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Josie Dixon, Simon Biggs, Martin Stevens, Jill Manthorpe and Anthea Tinker
The purpose of this paper is to set out and discuss findings from a developmental study, commissioned by the English Department of Health and the charity, Comic Relief…
The purpose of this paper is to set out and discuss findings from a developmental study, commissioned by the English Department of Health and the charity, Comic Relief, which was commissioned to clarify definitional issues and recommend ways of operationalising key concepts for a prospective survey of abuse, neglect and loss of dignity in the care of older people in residential care in the United Kingdom (UK).
As well as drawing upon their experience and expertise, the authors conducted a review of the literature, held consultation events with a range of stakeholders and undertook in‐depth interviews with international academics and care home residents.
Existing definitions and descriptions vary widely in form and content, are commonly subjective and imprecise and frequently make reference to abstract concepts which themselves need defining. Many of the concepts are also inherently evaluative, unspecific and open to interpretation. The study considered how, in this context, practical research definitions that are clear, unambiguous and widely acceptable to a range of stakeholders could be developed.
The study took a UK focus and the review of literature was confined to the English language. Further research might usefully extend discussion about definitions cross‐culturally. The interview samples were small and should not be considered to be representative.
The paper identifies key issues in defining the perpetrator. It focuses on the concepts of trust and intentionality, the responsibilities of the care home and multiple perpetrators and makes practical proposals for operationalising the “perpetrator” in research. Recommendations from the study were positively received and have directly informed the Government‐funded research programme in England.
Josie Evans, Karen Methven and Nicola Cunningham
As part of a pilot studyassessing the feasibility of record-linking health and social care data, the purpose of this paper is to examine patterns of non-delivery of home…
As part of a pilot studyassessing the feasibility of record-linking health and social care data, the purpose of this paper is to examine patterns of non-delivery of home care among older clients (>65 years) of a social home care provider in Glasgow, Scotland. The paper also assesses whether non-delivery is associated with subsequent emergency hospital admission.
After obtaining appropriate permissions, the electronic records of all home care clients were linked to a hospital inpatient database and anonymised. Data on home care plans were collated for 4,815 older non-hospitalised clients, and non-delivered visits were examined. Using case-control methodology, those who had an emergency hospital admission in the next calendar month were identified (n=586), along with age and sex-matched controls, to determine whether non-delivery was a risk factor for hospital admission.
There were 4,170 instances of “No Access” non-delivery among 1,411 people, and 960 instances of “Service Refusal” non-delivery among 427 people. The median number of undelivered visits was two among the one-third of clients who did not receive all their planned care. There were independent associations between being male and living alone, and non-delivery, while increasing age was associated with a decreased likelihood of non-delivery. Having any undelivered home care was associated with an increased risk of emergency hospital admission, but this could be due to uncontrolled confounding.
This study demonstrates untapped potential for innovative research into the quality of social care and effects on health outcomes.
Non-delivery of planned home care, for whatever reason, is associated with emergency hospital admission; this could be a useful indicator of vulnerable clients needing increased surveillance.