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Welfare Reform on the Web (March 2012): Care of the elderly - UK

Beyond compliance: quality improvement and practice development for person-centred outcomes in domiciliary services

P. Duff and R. Hurtley

Working with Older People, vol. 15, 2011, p. 177-182

The 360 Standard Framework (360 SF) is a quality improvement and practice development framework for 'relationship activated person-centred care'. Its outcome standards reflect the measures that clients, family carers and staff use to describe a good experience of care and care giving. The standard was developed for care homes, but has been successfully adapted for use in domiciliary settings.

Cheap loans plan to help elderly keep independence

J. Kirkup

Daily Telegraph, Jan. 30th 2012, p. 6

The report of an internal Department of Health working group seen by the newspaper revealed proposals for saving social care costs by reducing the flow of older people into residential care. The centrepiece of the initiative would be a system of government-funded loans to older people to help them pay for adaptations to their homes such as downstairs bathrooms. Younger people would also be encouraged to spend time with elderly neighbours to reduce the loneliness and isolation that helps push some into care homes. A comprehensive national advice and information service would also be set up to help people make better choices earlier in life about care.

Development of joint user/patient outcome measures for older adults with mental health problems

D. Walton, M. Fullerton and S. Patel

Quality in Ageing and Older Adults, vol. 12, 2011, p. 210-216

The UK government and Department of Health have a focus on outcomes and have developed outcome frameworks for health and social care. Traditional outcome measurements tend to mainly measure clinical outcomes and/or reduction in symptoms and are usually staff administered. They do not measure wider 'whole person' outcomes and the experience of the user. Building on previous surveys done with social care users in 2007/08, the Central and North West London NHS Foundation Trust and the Royal Borough of Kensington and Chelsea worked collaboratively with joint older adult mental health teams in Kensington and Chelsea to pilot a joint user outcome form using nationally validated questions from Patient Reported Outcome Measures, Patient Reported Experience Measures, and adult social care experience surveys wherever possible. This is thought to be the first such joint user outcome form to systematically collect user reported experience and outcome data.

Dignity code

National Pensioners' Convention


The code calls on nurses and carers to obtain consent for treatments and demands that older people are allowed to 'speak for themselves' either directly or through a friend or relation. It also requires carers to address older people formally rather than by their first name unless invited to do so.

(For comment see Daily Telegraph, Feb. 22nd 2012, p. 1 + 2)


Elderly told: go back to work and downsize

T. Ross

Daily Telegraph, Feb. 10th 2012, p. 1 + 2

On an official visit to Sweden, David Cameron and his advisers discussed radical plans on retirement with their Scandinavian counterparts. Mr Cameron said he supported plans to raise the retirement age in line with life expectancy, which could see workers remaining in employment until well into their seventies. A prime ministerial adviser, one David Halpern, said in his presentation that older people should also be encouraged to return to work to combat loneliness and isolation. He also argued that older people should be encouraged to move into smaller homes to make more large properties available for families as a way of tackling the housing shortage.

Holistic care and environmental design: the future for dementia care

A. Chaplin

Housing, Care and Support, vol.14, 2011, p. 91-97

The impact of dementia on social care and health budgets will be considerable over the next decade. To reduce the strain, more emphasis is being placed on helping people with the disease to live at home as long as possible. Two home improvement agencies in North West England are pioneering a new approach to dementia care based on adapting the client's home and on reminiscence-based life experience therapy. The approach has not yet been formally evaluated but early results suggest that design-based approaches may add significantly to the effectiveness of psychological management of dementia through reminiscence work.

Implementing functional assessment in older adult care: the experience of direct care staff

W. Spence

Quality in Ageing and Older Adults, vol. 12, 2011, p. 197-209

To optimise resource use in older adult care, rational planning of services and evaluation of their efficacy will be supported by routine standardised functional assessment tool use. This study examined the use of the Revised Elderly Person's Disability Scale (REPDS) at a care management and facility level in one local authority area. After training in the use of the instrument, staff assessed all residents in their respective facilities monthly and submitted data by post to a central office for collation. Results were fed back to the care facilities. The use of the REPDS was viewed by most as contributing in a positive way to planning and delivery of care in the facilities studied.

Involving specialist clinicians in policies for integrated care

P. Clarkson and others

Journal of Integrated Care, vol.19, no. 6, 2011, p. 14-22

Efforts at integration across health and social care have a well documented history in the UK. An important point at which to consider integration is the assessment stage. Improving assessment processes through the use of standardised tools, guidance and multidisciplinary training and the involvement of professionals from different backgrounds has been seen as an effective way of promoting integrated, efficient and person-centred care. At present clinical leadership is considered to be an important driver of integrated practice in England. In this context, this paper draws on a survey experience of a previous policy aimed at integrating assessments, the Single Assessment Process for Older People, where specialist clinicians were originally envisaged as occupying a central place in the proposed changes. Data from the survey are presented to raise issues relevant to the implementation of current policy around integration, particularly regarding clinical leadership and the involvement of specialist clinicians. The paper finds that clinician involvement was limited, with assessments not changing to a discernible degree, and little involvement of older people. Changes to assessments were predominantly related to paperwork.

Patients' and carers' views on dementia workforce skills

S.M. Benbow and others

Journal of Mental Health Training, Education and Practice, vol. 6, 2011, p. 195-202

The National Dementia Strategy issued in 2009 set out in its Objective 13 the need for an informed and effective workforce for people with dementia. Through consultation with people living with dementia and their carers in the West Midlands, this research sought to identify the skills that patients and carers felt needed to be developed in the workforce. Feedback was received from 69 individuals. In total, six major themes were identified from their responses: knowledge about dementia, person-centred care, communication, relationships, support and helping people engage in activities. The work was part of a project to develop competencies for the West Midlands dementia workforce.

Pensioners facing a decade of poor health

J. Hall

Daily Telegraph, Feb. 17th 2012, p. 4

Figures released by the Office for National Statistics showed that of the 17.5 years that the average man spent in retirement, only 10 were 'healthy' years. For a woman, just 11.5 of the 20 years she spent in retirement were healthy. This meant that every pensioner spent almost a decade in failing health, heaping pressure on the over-stretched NHS.

People, pets and care homes: a story of ambivalence

R. Smith, J. Johnson and S. Rolph

Quality in Ageing and Older Adults, vol. 12, 2011, p. 217-228

There is considerable evidence that pets can play a very significant role in the lives of older people and make an important contribution to their well-being. Despite this, only a minority of older people who move to a care home have the opportunity to take a pet with them and it is clear that the attitude of many care home managers is ambivalent. This paper explores the origins of this ambivalence and compares attitudes, policies and practices with regard to pets in residential care settings in the late 1950s with the early years of the 21st century.

Promises to simplify elderly care not kept, say MPs

R. Ramesh

The Guardian, Feb. 8th 2012, p. 6

Andrew Lansley's NHS reforms have failed to come up with the plans and the cash for an integrated system of health and social care to cope with an ageing population, a group of MPs said. The Health Select Committee says that elderly people are deeply reliant on public services, accounting for 50% of those in social housing, 70% of hospital beds and 91% of those needing nursing care. Despite ministerial promises, the MPs say there is no "joined-up approach" to dealing with elderly people. The Committee warns that "although the government has signed up to the idea of integration, little action has taken place to date. The Committee does not believe the proposals in the Health and Social Care Bill will simplify this process."

The socio-economic contribution of older people in the UK

J. Cook

Working with Older People, vol.15, 2011, p. 141-146

In the UK older people are often seen as a drain on society's resources. In fact, older people make a significant contribution to UK society whose value is not realised. This paper highlights the contribution made by older people to their local communities through engagement in paid work, provision of social care, volunteering and leadership of community activities.

What Wales can teach the world

M. Mordey

Working with Older People, vol. 15, 2011, p. 153-163

In response to population ageing, the Welsh government developed and implemented an Older People's Strategy and established an Older People's Commissioner with legal powers to drive and facilitate change. This paper briefly outlines the history of the development of the Strategy and presents evidence of the successful implementation of certain aspects of it. It also offers an overview of the role and work of the Older People's Commissioner and draws lessons for other countries from the Welsh experience.

Where next for the care of older people?

C. Harries

Community Practitioner, vol.85, Feb. 2012, p. 16-18

Failings in relation to the nursing care of older people, especially in terms of nutrition and the dignity afforded to them, have sparked calls for reform. The issue has become more pressing as research has shown that mental decline due to ageing sets in earlier than previously thought, in the mid-40s rather than the 60s. This article summarises the conclusions and recommendations of the reports from the Care Quality Commission and the Royal College of Psychiatrists.

Why 'stiff upper lip' means dying in pain

J. Bingham

Daily Telegraph, Feb. 3rd 2012, p. 8

The chairman of the National Council for Palliative Care has called for a change of philosophy in the medical profession to allow for a greater acceptance of death. Almost 500,000 people a year die in Britain, the majority of them in hospitals. Around a third of these could have been cared for at home. Doctors need to discuss options more openly with terminally ill patients to help them have a good death.

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