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Older care home residents who are assisted financially by their local authority have to have their placements reviewed at least annually. Such reviews provide an opportunity for the older person and their relatives to comment on the care that they receive.One of the themes that emerged from a recent study into the care home review system in one local authority was that older people who self‐fund do not have this opportunity and that this was inequitable. This paper discusses the possible benefits of extending the review system to include self‐funders, together with some of the issues that this might raise.

The purpose of this paper is to look at family carers’ views and experiences of self-funded care for older people with an emphasis on attitudes to public intervention.

Semi-structured interviews were conducted with family carers in a densely populated city in Northern England. Study participants were recruited according to a purposive sampling strategy; data analysis was based on a qualitative content analysis approach.

The paper concludes that it may not be straightforward for local authorities to engage with family carers as appropriate under the Care Act 2014. An issue is that family carers do not envisage an intervention of the local authority in circumstances involving the use of privately paid social services.

Qualitative information gathered within a broad study of family carers’ views, attitudes and practices of care of dependent older people have been interpreted in the light of the provisions of the Care Act 2014 concerning self-funders. The qualitative approach and the limited number of study participants are issues with the generalisation of findings.

Only a handful of studies have attempted to look into family carers’ experiences of self-funded care and the paper aims to contribute to such limited literature. It also provides an evidence-based assessment of the challenges associated with the implementation of the Care Act 2014.

The separation of housing from support and care services should lead to greater choice for service users. The process of separation has exposed the need for co‐ordination between housing, care and support to give a proper contractual framework of accountability and responsibility towards the tenant. This article gives some of the detail of funding, tenancy, support and agency agreements which provide the formal structure for joined‐up working.

This chapter addresses the grand challenge of an aging society and the subsequent growing demand for in-home care for the elderly – often referred to as homecare. It examines how emergent homecare models in England differ from the “time and task” model and how they are shaping the care market. These models offer new approaches regarding what, how, and when care is delivered at home. Homecare providers face rising demand driven not only by population aging but also by market demand for personalized care, choice, continuity of care, and real-time availability. The landscape presents an opportunity for innovative models to become established, by offering a more inducing service design and value propositions that respond to customers' needs. Using the “business model canvas” to guide data collection, this study presents an ethnographic case analysis of four homecare organizations with distinct emergent homecare models. The study includes 14 months of field observation and 33 in-depth interviews. It finds that providers are becoming increasingly aware of evolving customer needs, establishing models such as the “uberization,” “community-based,” “live-in,” and “preventative” described in the chapter. These models are becoming more pervasive and are mostly market-driven; however, some of their innovations are market shaping. The major innovations are in their value propositions, partnership arrangements, and customer segments. Their value propositions focus on well-being outcomes, including choice and personalization for care users; their workforces are perceived to be a major stakeholder segment, and their networks of partners offer access to complementary services, investments, and specialist knowledge.

This paper aims to whether current public expenditure on adult social care services might be associated with the number of delayed days of care attributable to the social care system in England.

Panel econometric models on data from local authorities with adult social care responsibilities in England between 2013–2014 and 2018–2019.

After controlling for other organisational sources of inefficiency, the level of demand in the area and the income poverty amongst the resident older population, this paper finds that a 4.5% reduction in current spending per head on adult social care per older person in one year is associated with an increase by 0.01 delayed days per head the following year.

Given the costs of adverse outcomes of delayed transfers of care reported in the literature, this paper suggests that budgetary constraints to adult social care services would represent a false economy of public funds.

This is the first paper that models the association between public spending on adult social care and delayed transfers of care due to issues originating in the social care system in England.

This article introduces the background and drivers behind the use of telecare and discusses the fit of telecare in providing support to people to enable them to continue living independently within their own home. It mentions the need to see telecare as one element within a care solution and illustrates the importance of an overall client‐focused assessment approach if a better long‐term outcome is to be achieved. It suggests that telecare needs to be embedded within the care pathway to enable it to become integrated and mainstreamed. Information, awareness, training and good signposting will be important factors to understanding the potential benefits of telecare. Evidence‐based practice data is important to provide a resource both for practitioners and commissioners of services to make decisions. This article reaffirms that telecare and other technology should fit around the user and not the other way round.

The Department of Health plans to reform the NHS and social care complaints arrangements from April 2009. This article looks at the proposals and considers some of the key issues.

Considering the views of service users is important to identify their needs as this helps providers to develop appropriate and responsive services. For older people receiving home care, recognising their needs is the first step towards supporting them to maintain independence and promote wellbeing. The paper aims to discuss these issues.

A systematic review was conducted in 2014 to explore the personal experiences of older people in England about the care and support they received at home. Studies published between 2004 and 2013 were identified from bibliographic databases and websites. A total of 17 studies satisfied the inclusion criteria. Data were extracted using a standardised coding tool and narratively synthesised. Study quality was evaluated.

Nine themes were identified. Older people valued an approach that was person centred, flexible and proactive to respond to their changing needs and priorities, focusing on what they can or would like to do to maintain their independence. Allowing time to build trust between older people and their care workers helped to realise older peoples’ aspirations and goals. Practical help to promote choice and reduce social isolation was perceived to be as important as personal care.

Evidence from this review contributed to the development of a social care guideline on home care, and informed key practice recommendations for care providers in England.

This review highlighted the value older people place in person-centred care incorporating practical help both inside and outside the realm of personal care.

Serious Case Reviews (SCRs, now Safeguarding Adults Reviews (SARs)) may be held at local level in England when a vulnerable adult dies or is harmed, and abuse or neglect is suspected, and there is cause for concern about multi-agency safeguarding practice. There has been no analysis of SCRs focussing on pressure ulcers. The purpose of this paper is to present findings from a documentary analysis of SCRs/SARs to investigate what recommendations are made about pressure ulcer prevention and treatment in a care home setting in the context of safeguarding. This analysis is presented in cognisance of the prevalence and risks of pressure ulcers among care home residents; and debates about the interface of care quality and safeguarding systems.

Identification of SCRs and SARs from England where the person who died or who was harmed had a pressure ulcer or its synonym. Narrative and textual analysis of documents summarising the reports was used to explore the Reviews’ observations and recommendations. The main themes were identified.

The authors located 18 relevant SCRs and 1 SAR covering pressure ulcer care in a care home setting. Most of these inquiries into practice, service communications and the events leading up to the death or harm of care home residents with pressure ulcers observed that there were failings in the care home, but also in the wider health and care systems. Overall, the reports reveal specific failings in multi-agency communication and in quality of care. Pressure ulcers featured in several SCRs, but it is problems and inadequacies with care and treatment that moved them to the safeguarding arena. The value of examining pressure ulcers as a key line of inquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what constitutes optimal care and treatment. In the new Care Act 2014 context they may continue to feature in safeguarding enquiries and investigations as they may be possible symptoms of system failures.

Reviews vary in content, structure and accessibility making it hard to compare their approach, findings and recommendations. There are risks in drawing too many conclusions from the corpus of Reviews since these are not published in full and contexts have subsequently changed. However, this is the first analysis of these documents to take pressure ulcers as the focus and it offers valuable insights into care home practices amid other systems and professional activity.

This analysis highlights that it is not inevitably poor quality care in a care home that gives rise to pressure ulcers among residents. Several SCRs note problems in wider communications with healthcare providers and their engagement. Nonetheless, poor care quality and negligence were reported in some cases. Various policies have commented on the potential overlap between the raising of concerns about poor quality care and about safeguarding. These were highlighted prior to the Care Act 2014 although current policy views problems with pressure ulcers more as care quality and clinical concerns.

The value of this documentary analysis is that it rests on real case examples and scrutiny at local level. Future research could consider the findings of SARs, similar documents from the rest of the UK, and international perspectives.

The value of having a set of documents about adult safeguarding is that they lend themselves to analysis and comparison. This first analysis to focus on pressure ulcers addresses wider considerations related to safeguarding policy and practice.