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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.

As a result of demographic changes, older people are increasingly living at home, with multi-morbidity and complex care needs. This calls for enhanced integration of homecare nursing and social services. The purpose of this paper is to describe the clinical collaboration, scope and impact of integration from the perspective of staff in a setting identified as fully integrated.

In this qualitative study, data consisted of interviews with managers and care workers in social services and homecare nursing (n=14) in daily clinical collaboration, followed by five focus group discussions (n=28). Data were analysed using framework analysis.

Although the homecare services studied were ostensibly fully integrated, the study showed that the process of integration was incomplete. Interdisciplinary coordination between nursing and social services team managers was described as strong and efficient, but weaknesses were identified in collaboration between care workers. They lacked acquaintance with one another, opportunities for communication and knowledge of the contribution of members of other teams. They felt unclear about their own role in coordinated teamwork and lacked a shared vision.

This paper’s originality lies in the model of integrated care studied and its focus on actual care practices. The findings highlight that integration does not automatically permeate between different levels of service. Time and space must be allowed for conversations between health and social service teams to promote integration.

The purpose is to share strategies, rationales and lessons learnt from user involvement in a quality and safety improvement research project from the practice field in nursing homes and homecare services.

This is a viewpoint paper summarizing how researchers and co-researchers from the practice field of nursing homes and homecare services (nurse counsellors from different municipalities, patient ombudsman and next-of-kin representatives/and elderly care organization representant) experienced user involvement through all phases of the research project. The project included implementation of a leadership intervention.

Multiple strategies of user involvement were applied during the project including partnership in the consortium, employment of user representatives (co-researchers) and user-led research activities. The rationale was to ensure sound context adaptation of the intervention and development of tailor-made activities and tools based on equality and mutual trust in the collaboration. Both university-based researchers and Co-researchers experienced it as useful and necessary to involve or being involved in all phases of the research project, including the designing, planning, intervention implementation, evaluation and dissemination of results.

User involvement in research is a growing field. There is limited focus on this aspect in quality and safety interventions in nursing homes and homecare settings and in projects focussing on the leadership' role in improving quality and safety.

The purpose of this paper is to investigate the multidimensional nature of social and nonprofit organisations' accountability and performance measurement systems (PMSs). It further considers how these systems help in defining outcome performance indicators downward to beneficiaries

The paper discusses participatory action research (PAR) within an Italian social enterprise. In order to increase dialogue, participation and engagement, the researchers adopted focus groups as a preferred method of investigation and conducted a broad documental analysis from July 2016 to March 2018. The paper discusses the gathered data in light of the social impact value chain as well as the multiple-constituency approach.

The findings support the idea that social and nonprofit organisations lack the expertise and resources to evaluate outcomes and impact; however, through PAR, the organisation defined their desired outcomes and ascertained which internal output measures were most likely to be correlated with these outcomes. Moreover, the findings highlight that nonprofits develop outcome measurements less frequently because they have more control over their immediate activities and outputs.

This research suggests the need to reinforce lateral and downward accountability based on mission and mission-based activities in order to make the performance management system of social and nonprofit organisation linked to the organisational strategies.

This paper innovates methodologically in two directions: 1) it adopts action research as a qualitative method, allowing the researcher to generate solutions to collectively-identified problems and 2) the paper's arguments are strongly supported by rich empirical exploration that occurred over a period of 20 months in an Italian social enterprise.

Assistive technology can make a significant difference to the lives of service users and carers, especially when dovetailed with health, housing and social care. In support of this aim, the UK Government recently announced £80 million funding for a Preventive Technologies Grant over two years from April 2006, to extend the benefits of new technology ‘community alarms’ with the aim of reducing the number of avoidable admissions to residential care and to hospital. Once the preserve of the allied health professions, multi‐disciplinary teams of professionals are increasingly expected to take on responsibility for assistive technology and the equipment that accompanies it. This article explores the use of assistive technology from the perspective of practitioners working in multi‐disciplinary hospice homecare. It draws on the findings of a small evaluative study of 25 hospice homecare schemes which participated in a project centred on rapid access to community alarm technology. It considers obstacles to implementation and workforce development issues arising out of an increased focus on assistive technology as a means of better managing the support of terminally ill people at home.

Research-based knowledge on homecare nursing is scarce and further information is warranted about citizens’ perceptions of receiving home care under existing conditions. The purpose of this study was to investigate citizen experiences with health-care professionals in the time allotted for home care.

A questionnaire survey was distributed to 348 citizens receiving home care. The questionnaire consisted of questions whether the citizens experienced that enough time was available during the homecare visit and how the conversation and care relationship with the health-care professionals were experienced. The differences in responses were analysed using Fisher’s Exact Tests.

Overall, 94% of the citizens reported that sufficient time had been available and that care relationship and conversation with the health-care professionals had been positive during the homecare visit. However, the findings indicated that citizens aged more than +76 years and citizens with a high educational level were more prone to report that the nurses did not spend enough time during the home visit.

The findings offer useful insights for the professionals in delivering appropriate home care. Listening to citizens’ wishes and needs for home care could lead to better individualised care. Especially the youngest and oldest of the citizens seem to have specific experiences that call for further investigation.

This article aims to discuss the relevancy of different instruments used to gather information on homecare service quality from multiple stakeholders and the challenges encountered when trying to blend their views for prioritizing areas needing improvement.

The study centers on four homecare agencies: one public, one private for‐profit and two not‐for‐profit services, implementing continuous quality improvement (CQI) programs. Various instruments were tested with random and convenience elderly service user, family caregiver and front‐line worker samples. Instrument evaluation included operational effectiveness and agency manageability.

A qualitative approach, centered on small stakeholder samples, is fairly effective at assessing service quality, yet demands a strong commitment from agencies in personnel time and resources, as well as the necessary skills. Small‐size, private homecare providers seem less‐well equipped to handle comprehensive assessments without external support. More importantly, assessments have to be done strategically, such that timing and work needed does not undermine program viability.

The approach and instruments tested have practical implications for decision makers and homecare organization managers interested in CQI.

The article systematically evaluates quality assessment and priority‐setting instruments applied to various stakeholders and homecare settings.

The purpose of this paper is to discuss whether the use of outcome-focused homecare improves the subjective well-being of the familial carers of older people with dementia. It also discusses familial carers’ perception of whether this intervention has improved the well-being of their relative.

This qualitative study followed the familial carers of 20 service users suffering from dementia over a six-month period. Semi-structured interviews were undertaken at three intervals during the six months. The carers were asked to assess their subjective well-being at the start, middle and end of the study.

The key findings were that all 20 familial carers expressed an improvement in their subjective well-being and that of their older family member, who appeared more settled as a result of this model of care.

The need to consider the use of outcome-focused care as an intervention strategy for older people living alone in the community. The need to provide supportive environments for the carers of older people with dementia to limit their sense of isolation. The prioritising of outcome-focused care in the most complex and chaotic cases.

This study provides an insight into the effectiveness of outcome-focused homecare with older people experiencing dementia as perceived by their familial carers. Previously, research has established that outcome-focused care increased the subjective well-being of non-dementia sufferers. This study dovetails neatly with this in demonstrating the same effect on dementia sufferers as perceived by their familial carers. Additionally, this study also demonstrated that this model of outcome-focused care also improved the subjective well-being of the familial carers themselves. These finding will help practitioners consider the use of this model of homecare as a potential alternative or a delaying strategy to residential care.

It is now accepted that a course of personalised, well‐planned support services for up to six weeks can prevent or delay the need for an older person to receive long‐term homecare and other labour‐intensive community services. Telecare can play an important role in managing the risks, both during the reablement period, and in the months following service delivery, irrespective of whether the individual needs long‐term homecare. This paper describes an innovative approach to provision that has been adopted in the Vale of Glamorgan, in which the service has been designed and is delivered by the Reablement Team. It is planned to expand the number of people being offered the service in the future by stratifying them using a new algorithm, and then support them subsequently with a pro‐active telephone calling service called CATRIN.

This paper aims to generate a better understanding of how challenges and opportunities for sustainable change during digitalization relate to the organizing work of change agents mandated to facilitate technology adoption from within local work organizations.

This study examines the work of welfare technology coordinators, health-care professionals who are mandated to facilitate the use of technologies in home-based services in a Norwegian city. Data comprise ethnographic observations of meetings and work practices, interviews and documents collected over one year. A practice-based approach was applied to analyze how the welfare technology coordinators go about integrating technologies with the work practices, and the forms of negotiations this work implies in their work community.

The analysis identified four sets of practices in the coordinators’ work: exploring and integrating new technologies into work practices, legitimizing aims and values, formalizing routines and responsibilities and critically considering existing and envisioned service practices. Through these practices, emerging problems and disconnections in the service organization were attended to in a continuous manner.

The study contributes to the literature by examining the work of internal change agents mandated to facilitate multiple and simultaneous technology adoption and demonstrates the importance of recognizing the continuous efforts and negotiations of these agents as significant to sustainable organizing.