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The purpose of this paper is to describe the employment conditions of social care personal assistants (PAs) in England. In England, disabled adults have been able to directly employ people to meet their care or support needs for a number of years, little is known about the employment conditions of people who are directly employed.

PAs were recruited mainly through third sector and user led organisations. A total of 105 social care PAs took part in a semi-structured telephone interview, which on average was an hour long. Interviews were fully transcribed. Quantitative data were analysed using SPSS (v.24) and qualitative data by NVIVO software.

The paper focuses on employment conditions: contracts, pay, pensions, national insurance, overtime, holiday and sick pay, etc. Access to training and support are also described. Though PAs enjoyed considerable job satisfaction, many did not enjoy good employment conditions. Though employer abuse was uncommon, many PAs could arguably be described as exploited. Occupational isolation and lack of support to resolve disputes was striking.

Though this may be currently the largest qualitative study of PAs in the UK, it is nonetheless relatively small and no claims for generalisability are made, though the geographical spread of the sample was wide and recruited from multiple sites.

PAs are an effective way of establishing relationship-based care, and confer direct control to disabled employers. Many PAs experienced high job satisfaction. However, lack of regulation and oversight creates considerable potential for exploitation or abuse. This may make the role less attractive to potential PAs in the medium term.

Social care PAs may be a very effective means of achieving genuinely person-centred care or support for many people. However, PAs do not always appear to enjoy satisfactory conditions of employment and their role is largely unregulated. Growth and long-term sustainability of this emergent role may be jeopardised by these employment conditions.

Little is known about PA working conditions. This study suggests that much more needs to be done to improve these.

The purpose of this paper is to explore how any proposed Women’s Health Strategy could address the needs of women affected by dementia in England.

The authors take the following three perspectives: women living with dementia, female carers and female practitioners supporting people with dementia.

In this paper, the authors explore the current evidence about dementia and female gender under three main strands relating to policy and practise.

There is worldwide interest amongst policy communities in gender inequalities.

The purpose of this paper is to present findings from one element of a study exploring the relationship between personalisation, in the form of personal budgets (PBs) for publicly funded social care and safeguarding.

Semi-structured interviews were conducted with 12 people receiving PBs who had recently been the focus of a safeguarding investigation. Participants were recruited from two English local authority areas and data were subject to thematic analysis.

The analysis identified three main themes: levels of information and awareness; safeguarding concerns and processes; and choice and control. Many of the participants in this small study described having experienced multiple forms of abuse or neglect concurrently or repeatedly over time.

This was a small scale, qualitative study, taking place in two local authorities. The small number of participants may have had strong opinions which may or may not have been typical. However, the study provides some rich data on people’s experiences.

The findings suggest that adults receiving PBs may need information on an ongoing and repeated basis together with advice on how to identify and address poor quality care that they are arranging for themselves. Practitioners need to be aware of the influence of the level of information received and the interaction of organisational or legal requirements when responding to safeguarding concerns when care being supplied tries to reflect the benefits of choice and control.

This paper reports original research asking adults with care and support needs about the interaction between two key policies of safeguarding and personalisation.

The purpose of this paper is to provide an overview of how social care staff experienced applying the Mental Capacity Act (MCA) 2005, following its implementation in 2007 in England and Wales.

A longitudinal qualitative interview study explored the expectations, experiences and practice challenges of social workers and social care staff in relation to implementing the MCA for people with dementia.

The MCA was widely welcomed, although more specific, fine-grained understandings were required. Updating and refresher training may be required, especially in settings where there is high staff turnover. Those in expert or advisory practice roles offer helpful detailed updating and legal digests to roll out to other staff.

Qualitative interviews are subjective and elucidate only what participants wish to cover. However, there were opportunities during this study for participants to be reflective and critical.

Practitioners need initial and sustained continuing professional development. Access to expertise locally is welcomed.

The MCA was implemented five years ago and is largely embedded in practice. The paper provides insight into the evolution of experiences, with suggestions of how to make implementation sustainable.

Local authorities and primary care trusts receive regular instructions to put new legislation into practice, and to ensure appropriate training. This article takes the implementation of the Mental Capacity Act as a case study of how commissioners are involved in such changes, and reports on two models. The MCA is an example of the gains that can be made if commissioners think about implementation across agencies, and between public and private sectors.

The purpose of this paper is to report on a part of a study examining the interrelationships between personalisation and safeguarding practice. Specifically the authors aimed to examine how safeguarding practice is affected by the roll out of personalisation in adult social care, particularly when the adult at risk has a personal budget or is considering this.

A sample of annual reports from Adult Safeguarding Boards in England was accessed for content analysis covering the period 2009-2011. One part of this sample of local authorities was selected at random; the other authorities selected had been early adopters of personalisation. The reports were analysed using a pro forma to collect salient information on personalisation that was cross-referenced to identify common themes and differences.

The authors found variable mentions of personalisation as part of the macro policy context reported in the annual reviews, some examples of system or process changes at mezzo level where opportunities to discuss the interface were emerging, and some small reports of training and case accounts relevant to personalisation. Overall these two policy priorities seemed to be more closely related than had been found in earlier research on the interface between adult safeguarding and personalisation.

There was wide variation in the annual reports in terms of detail, size and content, and reports for only one year were collected. Developments may have taken place but might not have been recorded in the annual reports so these should not be relied upon as complete accounts of organisational or practice developments.

Authors of Safeguarding Adults Board reports may benefit from learning that their reports may be read both immediately and potentially in the future. They may wish to ensure their comments on current matters will be intelligible to possible future readers and researchers.

There does not appear to have been any other previous study of Safeguarding Adult Boards’ annual reports. Documentary analysis at local level is under-developed in safeguarding studies.

Financial abuse of people with dementia is of rising concern to family carers, the voluntary sector and professionals. Little is known about preventative and early response practice among community services staff. The purpose of this paper is to investigate voluntary sector staff's views of the risks of managing money when a person has a dementia and explore ways that individuals may be protected from the risks of financial abuse.

An online survey of staff of local Alzheimer's Society groups across England was conducted in 2011 and was completed by 86 respondents. Open-ended responses supplemented survey questions. Statistical analysis and content analysis identified emergent findings.

Most respondents said their people with dementia experienced problems with money management, with almost half the respondents reporting encountering cases of financial abuse over the past year. Most were alert to warning signs and vulnerabilities and offered suggestions relevant to practice and policy about prevention and risk minimization.

Adult safeguarding practitioners are likely to encounter money management uncertainties and concerns about exploitation of people with dementia. They may be contacted by community-based support staff from the voluntary sector about individual queries but could ensure that such practitioners are engaged in local training and networking activities to promote their skills and confidence.

As with other forms of elder abuse, professionals need to be aware of risks of financial abuse and be able to suggest effective yet acceptable preventive measures and ways to reduce risks of harm and loss. Further publicity about adult safeguarding services may be needed among local community support services.

There have been few studies investigating the views of people working with people with dementia in the community about adult safeguarding.

The Mental Capacity Act 2005 was implemented in England and Wales in 2007. This article reports the findings of interviews with 15 adult safeguarding co‐ordinators in the London area about the operation of the Act and its impact upon adult safeguarding work, particularly in relation to people with dementia. The interviews covered participants' own training and understanding of the Act, their confidence in practice and capacity to be local sources of expertise about the Act and their perceptions of whether its existence is known among the public. The article concludes that adult safeguarding co‐ordinators are mostly well informed but would welcome specific updating, especially around the new offences introduced by the Act.

Mental health problems in later life are common and damaging experiences for individuals, their families and those who support them. Some become almost the defining feature of the older person and, while they are challenging professionally and costly for society, they are also influenced by the twin discriminations of stigma and ageism. In this, the last in our series on older people's mental health, we pull together some other key messages from the series and set them in the context of current and future service commissioning and provision. We point to remaining gaps in provision and suggest how commissioners might approach the problems of mental ill‐health in later life in a context of declining resources.

Little is known about migrant Indian care workers working in long-term care facilities for people with dementia in England and the purpose of this paper is to remedy this lack of information in the light of political interest in immigration to the UK and continued staff shortages in parts of the social care sector.

This pilot study investigated the experiences of workplace acculturation among 12 migrant Indian care workers who were employed in English care homes. Qualitative face-to-face interviews were conducted in 2013. Analysis of the interviews was conducted using principles of interpretative phenomenological analysis.

Following analysis five themes emerged along an acculturation timeline. First, during the first six months of their employment, the migrant care workers recalled feeling vulnerable, seemingly marked by a sense of insecurity and an overwhelming state of cognitive burden within an unfamiliar cultural context. Second, simultaneously, the migrants felt perturbed about their new role as direct care workers. Third, few had been able to draw on their networks of friends and relatives to build up knowledge of their new work environments before starting care home employment. Fourth, two years into the work, although they reported feeling better adapted, psychological and socio-cultural adjustments were still thought to be needed. Fifth, most participants retained their ambition to be recognised as a qualified nurse in the UK and to pursue a nursing career outside the social care sector.

This is a pilot study in which 12 migrant Indian care home workers were interviewed. Further interviews might provide a greater range of views and experiences. The care homes that participated in this research were in the London region where staff shortages are common in dementia services such as care homes.

The findings suggest a need for employers and human resource managers to respond to the specific needs of Indian and other migrants working with older people who are resident in care homes. Such responses should reflect the timeline of their acculturation and employers need also to acknowledge and address aspirations to move on to NHS work.

This study is unique to the best of the authors’ knowledge in addressing Indian care workers specifically as a substantial part of the migrant care workforce in the UK. It offers information about their perceptions and suggests practical human response and managerial initiatives.