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Article
Publication date: 7 June 2019

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

This study demonstrates untapped potential for innovative research into the quality of social care and effects on health outcomes.

Originality/value

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.

Details

Quality in Ageing and Older Adults, vol. 20 no. 2
Type: Research Article
ISSN: 1471-7794

Keywords

Article
Publication date: 7 September 2022

Koji Ueno, Lacey J. Ritter, Randi Ingram, Taylor M. Jackson, Emily Daina Šaras, Jason V. D'Amours and Jessi Grace

The authors aimed to identify the nature of customer harassment against lesbian, gay, bisexual, transgender, and queer (LGBTQ) workers.

Abstract

Purpose

The authors aimed to identify the nature of customer harassment against lesbian, gay, bisexual, transgender, and queer (LGBTQ) workers.

Design/methodology/approach

The authors analyzed data from in-depth interviews with 30 LGBTQ service workers in the United States who had recently experienced customer harassment.

Findings

Among various forms of customer harassment LGBTQ workers reported, some showed commonalities with previously reported cases of race-based and gender-based customer harassment. However, other cases highlighted unique aspects of LGBTQ-based customer harassment—customers morally condemned their LGBTQ identities, refused their service while displaying emotional disgust, and made sexual advances while imposing sexual stereotypes and fantasies about LGBTQ people. Experiences of customer harassment varied across subgroups of workers who had specific sexual and gender identities, and LGBTQ workers of color were harassed for their LGBTQ and racial identities simultaneously.

Originality/value

Past research on group-based customer harassment has focused on incidents against straight, cisgender women and workers of workers of color, but the present study identified the nature of customer harassment that targeted workers' LGBTQ status.

Details

Equality, Diversity and Inclusion: An International Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2040-7149

Keywords

Article
Publication date: 9 February 2015

Suzy Braye, David Orr and Michael Preston-Shoot

– The purpose of this paper is to report the findings from research into 40 serious case reviews (SCRs) involving adults who self-neglect.

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Abstract

Purpose

The purpose of this paper is to report the findings from research into 40 serious case reviews (SCRs) involving adults who self-neglect.

Design/methodology/approach

The study comprised analysis of 40 SCRs where self-neglect featured. The reviews were found through detailed searching of Local Safeguarding Adult Board (LSAB) web sites and through contacts with Board managers and independent chairs. A four layer analysis is presented of the characteristics of each case and SCR, of the recommendations and of the emerging themes. Learning for service improvement is presented thematically, focusing on the adult and their immediate context, the team around the adult, the organisations around the team and the Local Safeguarding Board around the organisations.

Findings

There is no one typical presentation of self-neglect; cases vary in terms of age, household composition, lack of self-care, lack of care of one's environment and/or refusal to engage. Recommendations foreground LSABs, adult social care and unspecified agencies, and focus on staff support, procedures and the components of best practice and effective SCRs. Reports emphasise the importance of a person-centred approach, within the context of ongoing assessment of mental capacity and risk, with agencies sharing information and working closely together, supported by management and supervision, and practising within detailed procedural guidance.

Research limitations/implications

There is no national database of SCRs commissioned by LSABs and currently there is no requirement to publish the outcomes of such inquiries. It may be that there are further SCRs, or other forms of inquiry, that have been commissioned by Boards but not publicised. This limits the learning that has been available for service improvement.

Practical implications

The paper identifies practice, management and organisational issues that should be considered when working with adults who self-neglect. These cases are often complex and stressful for those involved. The thematic analysis adds to the evidence-base of how best to approach engagement with adults who self-neglect and to engage the multi-agency network in assessing and managing risk and mental capacity.

Originality/value

The paper offers the first formal evaluation of SCRs that focus on adults who self-neglect. The analysis of the findings and the recommendations from the investigations into the 40 cases adds to the evidence-base for effective practice with adults who self-neglect.

Details

The Journal of Adult Protection, vol. 17 no. 1
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 2 December 2020

Stephen Martineau

The paper examines three English research papers on self-neglect, from 1957, 1966 and 1975, discussing them in the context of more recent thinking and the statutory…

Abstract

Purpose

The paper examines three English research papers on self-neglect, from 1957, 1966 and 1975, discussing them in the context of more recent thinking and the statutory framework in England.

Design/methodology/approach

In reviewing the three research papers, developments and points of continuity in the field of self-neglect were identified and are discussed in this paper.

Findings

In light of the findings of the three articles, the present paper traces some of the classificatory refinements in this field that have taken place since the papers were published, notably in respect of hoarding and severe domestic squalor. Some of the difficulties in making judgements about behaviour thought to breach societal norms are described, and the challenges practitioners face in intervening in cases, particularly where the person concerned is refusing assistance, are examined.

Originality/value

By drawing on the historical research context, the paper contributes to our current understanding of the field of self-neglect.

Details

The Journal of Adult Protection, vol. 23 no. 1
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 15 August 2011

Hilary Brown

This review of the decision‐making literature aims to challenge the rational model of decision‐making upon which the Mental Capacity Act (MCA) 2005 is premised.

3688

Abstract

Purpose

This review of the decision‐making literature aims to challenge the rational model of decision‐making upon which the Mental Capacity Act (MCA) 2005 is premised.

Design/methodology/approach

The paper forms part of a larger study commissioned by the Office of the Public Guardian looking into complex cases.

Findings

The literature supported the study findings that decisions are not made in a linear way and identified the importance of history and memory, motivation and drive, mood and stability, and openness to influence when assessing the mental capacity of vulnerable people, especially in the context of self‐neglect.

Practical implications

This paper will inform workers in health and social care about the emotional factors that influence decision‐making and increase their ability to make nuanced assessments.

Social implications

Taken together, with other publications from this project, this paper alerts practitioners to situations where vulnerable people are out of their depth; when the role of depression and anxiety may be at least as salient as their understanding of possible consequences and when the past may exert more control over their actions than their understanding of future options.

Originality/value

The paper's added value is that it uses ideas that are current within academic psychology to make explicit some of the factors that lead to complexity when assessing mental capacity under the MCA, especially in the context of self‐neglect.

Details

The Journal of Adult Protection, vol. 13 no. 4
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 5 April 2013

Hilary Brown and Liz Marchant

The purpose of this paper is to explore the way that practitioners apply the 2005 Mental Capacity Act (MCA) in complex cases involving people with learning disabilities…

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Abstract

Purpose

The purpose of this paper is to explore the way that practitioners apply the 2005 Mental Capacity Act (MCA) in complex cases involving people with learning disabilities who cannot make some key decisions by themselves. Like many qualitative studies it began with a felt sense that practitioners were struggling to apply the clear framework set out in the Act to real life situations, and that some of the decisions they were faced with did not fit neatly into the linear, cognitive model of decision making set out in the MCA and its accompanying guidance.

Design/methodology/approach

The study was conducted under the aegis of the Office of the Public Guardian (OPG) during 2010‐2011. A number of “complex” cases were obtained from Social Services, Primary Care Trusts and other organisations and subjected to thematic analysis. The current paper focuses on the 16 cases that involved people with learning disabilities.

Findings

A number of issues were identified that underlay the complexity of the cases examined. The cases drew attention, in particular, to the way in which practitioners were confronted with mounting concerns as opposed to single, discrete decisions, with the risk that decisions could be delayed until positive choices were much less available.

Originality/value

The aim of the study was to support the use of the Act in these situations and to give practitioners confidence in applying its principles across a wide range of diverse circumstances. Although the original study specifically related to the English legislation, the factors that led people to consider a case “complex” would apply equally in other jurisdictions. The study also shed light on difficulties that arise when intervening in less formal ways.

Details

Tizard Learning Disability Review, vol. 18 no. 2
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 15 September 2020

Michael Preston-Shoot

The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis and explore the degree to…

Abstract

Purpose

The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis and explore the degree to which SARs draw upon available research and learning from other completed reviews.

Design/methodology/approach

Further published reviews are added to the core data set, mainly drawn from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains used previously. The four domains and the thematic analysis are rounded in the evidence-based model of good practice, reported in this journal previously. Multiple exclusion homelessness and alcohol misuse are prominent in this sample of reviews.

Findings

Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. Multiple exclusion homelessness emerges as a subset within this sample, demonstrating that SABs are engaging in reviews of people who die on the streets or in temporary accommodation.

Research limitations/implications

The national database of reviews commissioned by SABs remains incomplete and does not contain many of the SARs reported in this evolving data set. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. NHS Digital annual data sets do not enable identification of reviews by types of abuse and neglect. It is possible, therefore, that this data set is also incomplete. Drawing together the findings from the reviews nonetheless builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice.

Practical implications

Answering the question “why” remains a significant challenge for safeguarding adult reviews. The findings confirm the relevance of the evidence-base for effective practice but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of research and other published SARs might assist with answering the “why” question, drawing attention where appropriate to policies being pursued by the central government that undermine any initiative to end rough sleeping.

Originality/value

This paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence-base for practice. The evidence-base also supports practice with individuals who experience multiple exclusion homelessness. Policymakers and practitioners have an approach to follow in this complex, challenging and demanding area of practice.

Details

The Journal of Adult Protection, vol. 22 no. 4
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 7 August 2019

Michael Preston-Shoot

The purpose of this paper is twofold: first, to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis; second, to…

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Abstract

Purpose

The purpose of this paper is twofold: first, to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis; second, to draw together the learning available from this data set of reviews to propose a model of good practice that can be used as the basis for subsequent SARs.

Design/methodology/approach

Further published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains employed previously. A sufficient number of reviews have been performed from which to construct an evidence-based model of good practice. A framework is presented with the proposition that this can be used as a proportional methodology for further SARs where self-neglect is in focus.

Findings

Familiar findings emerge from the thematic analysis. This level of analysis, constructed over time and across reviews, enables a framework to be developed that pulls together the findings into a model of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners involved in such cases. This framework can then be used as an evidence-based model with which to review new cases where SARs are commissioned.

Research limitations/implications

The national database of reviews commissioned by SABs is incomplete and does not contain many of the SARs reported in this evolving data set. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. It is possible, therefore, that this data set is also incomplete. Drawing together the findings from the reviews nonetheless enables conclusions to be proposed about the components of effective practice, and effective policy and organisational arrangements for practice. Future reviews can then explore what enables such effective to be achieved and what barriers obstruct the realisation of effective practice.

Practical implications

Answering the question “why” is a significant challenge for SARs. A framework is presented here, drawn from research on SARs featuring self-neglect, that enables those involved in reviews to explore the enablers and barriers with respect to an evidence-based model of effective practice. The framework introduces explicitly research and review evidence into the review process.

Originality/value

The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also proposes a new approach to SARs by using the findings and recommendations systematically within a framework designed to answer “why” questions – what promotes and what obstructs effective practice.

Details

The Journal of Adult Protection, vol. 21 no. 4
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 13 April 2015

Suzy Braye, David Orr and Michael Preston-Shoot

The purpose of this paper is to analyse in detail the findings from 40 serious case reviews (SCRs) involving adults who self-neglect, and to consider the commissioning and…

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Abstract

Purpose

The purpose of this paper is to analyse in detail the findings from 40 serious case reviews (SCRs) involving adults who self-neglect, and to consider the commissioning and reporting of such inquiries in the context of accountability that also involves the Coroner and the Local Government Ombudsman.

Design/methodology/approach

This study comprised a cross-case analysis of 32 SCRs, using a four-layer design of the adult and their living context, the team around the adult, the organisations around the team, and the Local Safeguarding Board around the organisations.

Findings

Available reports tend towards description of events rather than appraisal of what influenced practice. They highlight the challenges in cases of self-neglect practice, including person-centred approaches, capacity assessment and securing engagement. Familiar themes emerge when the spotlight turns to professional and organisational networks, namely information-sharing, supervision, recording and compliance with procedures and legal rules. Some Local Safeguarding Adults Boards found the process of conducting and then using serious case reviews for service improvement challenging.

Research limitations/implications

The cross-case approach to thematic analysis focuses on reports into situations where outcomes of professional and organisational intervention had been disappointing. Nonetheless, the themes derived from this analysis are similar to other research findings on what represents best practice when working with cases involving self-neglect.

Practical implications

The paper identifies learning for the effective commissioning and conduct of SCRs, and for service improvement with respect to practice with adults who self-neglect.

Originality/value

The paper offers further detailed analysis of a large sample of SCRs that builds the evidence-base for effective practice with adults who self-neglect and for efficient management of process of commissioning and conducting SCRs.

Details

The Journal of Adult Protection, vol. 17 no. 2
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 1 March 1982

Barbara R. Lewis

Discusses the increasing school‐leaving population and the number of school children entering full‐time further education, and the proportion of school‐leavers in…

Abstract

Discusses the increasing school‐leaving population and the number of school children entering full‐time further education, and the proportion of school‐leavers in full‐time further education remaining constant and around 21/22 percent. Proposes that UK clearing banks should be targeting these young people to open accounts with their grant cheques, therefore perhaps persuading them to say with the banks after graduation. States that specialist student advisers, or officers, may be seen as key personnel by helping banks to establish and maintain a ‘feel good’ image with students, showing that banks understand the relevant needs of young people, and providing a good service to them. Concludes that it is not surprising that banks are, in general, turning attention more to school leavers, and in particular to those reaching early employment.

Details

European Journal of Marketing, vol. 16 no. 3
Type: Research Article
ISSN: 0309-0566

Keywords

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