Challenging times: building a health, housing and social care local workforce strategy

2018 ◽  
Vol 21 (3/4) ◽  
pp. 108-122
Author(s):  
Patricia Dearnaley ◽  
Joanne E. Smith
Keyword(s):  
Service Delivery ◽  
Older People ◽  
Health Care Services ◽  
Social Care ◽  
Workforce Planning ◽  
Care Needs ◽  
Fiscal Impact ◽  
Content Type ◽  
Care Services ◽  
Health And Social Care

Purpose The purpose of this paper is to stimulate a wider debate around the coordination of workforce planning in non-statutory services (in this case, specialist housing for older people or those with long-term health and social care needs, such as learning disabilities). The authors argue that current NHS reforms do not go far enough in that they fail to include specialist housing and its workforce in integration, and by doing so, will be unable to optimise the potential efficiencies and streamlining of service delivery to this group. Design/methodology/approach The paper used exploratory study using existing research and data, enhanced by documentary analysis from industry bodies, regulators and policy think tanks. Findings That to achieve the greatest operational and fiscal impact upon the health care services, priority must be given to improving the efficiency and coordination of services to older people and those requiring nursing homes or registered care across the public and third sectors through the integration of service delivery and workforce planning. Research limitations/implications Whilst generalisable and achievable, the model proposed within the paper cannot be fully tested theoretically and requires further testing the in real health and social care market to evidence its practicality, improved quality of care and financial benefits. Originality/value The paper highlights some potential limitations to the current NHS reforms: by integrating non-statutory services, planned efficiency savings may be optimised and service delivery improved.

scholarly journals 532 CARING FOR AND CARING ABOUT OLDER PEOPLE LIVING WITH SEVERE FRAILTY DURING COVID-19

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
R Green ◽  
H King ◽  
C Nicholson
Keyword(s):  
Health Care ◽  
Older People ◽  
Health Care Services ◽  
Social Care ◽  
Social Contact ◽  
Care Services ◽  
Poor Access ◽  
Health And Social Care ◽  
Video And Audio ◽  
The Impact

Abstract Introduction An ongoing study collected survey and interview data from older people with frailty living in the community near end-of-life during the Covid-19 pandemic. Methods Unstructured interviews with older people with frailty living in the community (N = 10), which included accounts from unpaid carers (N = 5), were video and audio recorded between October–November 2021. Six of these older people have died since fieldwork completion. A face-to-face survey collected data from a further 10 older people. Participants ages ranged from 70–99, 11, men, and 9 women, living in owned, rented, or sheltered accommodation, with Clinical Frailty Scores of 6 (N = 8), 7 (N = 9), and 8 (N = 3). Results Topics raised in relation to the pandemic included loss of social contact and increased loneliness, concern about not physically getting out, and losing physical function. Older people struggled to gain access to health and social care for support and previously received services were withdrawn. Most participants did not have access to internet and relied heavily on families to facilitate virtual contact with health professionals. Families and friends were the main anchor in facilitating social and health care including chasing up medications, liaising with social care to ensure quality and consistency of care provided, and monitoring older people’s health. Where older people’s conditions worsened family provided intense support, though family carers described the strain and unsustainability of this provision. Older people and their families felt they had been forgotten. Conclusions These are insights from hard-to-reach population that are frequently invisible. Greater examination of the impact of using communication technologies in care provision on those with poor access to and capabilities with using these technologies is required. Unpaid carers need more information and resources to support the care they provide and to facilitate access to appropriate social and health care services for those they care for.

Being self in later life: maintaining continuity in the face of change

2016 ◽  
Vol 17 (2) ◽  
pp. 141-150
Author(s):  
Gareth O'Rourke
Keyword(s):  
Qualitative Study ◽  
Older People ◽  
Consumer Choice ◽  
Social Care ◽  
Later Life ◽  
Small Scale ◽  
Care Needs ◽  
Helping Relationships ◽  
Content Type ◽  
Care Services

Purpose – The purpose of this paper is to build upon existing knowledge of personalisation through an improved understanding of how the use of personalised social care services can support older people’s sense of self. It contains perspectives that are helpful to the development of personalisation policy and practice and to the future commissioning of social care services. Design/methodology/approach – The research involved a qualitative study with eight participants in two local authority areas in England. A series of three in-depth interviews conducted with each participant over a four to six week period explored their experience of using (in one case refusing) a direct payment to meet their social care needs. Ethical approval was obtained prior to the start of fieldwork via the research ethics committee of the author’s home university. Findings – Two inter-related themes emerge as findings of the research. First, that the locus of personalisation resides within the interpersonal dynamics of helping relationships; participants experienced personalisation when carers helped to meet needs in ways that validated their narrative of self. Second, whilst the experience of personalisation is not strongly related to consumer choice, it is important that older people are able to exercise control over and within helping relationships. Research limitations/implications – This is a small scale qualitative study conducted with only eight participants. Whilst it offers valid insights into what constitutes personalisation and the processes by which it was achieved for the participants, caution is required in applying the findings more generally. With the exception of one case, the study is focused exclusively on first person accounts of older people. Future studies might usefully be designed to incorporate the accounts of other involved parties such as family members and paid carers. Originality/value – The paper provides an alternative way of approaching personalisation of social care services for older people by exploring it in terms of its impact on self. It identifies the development of accommodations of “special requirements of Self” in helping relationships as a key mechanism of personalisation. This offers a balance to the current focus on consumer choice and control through the development of market like mechanisms.

Commentary on “Assisting individuals ageing with learning disability: support worker perspectives”

2015 ◽  
Vol 20 (4) ◽  
pp. 223-227
Author(s):  
Martin Stevens
Keyword(s):  
Learning Disabilities ◽  
Older People ◽  
Social Care ◽  
Support Worker ◽  
Policy And Practice ◽  
Content Type ◽  
Care Services ◽  
Role Of The State ◽  
Health And Social Care ◽  
The Uk

Purpose – The purpose of this paper is to explore some of the themes identified by Wark et al.’s paper and to highlight commonalities and differences between the Australian and the UK social and health care regimes. It also points to evidence about other implications for policy and practice of the increasing numbers of people growing older who have learning disabilities. Design/methodology/approach – The commentary analyses some policy and practice documents and identifies a range of other research and commentary on this topic. Findings – Wark et al. have identified areas of importance for supporting older people with learning disabilities, particularly access to suitable and acceptable services and the importance of sufficient support worker time. They also identify gaps in the research on people’s needs and service responses. The commentary also highlights other factors for consideration in work with this group of people, particularly the implementation of personalisation policies in social care and integration between health and social care services. Research limitations/implications – There is a need for further research into developing policy and practice for health and social care for older people with learning disabilities. Some of the evidence supports the case for specialist involvement, particularly by nursing professionals. Originality/value – The paper and this commentary highlight the challenges associated with the increasing number of older people with learning disabilities in contemporary debates about the role of the state and professional specialists.

Living well in later life in Scotland

2017 ◽  
Vol 21 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Anne Hendry
Keyword(s):  
Older People ◽  
Social Care ◽  
Action Plan ◽  
Later Life ◽  
Ageing Population ◽  
Content Type ◽  
Living Well ◽  
Care Services ◽  
Health And Social Care ◽  
Scottish Government

Purpose The purpose of this paper is to describe the development, implementation and early impact of a national action plan for active and healthy ageing in Scotland. Design/methodology/approach The Joint Improvement Team, NHS Health Scotland, the Scottish Government and the Health and Social Care Alliance Scotland (ALLIANCE) co-produced the action plan with older people from the Scottish Older People’s Assembly. Together they supported partnerships to embed the action plan as an important element of the reshaping care for older people transformation programme in Scotland. Findings A cross-sector improvement network supported health, housing and care partnerships to use a £300 million Change Fund to implement evidence based preventative approaches to enable older people to live well. Older people in Scotland spent over two million days at home than would have been expected based on previous balance of care and impact of ageing. Practical implications Improving the health and wellbeing of older people is not just the responsibility of health and social care services. Enabling older people to live independent, active and fulfilling lives requires coordinated effort that spans national and local government policy areas, mobilises all sectors of society, and involves all health and care disciplines. Success starts with listening to what matters to older people, and working together, and with older people and local communities, to make that a reality. Originality/value This case study from Scotland offers transferable learning for other systems who have an ageing population and an ambitions to enable them to live well in later life.

Pursuing collaborative advantage in Swedish care for older people: stakeholders' views on trust

2020 ◽  
Vol 28 (3) ◽  
pp. 231-241
Author(s):  
Inger Kjellberg ◽  
Stefan Szücs
Keyword(s):  
Older People ◽  
Social Care ◽  
Content Type ◽  
Complex Needs ◽  
Collaborative Advantage ◽  
Care Services ◽  
Health And Social Care ◽  
Swedish Experience ◽  
Coordination And Collaboration ◽  
Care For Older People

PurposeThe purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of trust in implementing the policy.Design/methodology/approachThe study used a qualitative interview design and interviews with nine strategically selected stakeholders. A thematic analysis focused on trust, as defined in the theory of collaborative advantage, was used.FindingsThis study of health and social care exposed a lack of trust on political, strategic and inter-professional levels. Two opposing lines of argument were identified in the interviews. One advocated a single government authority for health and social care. The other was in accordance with recently implemented national policies, which entailed more collaboration between local government authorities, obliging them to make joint local agreements. The Swedish experience is discussed in an international context, examining the need for collaboration in integrated care services for older people.Research limitations/implicationsAlthough the findings are important for the current adjustment in health and social care for older people, the number of interviewees are limited. Future studies will include more regions and longitudinal studies.Originality/valueSweden is currently undergoing an extensive adjustment in line with recent national government policy which involves more primary health care and a corresponding reduction in the number of hospital beds. The restructuring of the care system for older people with complex needs is a paradox, as it simultaneously increases the need for centralisation while also increasing coordination and collaboration on a local basis.

scholarly journals The importance of a room with a view for older people with limited mobility

2018 ◽  
Vol 19 (4) ◽  
pp. 273-285 ◽  
Author(s):  
Charles Musselwhite
Keyword(s):  
Older People ◽  
Design Methodology ◽  
Social Care ◽  
Structured Interviews ◽  
Content Type ◽  
Limited Mobility ◽  
Human Element ◽  
Health And Social Care ◽  
Vantage Points ◽  
Practical Implications

Purpose The purpose of this paper is to examine how older people who are almost entirely housebound use a view from their window to make sense of the world and stay connected to the outside space that they cannot physically inhabit. Design/methodology/approach Semi-structured interviews with 42 individuals were carried out who were living at home, were relatively immobile and had an interesting view outside they liked from one or more of their windows. Findings The findings suggest that immobile older people enjoy watching a motion-full, changing, world going on outside of their own mobility and interact and create meaning and sense, relating themselves to the outside world. Practical implications Findings suggest that those working in health and social care must realise the importance of older people observing the outdoors and create situations where that is enabled and maintained through improving vantage points and potentially using technology. Originality/value This study builds and updates work by Rowles (1981) showing that preference for views from the window involves the immediate surveillance zone but also further afield. The view can be rural or urban but should include a human element from which older people can interact through storytelling. The view often contains different flows, between mundane and mystery and intrigue, and between expected and random.

scholarly journals Informing patterns of health and social care utilisation in Irish older people according to the Clinical Frailty Scale

2021 ◽  
Vol 4 ◽  
pp. 54
Author(s):  
Aisling M. O'Halloran ◽  
Peter Hartley ◽  
David Moloney ◽  
Christine McGarrigle ◽  
Rose Anne Kenny ◽  
...  
Keyword(s):  
Older People ◽  
Social Care ◽  
Markov Models ◽  
Classification Tree ◽  
Community Health Services ◽  
Health Services Use ◽  
Care Needs ◽  
Clinical Frailty Scale ◽  
Care Utilisation ◽  
Health And Social Care

Background: There is increasing policy interest in the consideration of frailty measures (rather than chronological age alone) to inform more equitable allocation of health and social care resources. In this study the Clinical Frailty Scale (CFS) classification tree was applied to data from The Irish Longitudinal Study on Ageing (TILDA) and correlated with health and social care utilisation. CFS transitions over time were also explored. Methods: Applying the CFS classification tree algorithm, secondary analyses of TILDA data were performed to examine distributions of health and social care by CFS categories using descriptive statistics weighted to the population of Ireland aged ≥65 years at Wave 5 (n=3,441; mean age 74.5 (SD ±7.0) years, 54.7% female). CFS transitions over 8 years and (Waves 1-5) were investigated using multi-state Markov models and alluvial charts. Results: The prevalence of CFS categories at Wave 5 were: 6% ‘very fit’, 36% ‘fit’, 31% ‘managing well’, 16% ‘vulnerable’, 6% ‘mildly frail’, 4% ‘moderately frail’ and 1% ‘severely frail’. No participants were ‘very severely frail’ or ‘terminally ill’. Increasing CFS categories were associated with increasing hospital and community health services use and increasing hours of formal and informal social care provision. The transitions analyses suggested CFS transitions are dynamic, with 2-year probability of transitioning from ‘fit’ (CFS1-3) to ‘vulnerable’ (CFS4), and ‘fit’ to ‘frail’ (CFS5+) at 34% and 6%, respectively. ‘Vulnerable’ and ‘frail’ had a 22% and 17% probability of reversal to ‘fit’ and ‘vulnerable’, respectively. Conclusions: Our results suggest that the CFS classification tree stratified the TILDA population aged ≥65 years into subgroups with increasing health and social care needs. The CFS could be used to aid the allocation of health and social care resources in older people in Ireland. We recommend that CFS status in individuals is reviewed at least every 2 years.

scholarly journals Health and social care services for older male adults in prison: the identification of current service provision and piloting of an assessment and care planning model

2013 ◽  
Vol 1 (5) ◽  
pp. 1-138 ◽  
Author(s):  
J Senior ◽  
K Forsyth ◽  
E Walsh ◽  
K O'Hara ◽  
C Stevenson ◽  
...  
Keyword(s):  
Social Care ◽  
Qualitative Interviews ◽  
Research Programme ◽  
Older Men ◽  
Care Needs ◽  
Care Services ◽  
Older Prisoners ◽  
Care Assessment ◽  
Health And Social Care ◽  
The Impact

AbstractBackgroundOlder prisoners are the fastest growing subgroup in the English and Welsh prison estate. Existing research highlights that older prisoners have high health and social care needs and that, currently, these needs routinely remain unmet.Objectives(1) To explore the needs of men entering and leaving prison; (2) to describe current provision of services, including integration between health and social care services; and (3) to develop and pilot an intervention for identifying health and social care needs on reception into prison, ensuring that these are systematically addressed during custody.MethodsThe research programme was a mixed-methods study comprising four parts: (1) a study of all prisons in England and Wales housing older adult men, establishing current availability and degree of integration between health and social care services through a national survey and qualitative interviews; (2) establishing the health and social care needs of older men entering prison, including experiences of reception into custody, through structured (n = 100) and semistructured (n = 27) interviews; (3) the development and implementation of an intervention to identify and manage the health, social care and custodial needs of older men entering prison; and (4) exploration of the health and social care needs of older men released from prison into the community through qualitative interviews with older prisoners prior to and following discharge from prison. Descriptive statistics were produced for all quantitative data, and qualitative data were analysed using the constant comparison method.ResultsThe number of older prisoner leads has increased in recent years but they do not all appear always to be active in their roles, nor in receipt of specialist training. Nearly half (44%) of establishments do not have an older prisoner policy. There is a lack of integration between health and social care services because of ambiguity regarding responsibility for older prisoners' social care. The responsible social service may be located a considerable distance from where the prisoner is held; in such instances, local social services do not co-ordinate their care. The most frequent unmet need on prison entry was the provision of information about care and treatment. Release planning for older prisoners was frequently non-existent.LimitationsThe study used a cut-off age of 60 years as the lower limit for the definition of an older prisoner; evidence has emerged that supports a redefinition of that cut-off to 50 years. Our study examined the care provided for men and this should be considered if contemplating using the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) with older women in prison.ConclusionThe OHSCAP, developed as part of this study, provided a feasible and acceptable means of identifying and systematically addressing older prisoners' health and social care needs. Future work will include the conduct of a randomised controlled trial to examine the impact of the OHSCAP in terms of improving a range of outcomes, including economic impact.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Role of the Single Assessment Process in the Care of Older People. How Will Primary Dental Care Practitioners be Involved?

2006 ◽  
Vol os13 (4) ◽  
pp. 130-134 ◽  
Author(s):  
Elizabeth A Lane ◽  
Jennifer E Gallagher
Keyword(s):  
Older People ◽  
Dental Care ◽  
Social Care ◽  
Assessment Process ◽  
Care Needs ◽  
National Service Framework ◽  
Health And Social Care ◽  
Dental Practitioners ◽  
One Stop

Following the publication of the National Service Framework for Older People, there have been developments across health and social care to facilitate holistic assessment of older people's needs, through what is called a ‘single assessment process’ or ‘SAP’. In this paper, readers are introduced to the SAP. The process can be seen as a ‘one-stop’ approach to the assessment of vulnerable older people that facilitates cross-referral between the agencies involved and triggers access to dental care. The paper explores the benefits of this new way of working in support of older people and how it will provide an opportunity for innovative dental practitioners to integrate oral healthcare for people with complex health and social care needs into the SAP. In concludes that as local commissioning evolves, opportunities for practitioners to develop targeted services for this important patient group should be expanded to improve the uptake of healthcare and oral healthcare.

Psychiatric assessment of older people

2013 ◽  
Author(s):  
Alan Thomas
Keyword(s):  
Older People ◽  
Mental State ◽  
Cognitive Assessment ◽  
Social Care ◽  
Psychiatric History ◽  
Neurological Signs ◽  
Care Services ◽  
Health And Social Care ◽  
Holistic Assessment ◽  
State Examination

The venue for assessment varies but given the choice there are substantial advantages in the first assessment being conducted at home. The aims of the assessment are to do more than achieve a diagnosis, though this is crucial; the aim should also be to produce a holistic assessment of all needs leading to the involvement a range of appropriate professionals in health and social care services to address these needs and carry out their own specialist assessments. Information from informants will supplement that of the patient and enable completion of all the important domains in the psychiatric history. The mental state examination will include a special emphasis on cognitive assessment and a brief physical looking for neurological signs is important.

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