Search results

This article describes the development of the Supported to Independent Living project (SIL), which is for the support and care for people with mental health needs in Oxfordshire to live as independently as possible in ordinary housing in the community. The project is a partnership between NHS Oxfordshire (Primary Care Trust), the Oxfordshire Supporting People programme and Oxfordshire County Council Social and Community Services.Although there was a very vigorous development of community living for people with longstanding mental health needs through the provision of group homes, particularly in Oxford City that started in 1963, there has not been an overall strategy for the development of mental health services for the County as a whole. The needs of a diverse, younger, often more mobile and potentially more challenging group of service users for housing with appropriate care and support have not been met.A joint strategy between the County Council and the Primary Care Trust (PCT) to meet these needs has therefore been developed that introduces a pathway of linked accommodation and support arrangements. These range from intensive support through to floating support in the community, and are intended to offer individuals a guided pathway away from specialist services to more mainstream provision. The services are based on the principles of recovery, personalisation and ordinary housing.As well as achieving significantly reconfigured services the strategy has to deliver savings to meet the cuts imposed on the Supporting People programme grant by Central Government.The project has involved the PCT and the County Council in close partnership working, and important and significant involvement of and engagement with service users and carers. A framework agreement has been agreed by all of the organisations involved. It sets out the roles and responsibilities of each and covers local government, the NHS, housing and support.

Purpose: The aim is to explore how family relations are affected by societal changes in relation to informal and formal caregiving and self-determination of older adults.

Design/methodology/approach: Care managers (CMs)/social workers (SWs) (N = 124) participated in a comparative vignette study including Japan, South Korea, and Sweden. Systems theory was used.

Findings: Japanese CMs/SWs clearly describe their efforts to create networks in a relational way between formal and informal actors in the community. South Korean CMs/SWs balance between suggesting interventions to support daily life at home or a move to a nursing home, often acknowledging the family as the main caregiver. In Sweden, CMs/SWs highlight the juridical element in meeting the older adult and the interventions offered, and families primarily give social support. Regarding self-determination, the Japanese priority is for CMs/SWs to harmonize within the family and the community. South Korean CMs/SWs express ambivalent attitudes to older adults’ capability for self-determination in the intersection between formal and family care. Swedish CMs/SWs adhere to the older adult’s self-determination, while acknowledging the role of the family in persuading the older adult to accept interventions. The results suggest emerging defamilialization in South Korea, while tendencies to refamilialization are noticed in Japan and Sweden, albeit in different ways.

Research limitations/implications: In translation, nuances may be lost. A focus on changing families shows that country-specific details in care services have been reduced. For future research, perspectives of “care” need to be studied on different levels.

Originality/value: Using one vignette in three countries with different welfare regimes, discussing changing views on families’, communities’ and societal caregiving is unique. This captures changes in policy, influencing re- and defamilialization.

A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised healthcare support for care home residents has resulted in poorer outcomes, compared with community-dwelling older people. However, little is known about the forms, staff mix, organisation and delivery of such services for residents’ physical healthcare needs. The paper aims to discuss these issues.

This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to provide an overview of the range of healthcare services delivered to care homes and to identify core features of variation in their organisation, activities and responsibilities. The eligibility criteria for studies were services designed to address the physical healthcare needs of older people, permanently residing in care homes, with or without nursing. To search the literature, terms relating to care homes, healthcare and older people, across ten electronic databases were used. The quality of service descriptions was appraised using a rating tool designed for the study. The evidence was synthesised, by means of a narrative summary, according to key areas of variation, into models of healthcare support with examples of their relative effectiveness.

In total, 84 studies, covering 74 interventions, identified a diverse range of specialist healthcare support services, suggesting a wide variety of ways of delivering healthcare support to care homes. These fell within five models: assessment – no consultant; assessment with consultant; assessment/management – no consultant; assessment/management with consultant; and training and support. The predominant model offered a combination of assessment and management. Overall, there was a lack of detail in the data, making judgements of relative effectiveness difficult. Recommendations for future research include the need for clearer descriptions of interventions and particularly of data on resident-level costs and effectiveness, as well as better explanations of how services are implemented (review registration: PROSPERO CRD42017081161).

There is considerable debate about the best means of providing healthcare to older people in care homes. A number of specialist initiatives have developed and this review seeks to bring these together in a comparative approach deriving models of care of value to policy makers and commissioners.

This article refers to common values and principles underlying personalisation and housing, and the importance of personalisation for providers like Hanover (a leading provider of housing and support services for older people). It also refers to challenges that personalisation presents for supported housing services, such as extra care. Possible responses to these challenges include a re‐emphasis on listening to what residents ‐ as well as commissioners ‐ want, an honest appraisal of the concept of choice and its implications, especially in services such as extra care, and asking whether people might still be asked to choose a ‘package’ of core services, in order to retain sustainable models that will support other people now and in the future. The article then describes the Housing Associations' Charitable Trust's (hact's) Up2Us project, a key initiative to put supported housing service users centre stage in commissioning and purchasing care and support, in which Hanover and the London Borough of Barking and Dagenham are among the partners.

Approximately 100,000 people in the UK aged 75 and over have concurrent dementia and sight loss, but current understanding of their experiences, needs and preferences is limited. The purpose of this paper is to report on a research project that explored the provision of social care and support for older people with both conditions.

The project was a collaboration between the universities of York, Worcester, Bournemouth and Cambridge, supported by the Thomas Pocklington Trust and the Housing and Dementia Research Consortium. Data for this paper were drawn from focus groups held in 2013 involving 47 professionals across the dementia, sight loss and housing sectors.

Thematic analysis identified five main barriers to providing high-quality, cost-effective social care and support: time constraints; financial limitations; insufficient professional knowledge; a lack of joint working; and inconsistency of services. The requirements of dementia and sight loss often conflict, which can limit the usefulness of equipment, aids and adaptations. Support and information needs to address individual needs and preferences.

Unless professionals consider dementia and sight loss together, they are unlikely to think about the impact of both conditions and the potential of their own services to provide effective support for individuals and their informal carers. Failing to consider both conditions together can also limit the availability and accessibility of social care and support services. This paper is based on input from a small sample of self-selecting professionals across three geographical regions of England. More research is needed in this area.

There are growing numbers of people living with concurrent dementia and sight loss, many of whom wish to remain living in their own homes. There is limited awareness of the experiences and needs of this group and limited provision of appropriate services aids/adaptations. A range of measures should be implemented in order to support independence and well-being for people living with both conditions and their family carers. These include increased awareness, improved assessment, more training and greater joint working.

People living with dementia or sight loss are at high risk of social isolation, increasingly so for those with both conditions. Services that take an inclusive approach to both conditions can provide crucial opportunities for social interaction. Extra care housing has the potential to provide a supportive, community-based environment that can help residents to maintain social contact.

This paper adds much-needed evidence to the limited existing literature, and reflects the views of diverse professionals across housing, health and social care.

Using Andersen’s (1968) behavioral model of health services use as a guiding conceptual framework, this study examined how receipt of family-centered care relates to the perceived family challenges for families of children with autism spectrum disorder (ASD).

Data from the 2009–2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) were analyzed for 812 parents of children with ASD.

Multiple regression analyses provided substantive statistical evidence that a child’s race, the adequacy of a family’s insurance, and the stability of child’s health care needs significantly contributed to predicting his or her receipt of family-centered care. Further results suggested a relationship between receipt of family-centered care and the perception of challenge for these families; families receiving family-centered care perceive fewer challenges and feel less unmet need for child health services.

Family-centered professionals provide critical voices in the development of policies and programs geared toward improving the health outcomes of children with ASD and their families.

Improvements in neonatal and paediatric care mean that many children with complex care needs (CCNs) now survive into adulthood. This cohort of children places great challenges on health and social care delivery in the community: they require dynamic and responsive health and social care over a long period of time; they require organisational and delivery coordination functions; and health issues such as minor illnesses, normally presented to primary care, must be addressed in the context of the complex health issues. Their clinical presentation may challenge local care management. The project explored the interface between primary care and specialised health services and found that it is not easily navigated by children with CCNs and their families across the European Union and the European Economic Area countries. We described the referral-discharge interface, the management of a child with CCNs at the acute–community interface, social care, nursing preparedness for practice and the experiences of the child and family in all Models of Child Health Appraised countries. We investigated data integration and the presence of validated standards of care, including governance and co-creation of care. A separate enquiry was conducted into how care is accessed for children with enduring mental health disorders. This included the level of parental involvement and the presence of multidisciplinary teams in their care. For all children with CCNs, we found wide variation in access to, and governance of, care. Effective communication between the child, family and health services remains challenging, often with fragmentation of care delivery across the health and social care sector and limited service availability.

Four routes or pathways have now been identified by which individuals may come within the scope of PSA 16 National Indicator 149, which is concerned with monitoring efforts to achieve settled accommodation for individuals with significant mental health problems. This article focuses on their needs and the identification of those with mental health needs as seen through these four principal routes. An understanding of these four possible pathways can help to identify areas for priority action, local delivery chains and partnerships, and also highlight some of the challenges and risks in and for delivery.

Enabling optimal care transitions for older people remains a key challenge facing policy‐makers and service providers. This qualitative Australian study aimed to provide a comprehensive picture of the factors/issues surrounding care transitions from the perspective of older people and their carers. It documents how supports and services are searched for and gained during the care transition process and the effect of this process on older people and their families. These findings have implications for service provision and policy relating to both assisting older people to age in place wherever possible and facilitating optimal care transitions when they are required.