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Persistent and particular health and social care challenges face socially excluded groups and communities in the more deprived areas of the country. Involvement of communities in design and delivery of services, including those whose voices have traditionally not been heard, will help to shape services to meet better their health and well‐being needs. Effective community‐led commissioning can empower individuals and communities by giving them the chance to voice their needs, while local ownership of the process will increase the relevance of services, and improve their uptake and sustainability. For commissioners, the ‘World Class’ commissioning agenda is about connecting development of services with the real requirements of communities, and increasing engagement and satisfaction with services.

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.

Recently arrived older refugees in resettlement countries are a particularly vulnerable population who face many risks to their health and well‐being, and many challenges in accessing services. This paper reports on a project undertaken in Victoria, Australia to explore the needs of older people from 14 recently arrived refugee communities, and the barriers to their receiving health and aged care. Findings from consultations with community workers and service providers highlight the key issues of isolation, family conflict and mental illness affecting older refugees, and point to ways in which policy‐makers and service providers can better respond to these small but deserving communities.

This paper presents findings from a qualitative study that sought to identify what works well in supporting older people to live in their own homes and local communities. Drawing on data from six focus groups conducted with key stakeholders, including older people, carers, care managers and direct service providers, the shortcomings of existing services to meet the needs of older people are recognised and the paper seeks to move discusion forward to what might help improve provision. Examples identified during the focus groups are explored and highlight the importance of enabling older people to maintain community connections and draw on existing community facilities. To be effective, support needs to be underpinned by a person‐centred approach which takes into account individual preferences and priorities, and is organised locally to where older people live. Statutory organisations are often constrained by restrictive thinking and financial pressures lead to resourcecentred rather than person‐centred responses to individuals in need. Our findings suggest that commissioners of services should be more creative in developing flexible providers in local communities and that we consider approaches that may be helpful in achieving this and transforming support arrangements. The potential of an action research programme to explore the ideas raised and enable processes for development, outcomes for older people, their carers and the communities in which they live, as well as the costs, to be tested comparatively with traditional services is noted. The importance of capacity building and investment in the independent sector and other community partners is critical to achieving change.

This paper aims to explore the match between needs and services related to participation for frail older adults receiving home care.

A qualitative multiple case study was conducted with 11 triads each involving an elder, a caregiver and a healthcare provider working in a Health and Social Services Centers (HSSCs).

Although HSSCs in Québec are supposed to promote social integration and participation of older adults, services provided to the older adults in this study focused mainly on safety and independence in personal care, dressing, mobility and nutrition, without fully meeting older adults’ needs in these areas. Discrepancies between needs and services may be attributable to the assessment not covering all the dimensions of social participation or accurately identifying older adults’ complex needs; older adults’ and their caregivers’ difficulties identifying their needs and accepting their limitations and the assistance offered; healthcare providers’ limited knowledge and time to comprehensively assess needs and provide services; guidelines restricting the types and quantity of services to be supplied; and limited knowledge of older adults, caregivers and healthcare providers about services and resources available in the community.

To improve and maintain older adults’ participation, a more thorough assessment of their participation, especially in social activities, is required, as is greater support for older adults and their families in using available community resources. It is also important to review the services provided by HSSCs and to optimize partnerships with community organizations.

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.

The United Kingdom as it approaches the millennium is frequently described as both an ‘information society’ and an ‘ageing society’. This paper outlines the findings of a piece of research exploring the relationship between older people and information, with particular references to the National Health Service and Community Care Act, 1990. The research findings suggest that urgent action is required if older people are fully to participate in and benefit from the information society.

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.

Hartlepool's connected care pilot is a partnership between residents, councillors, Turning Point, the NHS and the local council in one of the most deprived wards in England. A local audit was conducted by residents, demonstrating the relevance of information held by the community about its needs, ambitions and interactions with services. A new service model aims to provide integrated responses to complex need, commissioned through a local partnership agreement and delivered through a social enterprise. The implementation will demonstrate how far real power is shifting to local people.

Through a literature review, this article aims to identify the needs of those people with dementia who wish to remain at home, and those of their carers. It goes on to model a range of services that can be linked together to meet these needs comprehensively.