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Welfare reform on the Web (December 2006): Care of the elderly - UK

Assessing care home quality using routine regulatory information

A. Worden and D. Challis

Quality in Ageing, vol.7, Sept. 2006, p.33-44

This study attempted to derive measures of care home quality from routine data. It appeared that certain home characteristics were related to homes with higher quality. Homes which were of higher quality were part of a group; had better quality assessment documents; used assessment material as part of the home operation; and had higher staffing levels per bed. Results suggest that it is possible to use material from routine inspection reports to produce measures of quality.

Big brother or brave new world? Telecare and its implications for older people’s independence and social inclusion

J. Percival and J. Hanson

Critical Social Policy, vol.26, 2006, p.888-909

Politicians, providers and academics herald telecare as a major tool for enabling older people to remain in their own homes for longer and avoid institutional care. This study sought to elicit the views of older people, carers and professionals on the development and use of telecare through a series of focus group discussions. The debate centres on the potential impact of telecare on older people’s autonomy and privacy. There is also concern that it may be used as a substitute for human support and lead to a loss of contact with others.

The CARE (Combined Assessment of Residential Environments) profiles: a new approach to improving quality in care homes

M. Faulkner and S. Davies

Quality in Ageing, vol.7, Sept.2006, p.15-25

This paper describes the rationale for and development of the CARE (Combined Assessment of Residential Environments) profiles. The CARE profiles represent a new approach to quality improvement in care homes for older people that seeks to gain the views of residents, relatives and staff and to use these as a basis for celebrating what works well in a home and for identifying areas that need attention.

Extra care housing: is it really an option for older people

L. Dawson, J. Williams and A. Netten

Housing, Care and Support, vol.9, Oct. 2006, p.23-29

This study shows that local authorities and the government are united in their aims for developing extra care housing. Provision was expanding steadily in the sample of local authorities surveyed and even more rapidly in the registered social landlords active in the field. The baseline level of provision in the sample of local authorities was very limited in comparison with the number of care home places: there were 16 places in care homes for every one in extra care housing. Lack of financial capital, lack of suitable sites and lack of appropriate revenue funding were impeding development.

Implementing telecare: practical experiences

S. Brownsell and others

Housing, Care and Support, vol.9, Oct. 2006, p.6-12

With an ageing population, the role of telecare in supporting older people will increase. Many telecare initiatives have failed because organisations have not understood the practical difficulties that can arise with implementation. This paper suggests some common issues that need to be considered.

In sickness and in health

A.U. Sale

Community Care, Nov. 16th-22nd 2006, p.26-27

The Commission for Social Care Inspection has criticised domiciliary care services because of the wide variations between areas in the numbers of older people served and the quality of services. There are also serious recruitment and retention problems due to poor pay and conditions. To give a view from the frontline, the author describes a typical shift worked by a home carer in Islington.

The joys and tribulations of partnership working in care homes for older people

K.A. Froggatt and others

Quality in Ageing, vol.7, Sept.2006, p.26-32

This article describes three different approaches to partnership working in care homes involving relatives, staff and external researchers. Each project aimed to improve the residents’, relatives’ and staff experiences of being part of the community in each home. Bringing together people from different backgrounds and with different priorities and concerns in order to achieve change, involves many challenges. However, evaluation of each of the projects described in this article suggests that a wealth of ideas was produced that would have been unlikely to emerge in the absence of partnership working. Many of these ideas were translated into positive action, enhancing experiences of life within the home.

Mainstreaming equality: implications of the provision of support at home for majority and minority ethnic older people

A. Bowes

Social Policy and Administration, vol.40, 2006, p.739-757

Mainstreaming equality involves integrating an equalities perspective into the principles, policies and practices of organisations. This paper draws on Scottish studies which examined older people’s experience of home care provision. The research shows a gap between high-level commitment to mainstreaming equality and people’s lived experiences. Autonomy and choice are central to community care legislation, policy and practice guidance, but in reality choices are limited for both minority ethnic and majority older people. More user-focused approaches and grassroots involvement may offer ways forward, despite some limitations of current models.

Professional perspectives on decision making about the long-term care of older people

B.J. Taylor and M. Donnelly

British Journal of Social Work, vol.36, 2006, p.807-826

With population ageing, health and social care professionals are increasingly involved in decision-making about long-term care arrangements for older people in the UK. This study used 19 focus groups and nine semi-structured interviews with professionals to explore how they reached decisions about the long-term care of older people. Results suggest that decisions that older people should enter residential care revolve around a crisis situation and the interplay between needs and:

  1. The individual’s confidence about continuing to live at home (normally when living alone)
  2. Family carers’ ability and willingness to cope
  3. The availability of publicly funded primary and home care services.

Public policy and private provision: changes in residential care from 1991 to 2001

P. Haynes and others

Health and Social Care in the Community, vol.14, 2006, p.499-507

This paper discusses evidence provided by census data for 1991 and 2001 on the incidence of residential care for adults in the UK. Local authority care home provision declined throughout the UK, but private provision grew in some places and declined in others. There have been changes in both the numbers of homes and the numbers of residents. The variation from place to place in private provision is hard to explain. The behaviour of the private sector may have been influenced by cost considerations in areas like London, and by the strength of demand in places where local authority support for residential care was low.

Specialist clinical assessment of vulnerable older people: outcomes for carers from a randomised controlled trial

D. Venables and others

Ageing and Society, vol.26, 2006, p.867-882

The health of carers is vital to maintaining older people at home for as long as possible, and the provision of support for carers is high on the UK government’s policy agenda. In seeking to support carers, services and expenditure are commonly aimed at them directly. However, research suggests that an alternative way of helping carers is to target enhanced services on the cared-for person. This paper reports a randomised controlled trial of the effects on carer distress of an additional specialist clinical assessment for older people at risk of placement in a residential or nursing home. Analysis indicated that changes in older people’s behaviour, as opposed to carer or service-related factors, predicted changes in carer distress, and that carers of older people who experienced depressive symptoms received greatest benefit from the specialist assessment. Results suggest that an effective means of improving outcomes for carers may be to target services on the distressing behaviours of the person for whom they care.

Specialist services for older people: issues of negative and positive ageism

J. Reed and others

Ageing and Society, vol.26, 2006, p.849-865

This paper reports selected findings from a survey carried out in 2004 to investigate the implementation of the National Service Framework for Older People (NSF-OP) in England. Information was collected through a questionnaire about the nature of specialist developments at three levels of the NHS: strategic health authorities, provider trusts and service units. Analysis of the survey data showed that there were variations in the way that the NSF-OP was being interpreted and implemented. In particular, there was inconsistency in the interpretation of its anti-ageism standard: some concluded that the strategy discouraged services exclusively for older people, others that it encouraged dedicated provision for them.

Transitions in care homes: towards relationship-centred care using the “Senses Framework”

M. Nolan, S. Davies and J. Brown

Quality in Ageing, vol.7, Sept. 2006, p. 5-14

Residential care homes for older people have never enjoyed high public esteem or much political interest. In large part this marginalised position is due to the failure to value the contribution care homes make to supporting frail older people. In order to improve the situation, this paper argues for the adoption of a relationship-centred approach to care and its application through the “Senses Framework”. Relationshp-centred care should offer both staff and residents:

  • A sense of security
  • A sense of continuity
  • A sense of belonging to the community of the home
  • A sense of purpose, with clear goals to aim for
  • A sense of fulfilment
  • A sense of being valued as a person of worth
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