Context: Experience of loneliness amongst care home residents with sight loss is associated with limitations in activities of daily living, poor self-reported health, and increased rates of depression. Care homes are encouraged to use screening tools to identify those at risk of loneliness. Objectives: The study aimed to describe the findings and experience of applying a validated, multi-item scale to identify loneliness and isolation in care home residents with sight loss in England, UK. Methods: The six-item De Jong Gierveld Loneliness Scale was administered to residents residing in long-term care homes with sight loss. Participants were aged 65+ years old with vision impairment that could not be corrected by glasses. Descriptive analysis of loneliness scale data was undertaken supplemented with observational field notes of implementation challenges. Findings: Only 42 applications of the De Jong Gierveld Loneliness Scale were possible. The mean sub-scale scores for emotional loneliness, social loneliness and the mean overall loneliness score were 1.36 (sd = 1.16), 1.19 (sd = 1.04) and 2.55 (sd = 1.9) respectively. Challenges observed in scale administration and understanding of scale items by residents might preclude it as a loneliness case-identification tool in busy care home environments. Limitations: The study reports on the challenges implementing a questionnaire which achieved a low rate of data collection. Implications: For case-identification of loneliness, care homes may wish to consider use of a single-item loneliness question rather than multi-item scales due to variable length of administration and resident comprehension.
背景:视力丧失的护理院居民的孤独经历与日常生活活动的限制、自我报告的健康状况不佳和抑郁症发病率增加有关。养老院被鼓励使用筛选工具来识别那些有孤独风险的人。目的:本研究旨在描述在英国英格兰使用一套有效的多条目量表来识别视力丧失的护理院居民的孤独感和孤立感的结果和经验。方法:采用六项De Jong Gierveld孤独感量表对视力丧失的长期护理院老人进行问卷调查。参与者年龄在65岁以上，有不能通过眼镜矫正的视力障碍。对孤独量表数据进行了描述性分析，并补充了对实施挑战的实地观察笔记。结果:De Jong Gierveld孤独感量表仅适用42种。情感孤独、社交孤独和整体孤独的平均分量表得分分别为1.36 (sd = 1.16)、1.19 (sd = 1.04)和2.55 (sd = 1.9)。在量表管理和居民对量表项目的理解方面所观察到的挑战可能会妨碍它在繁忙的养老院环境中作为孤独病例识别工具。局限性:该研究报告了实施问卷调查的挑战，该问卷的数据收集率很低。含义:对于孤独感的个案识别，由于管理时间长短和住院医师的理解不同，护理院可能希望考虑使用单项孤独问题而不是多项目量表。
{"title":"Identifying Loneliness and Social Isolation in Care Home Residents with Sight Loss: Lessons from Using the De Jong Gierveld Scale","authors":"R. Mann, P. Rabiee, Y. Birks, M. Wilberforce","doi":"10.31389/jltc.39","DOIUrl":"https://doi.org/10.31389/jltc.39","url":null,"abstract":"Context: Experience of loneliness amongst care home residents with sight loss is associated with limitations in activities of daily living, poor self-reported health, and increased rates of depression. Care homes are encouraged to use screening tools to identify those at risk of loneliness. Objectives: The study aimed to describe the findings and experience of applying a validated, multi-item scale to identify loneliness and isolation in care home residents with sight loss in England, UK. Methods: The six-item De Jong Gierveld Loneliness Scale was administered to residents residing in long-term care homes with sight loss. Participants were aged 65+ years old with vision impairment that could not be corrected by glasses. Descriptive analysis of loneliness scale data was undertaken supplemented with observational field notes of implementation challenges. Findings: Only 42 applications of the De Jong Gierveld Loneliness Scale were possible. The mean sub-scale scores for emotional loneliness, social loneliness and the mean overall loneliness score were 1.36 (sd = 1.16), 1.19 (sd = 1.04) and 2.55 (sd = 1.9) respectively. Challenges observed in scale administration and understanding of scale items by residents might preclude it as a loneliness case-identification tool in busy care home environments. Limitations: The study reports on the challenges implementing a questionnaire which achieved a low rate of data collection. Implications: For case-identification of loneliness, care homes may wish to consider use of a single-item loneliness question rather than multi-item scales due to variable length of administration and resident comprehension.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83829615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Towers, Anne Killett, Melanie Handley, K. Almack, T. Backhouse, D. Bunn, F. Bunn, A. Dickinson, E. Mathie, A. Mayrhofer, Rasa Mikelyte, C. Goodman
Context: The work presented in this paper was undertaken during the first three months of the COVID-19 crisis in the UK. Objectives: The project is aimed to respond to questions and concerns raised by front-line care staff during this time, by producing research-based ‘Top Tips’ to complement emerging COVID-19 policy and practice guidelines. Methods: Eight rapid, expert reviews of published, multidisciplinary research evidence were conducted to help answer care home workers’ questions about ‘how’ to support residents, family members and each other at a time of unprecedented pressure and grief and adhere to guidance on self-distancing and isolation. A review of the emerging policy guidelines published up to the end of April 2020 was also undertaken. Findings: The rapid reviews revealed gaps in research evidence, with research having a lot to say about what care homes should do and far less about how they should do it. The policy review highlighted the expectations and demands placed on managers and direct care workers as the pandemic spread across the UK. Implications: This paper highlights the value of working with the sector to co-design and co-produce research and pathways to knowledge with those who live, work and care in care homes. To have a real impact on care practice, research in care homes needs to go beyond telling homes ‘what’ to do by working with them to find out ‘how’.
{"title":"Producing ‘Top Tips’ for Care Home Staff During the COVID-19 Pandemic in England: Rapid Reviews Inform Evidence-Based Practice but Reveal Major Gaps","authors":"A. Towers, Anne Killett, Melanie Handley, K. Almack, T. Backhouse, D. Bunn, F. Bunn, A. Dickinson, E. Mathie, A. Mayrhofer, Rasa Mikelyte, C. Goodman","doi":"10.31389/jltc.43","DOIUrl":"https://doi.org/10.31389/jltc.43","url":null,"abstract":"Context: The work presented in this paper was undertaken during the first three months of the COVID-19 crisis in the UK. Objectives: The project is aimed to respond to questions and concerns raised by front-line care staff during this time, by producing research-based ‘Top Tips’ to complement emerging COVID-19 policy and practice guidelines. Methods: Eight rapid, expert reviews of published, multidisciplinary research evidence were conducted to help answer care home workers’ questions about ‘how’ to support residents, family members and each other at a time of unprecedented pressure and grief and adhere to guidance on self-distancing and isolation. A review of the emerging policy guidelines published up to the end of April 2020 was also undertaken. Findings: The rapid reviews revealed gaps in research evidence, with research having a lot to say about what care homes should do and far less about how they should do it. The policy review highlighted the expectations and demands placed on managers and direct care workers as the pandemic spread across the UK. Implications: This paper highlights the value of working with the sector to co-design and co-produce research and pathways to knowledge with those who live, work and care in care homes. To have a real impact on care practice, research in care homes needs to go beyond telling homes ‘what’ to do by working with them to find out ‘how’.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49213979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Longo, P. Saramago, H. Weatherly, P. Rabiee, Y. Birks, A. Keding, I. Sbizzera
Context: Vision rehabilitation (VR) services in England promote users’ health and wellbeing, and support all aspects of daily living through two dominant models: in-house and contracted-out VR services. The two models differ in terms of service delivery, but they share a common aim to enhance service users’ quality of life and reduce utilisation of social and health care services. Objective: This study investigated the cost-effectiveness of in-house versus contracted-out VR services. Methods: The analysis was performed from a social care perspective and a social and health care perspective. The analyses used data from a six-month follow-up observational study of VR users. Regression analysis was used to estimate differential outcomes and costs, taking user and local authority characteristics into account. Findings: At a cost-effectiveness threshold of £13,000 and £30,000 per QALY, in-house VR services have a high probability (greater than 90% vs. contracted-out VR services) of being cost-effective from a social care perspective. In-house VR services have a lower probability (lower than 25% vs. contracted-out VR services) of being cost-effective from a social and health care perspective. Limitations: Observational studies are prone to selection bias compared to randomised controlled trials due to confounding. We employed econometric techniques that control for several user and LA characteristics to reduce potential bias. Implications: Contracted-out VR services may be better value for money compared to in-house VR services in the context of integrated social and health care due to substantial healthcare resource savings.
{"title":"Cost-Effectiveness of In-House Versus Contracted-Out Vision Rehabilitation Services in England","authors":"F. Longo, P. Saramago, H. Weatherly, P. Rabiee, Y. Birks, A. Keding, I. Sbizzera","doi":"10.31389/JLTC.26","DOIUrl":"https://doi.org/10.31389/JLTC.26","url":null,"abstract":"Context: Vision rehabilitation (VR) services in England promote users’ health and wellbeing, and support all aspects of daily living through two dominant models: in-house and contracted-out VR services. The two models differ in terms of service delivery, but they share a common aim to enhance service users’ quality of life and reduce utilisation of social and health care services. Objective: This study investigated the cost-effectiveness of in-house versus contracted-out VR services. Methods: The analysis was performed from a social care perspective and a social and health care perspective. The analyses used data from a six-month follow-up observational study of VR users. Regression analysis was used to estimate differential outcomes and costs, taking user and local authority characteristics into account. Findings: At a cost-effectiveness threshold of £13,000 and £30,000 per QALY, in-house VR services have a high probability (greater than 90% vs. contracted-out VR services) of being cost-effective from a social care perspective. In-house VR services have a lower probability (lower than 25% vs. contracted-out VR services) of being cost-effective from a social and health care perspective. Limitations: Observational studies are prone to selection bias compared to randomised controlled trials due to confounding. We employed econometric techniques that control for several user and LA characteristics to reduce potential bias. Implications: Contracted-out VR services may be better value for money compared to in-house VR services in the context of integrated social and health care due to substantial healthcare resource savings.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42155102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: Older people and people with an intellectual disability who receive long-term care are considered particularly vulnerable to infection outbreaks, such as the current Coronavirus Disease 2019. The combination of healthcare concerns and infection-related restrictions may result in specific challenges for long-term care staff serving these populations during infection outbreaks. Objectives: This review aimed to: (1) provide insight about the potential impact of infection outbreaks on the psychological state of healthcare staff and (2) explore suggestions to support and protect their psychological well-being. Method: Four databases were searched, resulting in 2,176 hits, which were systematically screened until six articles remained. Thematic analysis was used to structure and categorise the data. Findings: Studies about healthcare staff working in long-term care for people with intellectual disabilities were not identified. Psychological outcomes of healthcare staff serving older people covered three themes: emotional responses (i.e., fears and concerns, tension, stress, confusion, and no additional challenges), ethical dilemmas, and reflections on work attendance. Identified suggestions to support and protect care staff were related to education, provision of information, housing, materials, policy and guidelines. Limitations: Only six articles were included in the syntheses. Implications: Research into support for long-term care staff during an infection outbreak is scarce. Without conscious management, policy and research focus, the needs of this professional group may remain underexposed in current and future infection outbreaks. The content synthesis and reflection on it in this article provide starting points for new research and contribute to the preparation for future infection outbreaks.
{"title":"Impact of Infection Outbreak on Long-Term Care Staff: A Rapid Review on\u0000 Psychological Well-Being","authors":"P. Embregts, Wietske van Oorsouw, S. Nijs","doi":"10.31389/jltc.40","DOIUrl":"https://doi.org/10.31389/jltc.40","url":null,"abstract":"Context: Older people and people with an intellectual disability who receive long-term care are considered particularly vulnerable to infection outbreaks, such as the current Coronavirus Disease 2019. The combination of healthcare concerns and infection-related restrictions may result in specific challenges for long-term care staff serving these populations during infection outbreaks. Objectives: This review aimed to: (1) provide insight about the potential impact of infection outbreaks on the psychological state of healthcare staff and (2) explore suggestions to support and protect their psychological well-being. Method: Four databases were searched, resulting in 2,176 hits, which were systematically screened until six articles remained. Thematic analysis was used to structure and categorise the data. Findings: Studies about healthcare staff working in long-term care for people with intellectual disabilities were not identified. Psychological outcomes of healthcare staff serving older people covered three themes: emotional responses (i.e., fears and concerns, tension, stress, confusion, and no additional challenges), ethical dilemmas, and reflections on work attendance. Identified suggestions to support and protect care staff were related to education, provision of information, housing, materials, policy and guidelines. Limitations: Only six articles were included in the syntheses. Implications: Research into support for long-term care staff during an infection outbreak is scarce. Without conscious management, policy and research focus, the needs of this professional group may remain underexposed in current and future infection outbreaks. The content synthesis and reflection on it in this article provide starting points for new research and contribute to the preparation for future infection outbreaks.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42958227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Damant, Lorrainea Williams, R. Wittenberg, Stefanie Ettelt, M. Perkins, D. Lombard, N. Mays
Context: Direct payments (DP) – cash for care – have been promoted in England as a mechanism to enhance the choice and control of service users living in community settings who are eligible for state-funded care. In 2011, the government decided to pilot DPs in residential care in a few areas and to commission an evaluation of the pilot programme. Objective: To explore the experiences of care home residents and their families offered a DP, in terms of choice of and control over their care and of their consumer power in local care home markets. Methods: We held 34 semi-structured interviews with care home residents and family members as part of the evaluation. Interviews were analysed using the “Antagonisms of Choice” framework to study the frictions caused by promoting self-directed care via private market mechanisms within publicly funded systems. Findings: Findings suggest unequal access to DPs according to residents’ access to family networks, level of cognitive function and underlying physical health. Some participants expressed concern about the effects of DPs on quality of care home services. Several family members using DPs perceived enhanced power in relation to the care providers; others saw no benefit from DPs. Limitations: Uptake of DPs was lower than expected, potentially limiting the generalisability of these findings.
{"title":"Experience of Choice and Control for Service Users and Families of Direct\u0000 Payments in Residential Care Trailblazers","authors":"J. Damant, Lorrainea Williams, R. Wittenberg, Stefanie Ettelt, M. Perkins, D. Lombard, N. Mays","doi":"10.31389/JLTC.27","DOIUrl":"https://doi.org/10.31389/JLTC.27","url":null,"abstract":"Context: Direct payments (DP) – cash for care – have been promoted in England as a mechanism to enhance the choice and control of service users living in community settings who are eligible for state-funded care. In 2011, the government decided to pilot DPs in residential care in a few areas and to commission an evaluation of the pilot programme. Objective: To explore the experiences of care home residents and their families offered a DP, in terms of choice of and control over their care and of their consumer power in local care home markets. Methods: We held 34 semi-structured interviews with care home residents and family members as part of the evaluation. Interviews were analysed using the “Antagonisms of Choice” framework to study the frictions caused by promoting self-directed care via private market mechanisms within publicly funded systems. Findings: Findings suggest unequal access to DPs according to residents’ access to family networks, level of cognitive function and underlying physical health. Some participants expressed concern about the effects of DPs on quality of care home services. Several family members using DPs perceived enhanced power in relation to the care providers; others saw no benefit from DPs. Limitations: Uptake of DPs was lower than expected, potentially limiting the generalisability of these findings.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49185799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: Demographic and other pressures have placed strains on the social (long-term) care systems in many countries. An ageing population and cuts to local authority budgets have put pressure on the availability of local authority funded adult social care in England and have raised concerns about unmet social care needs among older people. To prevent care needs going unmet, it is crucial to understand their predictors. However, research on this topic is limited. Objective(s): To understand the predictors of unmet needs for adult social care in England. Method(s): Using data from the English Longitudinal Study of Ageing (2002–2012), we employed an activities-based approach to develop a definition of unmet social care needs, drawing on available data, previous literature and consultations with social care users and carers. We then used logistic regression to analyse the factors that predict developing an unmet care need over a 10-year period among a sample of those aged 50 and older. Findings: The likelihood of developing unmet care needs does not differ by factors like gender, wealth, social contact, education or health behaviours. The only significant predictors for unmet needs are living alone, being relatively young (though still over 50), not having a longstanding illness, losing a spouse and developing more severe needs. These findings are robust to a variety of model specifications. Limitations: Results of this analysis may be sensitive to the definition of unmet need employed. Implications: These findings contribute to the current debate on the funding and organisation of adult social care in England and will inform policymakers interested in addressing the issue of unmet social care needs among older people.
{"title":"Predicting Unmet Need for Social Care","authors":"Allison Dunatchik, Rossella Icardi, M. Blake","doi":"10.31389/JLTC.33","DOIUrl":"https://doi.org/10.31389/JLTC.33","url":null,"abstract":"Context: Demographic and other pressures have placed strains on the social (long-term) care systems in many countries. An ageing population and cuts to local authority budgets have put pressure on the availability of local authority funded adult social care in England and have raised concerns about unmet social care needs among older people. To prevent care needs going unmet, it is crucial to understand their predictors. However, research on this topic is limited. Objective(s): To understand the predictors of unmet needs for adult social care in England. Method(s): Using data from the English Longitudinal Study of Ageing (2002–2012), we employed an activities-based approach to develop a definition of unmet social care needs, drawing on available data, previous literature and consultations with social care users and carers. We then used logistic regression to analyse the factors that predict developing an unmet care need over a 10-year period among a sample of those aged 50 and older. Findings: The likelihood of developing unmet care needs does not differ by factors like gender, wealth, social contact, education or health behaviours. The only significant predictors for unmet needs are living alone, being relatively young (though still over 50), not having a longstanding illness, losing a spouse and developing more severe needs. These findings are robust to a variety of model specifications. Limitations: Results of this analysis may be sensitive to the definition of unmet need employed. Implications: These findings contribute to the current debate on the funding and organisation of adult social care in England and will inform policymakers interested in addressing the issue of unmet social care needs among older people.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49002624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scotland is unique in its collection of routine data for all individuals in receipt of social care services. This care encompasses home and personal care services, down to telecare and meals services. As the Scottish population continues to age and local authorities stretch shrinking budgets over an increasing number of people, there is a pressing need to understand how older people use these services to ensure they are delivered in an efficient and effective way. The availability of administrative data in Scotland provides an opportunity to explore how it might be used in a research setting to enhance this understanding. One area of interest concerns the relationship between unpaid care and formal care services. In particular, how unpaid carers might influence older peoples use of formal care services. Whether this influence is positive or negative will have important implications for the costs of care provision. The existing evidence on the impact of unpaid care on social care utilisation is extremely mixed. Scotland provides an interesting context in which to study this relationship because unlike many other jurisdictions, personal care in Scotland is provided free to all individuals aged 65+ who are assessed as needing it. This may affect the incentives faced by unpaid carers, leading to different conclusions about the relationship between unpaid and paid care, compared to previous literature. This paper uses Scotland's unique administrative Social Care Survey (SCS) for the years 2014-2016 to investigate how the presence of an unpaid carer influences personal care use by those aged 65+ in Scotland. The results suggest that unpaid care complements personal care services. Complementarity between unpaid and paid care may imply that incentivising unpaid care could increase personal care costs, and at the same time it points to the potential for unmet need of those who do not have an unpaid carer. The paper highlights some of the limitations of the administrative SCS but also demonstrates how it can be used in an effective way to enhance our understanding in an important, policy relevant area.
{"title":"Utilisation of Personal Care Services in Scotland: The Influence of\u0000 Unpaid Carers","authors":"E. Lemmon","doi":"10.31389/JLTC.23","DOIUrl":"https://doi.org/10.31389/JLTC.23","url":null,"abstract":"Scotland is unique in its collection of routine data for all individuals in receipt of social care services. This care encompasses home and personal care services, down to telecare and meals services. As the Scottish population continues to age and local authorities stretch shrinking budgets over an increasing number of people, there is a pressing need to understand how older people use these services to ensure they are delivered in an efficient and effective way. The availability of administrative data in Scotland provides an opportunity to explore how it might be used in a research setting to enhance this understanding. \u0000One area of interest concerns the relationship between unpaid care and formal care services. In particular, how unpaid carers might influence older peoples use of formal care services. Whether this influence is positive or negative will have important implications for the costs of care provision. The existing evidence on the impact of unpaid care on social care utilisation is extremely mixed. \u0000Scotland provides an interesting context in which to study this relationship because unlike many other jurisdictions, personal care in Scotland is provided free to all individuals aged 65+ who are assessed as needing it. This may affect the incentives faced by unpaid carers, leading to different conclusions about the relationship between unpaid and paid care, compared to previous literature. \u0000This paper uses Scotland's unique administrative Social Care Survey (SCS) for the years 2014-2016 to investigate how the presence of an unpaid carer influences personal care use by those aged 65+ in Scotland. \u0000The results suggest that unpaid care complements personal care services. Complementarity between unpaid and paid care may imply that incentivising unpaid care could increase personal care costs, and at the same time it points to the potential for unmet need of those who do not have an unpaid carer. The paper highlights some of the limitations of the administrative SCS but also demonstrates how it can be used in an effective way to enhance our understanding in an important, policy relevant area.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42686120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rowan Jasper, J. Hughes, A. Roberts, Helen Chester, S. Davies, D. Challis
Context: Many people over the age of 65 receive support from home care providers to enable them to continue to live at home. In the UK, local authorities (England, Wales and Scotland) and Health and Social Care Trusts (Northern Ireland) commission these support services. 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.
{"title":"Commissioning Home Care for Older People: Scoping the Evidence","authors":"Rowan Jasper, J. Hughes, A. Roberts, Helen Chester, S. Davies, D. Challis","doi":"10.31389/JLTC.9","DOIUrl":"https://doi.org/10.31389/JLTC.9","url":null,"abstract":"Context: Many people over the age of 65 receive support from home care providers to enable them to continue to live at home. In the UK, local authorities (England, Wales and Scotland) and Health and Social Care Trusts (Northern Ireland) commission these support services. 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.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46208307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: Poorer mortality rates and quality of care in hospitals outside of office hours is well documented. The literature on adult social (long-term) care, and in particular, care homes, is much less developed. There are, however, a few studies that suggest that outside of Monday to Friday between 9.00am and 16.30pm, quality of care in care homes might be lower. Objective(s): The objective of this study was to compare the social care-related quality of life (SCRQoL) of residents in older adult care homes during office hours (0900 to 16.30) with outside of office hours (evenings and weekends). Method(s): We conducted a nested, cross-sectional study, collecting SCRQoL data using the Adult Social Care Outcomes Toolkit at two time points, office hours (Monday-Friday between 9.00 and 16.30) and outside of office hours. We did not examine nigh times in the homes. Data were collected for 99 older adult care home residents in 13 care homes (5 residential and 8 nursing) and analysed using a combination of non-parametric and parametric techniques. Findings: SCRQoL ratings were lower during the weekends and early evenings than during office hours. The differences were most pronounced in the higher order domains of social participation, occupation and control over daily life. Limitations: The study struggled to explain this variation. This work was both exploratory and small in size. We also did not collect data on levels of staffing. Implications: Further work is required to both confirm our findings and explore the reasons for the difference. Nonetheless, this study challenges the traditional model of care, in which social activities and meaningful pastimes are mostly organised during ‘office hours’. We observed evenings that were very short, as residents tended to return to their room shortly after dinner, and quiet weekends, and this was reflected in residents’ quality of life. This is contrary to the rhetoric of care homes being people’s own homes, where they would be able to choose to remain active and engaged into the evening and on the weekends, as they may have done throughout their lives.
{"title":"Quality of Life in Older Adult Care Homes: Comparing Office Hours with\u0000 Out-of-Office Hours","authors":"N. Smith, A. Towers, Sinead Palmer, Grace Collins","doi":"10.31389/JLTC.29","DOIUrl":"https://doi.org/10.31389/JLTC.29","url":null,"abstract":"Context: Poorer mortality rates and quality of care in hospitals outside of office hours is well documented. The literature on adult social (long-term) care, and in particular, care homes, is much less developed. There are, however, a few studies that suggest that outside of Monday to Friday between 9.00am and 16.30pm, quality of care in care homes might be lower. Objective(s): The objective of this study was to compare the social care-related quality of life (SCRQoL) of residents in older adult care homes during office hours (0900 to 16.30) with outside of office hours (evenings and weekends). Method(s): We conducted a nested, cross-sectional study, collecting SCRQoL data using the Adult Social Care Outcomes Toolkit at two time points, office hours (Monday-Friday between 9.00 and 16.30) and outside of office hours. We did not examine nigh times in the homes. Data were collected for 99 older adult care home residents in 13 care homes (5 residential and 8 nursing) and analysed using a combination of non-parametric and parametric techniques. Findings: SCRQoL ratings were lower during the weekends and early evenings than during office hours. The differences were most pronounced in the higher order domains of social participation, occupation and control over daily life. Limitations: The study struggled to explain this variation. This work was both exploratory and small in size. We also did not collect data on levels of staffing. Implications: Further work is required to both confirm our findings and explore the reasons for the difference. Nonetheless, this study challenges the traditional model of care, in which social activities and meaningful pastimes are mostly organised during ‘office hours’. We observed evenings that were very short, as residents tended to return to their room shortly after dinner, and quiet weekends, and this was reflected in residents’ quality of life. This is contrary to the rhetoric of care homes being people’s own homes, where they would be able to choose to remain active and engaged into the evening and on the weekends, as they may have done throughout their lives.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41279966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. J. V. D. Aa, A. Paulus, S. Klosse, S. Evers, J. Maarse
Context: Throughout Europe, the financial risks of health and long-term care are covered to varying degrees through models of national (health) insurance. Such insurance draws upon the principle of solidarity. Much is unknown on the solidarity-effects of reforms in national insurance schemes. Objective: To present an empirical analysis of the effects of recent reforms in national health insurance on solidarity in one country. Methods: We conducted a comparative analysis of the 2006 health care insurance reform and the 2015 long-term care insurance reform in the Netherlands. A multidimensional analytical framework of solidarity was developed to study the solidarity-effects of both reforms. Findings: Reforms of health care and long-term care insurance in the Netherlands had some solidarity effects, but they should not be overstated. We found evidence for increased and decreased solidarity. Health care insurance seems more ‘immune’ to reductions in solidarity than long-term care insurance. Limitations: The present case study involves reforms in the Netherlands. The solidarity framework is specifically designed for the study of solidarity-effects of reforms on national health and long-term care insurance. Effects on informal arrangements for care are beyond the scope of this study. More detailed and quantitative research is required to investigate how the reforms played out for specific groups, for instance the frail elderly, people with a disability and people with rare conditions. Similarly, long-term effects require further investigation. Implications: Given the limited scope of our analysis, more comparative research (including on an international scale) is required to develop systematic insight into the solidarity-effects of reforms in national health and long-term care insurance.
{"title":"The Impact of Reforms of National Health Insurance on Solidarity in the\u0000 Netherlands: Comparing Health Care Insurance and Long-Term Care\u0000 Insurance","authors":"M. J. V. D. Aa, A. Paulus, S. Klosse, S. Evers, J. Maarse","doi":"10.31389/JLTC.22","DOIUrl":"https://doi.org/10.31389/JLTC.22","url":null,"abstract":"Context: Throughout Europe, the financial risks of health and long-term care are covered to varying degrees through models of national (health) insurance. Such insurance draws upon the principle of solidarity. Much is unknown on the solidarity-effects of reforms in national insurance schemes. Objective: To present an empirical analysis of the effects of recent reforms in national health insurance on solidarity in one country. Methods: We conducted a comparative analysis of the 2006 health care insurance reform and the 2015 long-term care insurance reform in the Netherlands. A multidimensional analytical framework of solidarity was developed to study the solidarity-effects of both reforms. Findings: Reforms of health care and long-term care insurance in the Netherlands had some solidarity effects, but they should not be overstated. We found evidence for increased and decreased solidarity. Health care insurance seems more ‘immune’ to reductions in solidarity than long-term care insurance. Limitations: The present case study involves reforms in the Netherlands. The solidarity framework is specifically designed for the study of solidarity-effects of reforms on national health and long-term care insurance. Effects on informal arrangements for care are beyond the scope of this study. More detailed and quantitative research is required to investigate how the reforms played out for specific groups, for instance the frail elderly, people with a disability and people with rare conditions. Similarly, long-term effects require further investigation. Implications: Given the limited scope of our analysis, more comparative research (including on an international scale) is required to develop systematic insight into the solidarity-effects of reforms in national health and long-term care insurance.","PeriodicalId":73807,"journal":{"name":"Journal of long-term care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47197863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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