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Adult social care services are increasingly establishing reablement services as part of their range of home care provision, sometimes alone, sometimes jointly with NHS partners. Typically, home care reablement is a short‐term intervention, often free of charge, that aims to maximise independent living skills. This paper describes two small studies examining the impact of home care reablement on subsequent service use. The evidence so far strongly suggests that a period of home care reablement can reduce the subsequent use of home care services and that, for some people, these benefits may last for a year or more. However, a number of organisational and cultural factors can limit the immediate and longer‐term benefits of home care reablement.

The aim of this study was to test whether the client homebound score (CHS), the case management intensity score (CMIS) and the client priority visit score (CPVS) could be used to predict in‐home time of professional caregivers in the Aspen community care program. A random sample of 34 community care clients from the different geographical areas of the Aspen Regional Health Authority was selected and the home visits for each client were tracked for three months. Information such as client demographics, the client diagnostic category, number and in‐home time of visits was collected. In addition, the CHS, the CMIS and the CPVS were measured for each client. Data were analyzed, using a robust variance estimator regression model. CMIS was found to be the best predictor of in‐home time (coefficient 9.521, p > 0.001), followed by the CHS and the CPVS.

The paper describes the size, nature and trends in home care, including telemedicine and hospital at home, emphasising the independent sector's contribution and highlighting the importance of home care to health and social care. It identifies a funding and capacity crisis, outlines the likely impact of any further reduction and explores contributory recruitment, training and commissioning practice issues.

More and more people are receiving care while living in their own homes, a far greater number than are in residential and nursing home care, and in some cases with more complex needs. Yet there persists an image of home care as a very basic activity needing little or no training and in volving no career pr ogression. This image will have to change radically if registered providers are to meet the new national regulatory standards and if there is to be sufficient staff recruitment to meet the ever increasing demand for home care. This article sets out ways in which provider or ganisations can respond to these changes, particularly by building staff development and training strategies. Such strategies must recognise the growing importance and complexity of home care and take special account of the need for staff to gain vocational qualifications. Home care must be seen as offering professional career opportunities, not just a job. The article concludes that the future will lie in bringing care to the people who need it, rather than bringing people to the care.

The purpose of this paper is to outline the learning from an innovative approach to using volunteers as lay assessors in order to secure improvements in the quality of life of older people in care homes.

The paper describes the implementation of pilot lay assessor scheme in Bristol and systematically explores the learning from this case study.

The paper concludes that despite a number of important challenges and limitations, a lay assessor approach, particularly when conducted in close co-operation with a local council, can indeed provide demonstrable quality of life benefits for older people in closed institutions such as care homes.

The case study highlights a number of key implications for practice including: it is possible to recruit, motivate and train volunteers to provide a lay assessor scheme; working with a local council and providers of care homes can produce real improvements in quality of life; lay assessor schemes are an important way of “shining a light” into closed institutions; defining quality of life and balancing this with institutional attitudes towards risk can be extremely challenging; and working with care home managers, providing them with ideas and support can be effective in bringing about meaningful change.

This case study reports on one of the first volunteer lay assessor initiatives in the country. There has been very little if any reporting or analysis of such schemes. This paper therefore adds significantly to this important are of public policy and provision.

The purpose of this paper is to observe and analyse the effects of the use of telemedicine in care homes on the use of acute hospital resources.

The study was an uncontrolled retrospective observational review of data on emergency hospital admissions and Emergency Department (ED) visits for care home residents in Airedale, Wharfedale and Craven. Acute hospital activity for residents was observed before and after the installation of telemedicine in 27 care homes. Data from a further 21 care homes that did not use telemedicine were used as a control group, using the median date of telemedicine installation for the “before and after” period. Patient outcomes were not considered.

Care homes with telemedicine showed a 39 per cent reduction in the costs of emergency admissions and a 45 per cent reduction in ED attendances after telemedicine installation. In the control group reductions were 31 and 31 per cent, respectively. The incremental difference in costs between the two groups of care homes was almost £1.2 million. The cost of telemedicine to care commissioners was £177,000, giving a return on investment over a 20-month period of £6.74 per £1 spent.

The results should be interpreted carefully. There is inherent bias as telemedicine was deployed in care homes with the highest use of acute hospital resources and there were some methodological limitations due to poor data. Nevertheless, controlling the data as much as possible and adopting a cautious approach to interpretation, it can be concluded that the use of telemedicine in these care homes was cost-effective.

There are very few telemedicine studies focused on care homes.

The purpose of this paper is to explore what existing literature about the care home environment for people with dementia reveals. It also evaluates the implications for practice, to show which parts of the care home environment staff feel have the most impact on the day to day lives of residents living with dementia. In turn, this paper seeks to feedback to care home management to improve practice and to contribute to research in care homes in the future.

A literature review forms the basis of this research, in addition to four semi-structured interview conducted with care home staff of different roles; allowing them to share their experiences with little restriction. Participants were recruited through informal discussions with the researcher before the research took place, as part of her job role and using purposive sampling.

Data were analysed using computer software Nvivo and identified four main categories which all participants discussed: social interaction, staff involvement, staff restrictions, staff involvement and physical elements of the environment. This research has shown the importance of staff presence in the care home environment to facilitate social interaction among residents with dementia.

The sample is very small due to staff not having the time to take part in the interview and this itself is a key finding. Interviews were able to capture feelings but not the overall experience of interaction between resident and staff, which observations would have achieved if there was more time to conduct the research.

A literature review and qualitative research signifying the importance of staff presence in the care home setting in order for the residents to socially engage in their environment. However, it has also show the lack of time that is face by staff and the impact this has on people living with dementia.

This is an adaptation of the opening address given by Sister Elizabeth Davis to the Canadian Healthcare Association’s intramural session for its Distance Education programme. The intramural session is an intensive week of plenary and programme‐specific sessions, working groups and student presentations.

Posits that Canadian home care services compete with hospitals and other community and public health agencies for scarce financial resources but as yet regional authorities are not responsible for paying physicians. Investigates all the various facets of home care services and concludes that by using joint ventures, there may be the possibility of making informed decisions for the Canadian healthcare system.

This study compares and contrasts the clients of two domiciliary care services delivered to elderly people in Darlington, Durham, UK, in terms of their living circumstances, dependency levels and the service inputs they receive. The two services are the Home Help Service managed by the local authority social services department and a Home Care Service managed by the Darlington Health Authority which offers an alternative to long‐stay hospital care for elderly people. The study examined only a sample of the most dependent home help clients and all of the home care clients. The instruments used to measure dependency were found to be limited in their ability to detect crucial differences in the two client groups and suggestions are made about how these might be improved. The main distinguishing characteristics of the Home Care Service clients were that they were, on average, younger and frailer than the home help clients and were far more likely to need help with toiletting, dressing, getting in/out of bed, walkng and making hot drinks. In contrast the main predictor of Home Help Service membership was living alone. It was concluded that although some home help clients were as incapacitated as home care ones, the latter scheme was far more consistently targetted on very frail, and often ill, people.