Search results

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.

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.

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.

Sheltered housing schemes for older people took a new turn in the UK with the community care policy of the early 1990s giving care provision for people living in such schemes. There is relatively little research on what sheltered housing schemes provide and what makes them work well. Data was gathered in relation to sheltered housing provision for older people in the north Antrim area of Northern Ireland through 10 focus groups with tenants and 16 questionnaires administered with managers of schemes. Tenants valued the independence and choice of sheltered housing in comparison with institutional care. They also highly valued the social interaction with other tenants, fostered by activities such as coffee mornings, regular lunches and social events. Tenants often helped each other with transport and when sick. Tenants of schemes in small towns were generally satisfied, because of access to shops, churches and other services. Transport was an issue for many, particularly in more rural areas and in relation to attending hospital appointments. Scheme managers were often available to tenants for long and anti‐social hours. The home care arrangements were generally regarded as satisfactory although there were criticisms of the limited hours for tasks and the skills of some care workers. Some scheme managers thought that the publicly‐funded homecare service would be more efficient if the staff were managed from the housing scheme. Appropriate social activities and effective care arrangements are an important aspect of supported housing, as well as the independence it offers. Consideration needs to be given to access to services in locating new schemes.

The purpose of this paper is to examine the effects of an integration programme on service users from users’ own perspective.

Multi-method approach was used. Both quantitative and qualitative data collection and analysis were employed to uncover and examine service users’ views of the impact of the integration programme.

An improvement in the physical functioning of one in three occupational equipment users; a rise in the level of satisfaction of 85 per cent of occupational health and 82 per cent of physiotherapy users; older people with complex problems and high-level needs were able to be helped to live at home; and waiting times for both assessment and for services within two weeks and four weeks were below the national achievement and ministerial targets. The impact of the integration programme on users was complex. Positive outcomes were achieved for some user groups and individuals but not for others. A lack of change outcomes in social care, and service users’ low level of satisfaction with social care services appears to be associated with the impact of agency work and the predominant aim in social work of achieving maintenance and prevention outcomes.

This paper contributes to knowledge on what and how the total integration in Cambridgeshire has benefited users.

This paper critically reviews the motivations for introducing different connected healthcare to support Assisted Living in older and other vulnerable groups. The aim is to develop a new approach that will be sustainable in the future.

The methodology involves a consideration of assessment criteria currently being employed and the resulting costs and limitations in providing a person centred approach. The implications of introducing new technologies such as plesiocare and mCare are then considered.

It was found that one of the most cost‐effective applications of technology is in the support of informal carers but the telecare equipment that they are offered may not be the most appropriate.

The findings are limited by a lack of formal risk assessments that are person centred. The implications include the need for improved training in assessment processes and access to a wider inventory of technologies.

Existing telecare services will need to change in order to adopt more plesiocare and self‐care approaches and to engage more actively in the development of models based on mcare.

Governments and health ministries may achieve better and lower cost support for their ageing population by adopting a model that includes multiple layers of technology, including easier access to self‐care and mCare technologies.

This paper includes the first discussion on plesiocare and its relative advantages over telecare in supporting informal carers.

This study aims to explore the opportunities and challenges Self-directed Support policy has presented to Scottish social enterprises, thereby increasing understanding of emerging social care markets arising from international policy-shifts towards empowering social care users to self-direct their care.

This study used guided conversations with a purposive sample of 19 stakeholders sampled from frontline social care social enterprises; social work; third sector; health; and government.

An inconsistent social care market has emerged across Scotland as a result of policy change, providing both opportunities and challenges for social enterprises. Social innovation emerged from a supportive partnership between the local authority and social enterprise in one area, but elsewhere local authorities remained change-resistant, evidencing path dependence. Challenges included the private sector “creaming” clients and geographic areas and social enterprises being scapegoated where the local market was failing.

This study involved a small purposively sampled group of stakeholders specifically interested in social enterprise, and hence the findings are suggestive rather than conclusive.

This paper contributes to currently limited academic understanding of the contribution of social enterprise to emerging social care markets arising from the international policy-shifts. Through an historical institutionalism lens, this study also offers new insight into interactions between public institutions and social enterprise care providers. The insights from this paper will support policymakers and researchers to develop a more equitable, sustainable future for social care provision.

The development of a national strategy for carers underlines the importance of making the connections between all the different policies which impinge on carers. This needs to be mirrored at a local level, where there are some moves to embed support to carers within mainstream health and social services. However, achieving positive change for carers' needs not only more coherence about carers' relationship with the whole system of care, but also better ways of monitoring services.