Edited publisher abstract)