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Understanding social care need through primary care big data: a rapid scoping review. BJGP Open 2022; 6:BJGPO.2022.0016. [PMID: 35788025 PMCID: PMC9904775 DOI: 10.3399/bjgpo.2022.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND A more comprehensive understanding and measurement of adult social care need could contribute to efforts to develop more effective, holistic personalised care, particularly for those with multiple long-term conditions (MLTC). Progress in this area faces the challenge of a lack of clarity in the literature relating to how social care need is assessed and coded within variables included in primary care databases. AIM To explore how social care need is assessed and coded within variables included in primary care databases. DESIGN & SETTING An exploratory rapid scoping review of peer-reviewed articles and grey literature. METHOD Articles were screened and extracted onto a charting sheet and findings were summarised descriptively. Articles were included if published in English and related to primary and social care using data from national primary care databases. RESULTS The search yielded 4010 articles. Twenty-seven were included. Six articles used the term 'social care need', although related terminology was identified including 'need factors', 'social support', and 'social care support'. Articles mainly focused on specific components of social care need, including levels of social care usage or service utilisation and costs incurred to social care, primary care, and other providers in addressing needs. A limited range of database variables were found measuring social care need. CONCLUSION Further research is needed on how social care need has been defined in a UK context and captured in primary care big databases. There is potential scope to broaden the definition of social care need, which captures social service needs and wider social needs.
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What kind of home is your care home? A typology of personalised care provided in residential and nursing homes. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
This paper examines how care home managers in England conceptualised the approach to delivering personalised care in the homes they managed. We conducted interviews with care home managers and mapped the approaches they described on two distinct characterisations of personalised care prominent in the research and practitioner literature: the importance of close care relationships and the degree of resident choice and decision-making promoted by the care home. We derived three ‘types’ of personalised care in care homes. These conceptualise the care home as an ‘institution’, a ‘family’ and a ‘hotel’. We have added a fourth type, the ‘co-operative’, to propose a type that merges proximate care relationships with an emphasis on resident choice and decision-making. We conclude that each approach involves trade-offs and that the ‘family’ model may be more suitable for people with advanced dementia, given its emphasis on relationships. While the presence of a range of diverse approaches to personalising care in a care home market may be desirable as a matter of choice, access to care homes in England is likely to be constrained by availability and cost.
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Cameron A, Johnson EK, Evans S. Older people's perspectives on living in integrated housing and care settings: the case of extra care housing. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-09-2019-0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper explores residents' perceptions and experiences of extra care housing as an integrated model of housing with care.Design/methodology/approachData were collected in a longitudinal qualitative study based on four extra care housing schemes. Data from interviews with residents, care workers, managers and local commissioners were analysed thematically.FindingsThe integration of housing with care enabled many older people to manage their care proactively. However, the increasing number of residents with complex health and care needs, including chronic illness, led some residents to question the ability of the model to support residents to live independently.Research limitations/implicationsThe study struggled to recruit sufficient residents from the specialist dementia setting who were able to communicate their consent to take part in the research. In addition, the quality of qualitative data collected in interviews with participants at this setting reduced over successive rounds of interviews.Practical implicationsThe study suggests the need to ensure that residents are fully informed about levels of care and support is available when considering a move into extra care housing.Originality/valueThis paper provides a timely opportunity to consider extra care housing as an example of an integrated housing service, particularly in light of the current challenges facing the sector.
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Cameron A, Johnson EK, Lloyd L, Evans S, Smith R, Porteus J, Darton R, Atkinson T. Using longitudinal qualitative research to explore extra care housing. Int J Qual Stud Health Well-being 2019; 14:1593038. [PMID: 30935291 PMCID: PMC6450491 DOI: 10.1080/17482631.2019.1593038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: The process of individual ageing in the context of a care environment is marked by continuity and change. It is shaped by individual, health-related factors as well as by diverse social and environmental factors, including characteristics of the places where older people live. The aim of this paper was to explore how longitudinal qualitative research, as a research method, could be used to explore older people’s changing care needs. Methods: The study used a longitudinal design to examine how the care and support needs of residents and their expectations of services developed over time and how these were influenced by changes in the organisation of their housing as well as in the make-up of the resident population. Residents were interviewed on four occasions over 20 months. Results: The study highlighted the complex ways in which some participants proactively managed the care and support they received, which we argue would have been difficult to discern through other methods. Conclusion: The study adds to the growing evidence base that supports the use of qualitative longitudinal research; the approach enables the researcher to capture the diverse and mutable nature of older people’s experiences at a time of profound change in their lives.
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Affiliation(s)
- Ailsa Cameron
- a School for Policy Studies , University of Bristol , Bristol , UK
| | | | - Liz Lloyd
- a School for Policy Studies , University of Bristol , Bristol , UK
| | - Simon Evans
- b Association for Dementia Studies , University of Worcester, Institute of Health and Society , Worcester , UK
| | - Randall Smith
- a School for Policy Studies , University of Bristol , Bristol , UK
| | - Jeremy Porteus
- c Housing Learning and Improvement Network , London , UK
| | - Robin Darton
- d Personal Social Services Research Unit , University of Kent , Kent , UK
| | - Teresa Atkinson
- b Association for Dementia Studies , University of Worcester, Institute of Health and Society , Worcester , UK
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Ageing in extra-care housing: preparation, persistence and self-management at the boundary between the third and fourth age. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractExtra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents’ attempts to manage this boundary.
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Abstract
ABSTRACTPerson-centred provision of long-term care (LTC) requires information on how individuals value respective LTC services. The literature on LTC preferences has not been comprehensively reviewed, existing summaries are contradictory. An explorative, scoping review was conducted to provide a thorough methodological description and results synthesis of studies that empirically investigated LTC preference outcomes based on respondents’ statements. A wide search strategy, with 18 key terms relating to ‘LTC’ and 31 to ‘preferences’, was developed. Database searches in PubMed, Ovid and ScienceDirect were conducted in February 2016. The 59 studies meeting the inclusion criteria were grouped and methodically described based on preference elicitation techniques and methods. Despite substantial methodological heterogeneity between studies, certain findings consistently emerged for the investigated LTC preference outcomes. The large majority of respondents preferred to receive LTC in their known physical and social environment when care needs were moderate, but residential care when care needs were extensive. Preferences were found to depend on a variety of personal, environmental, social and cultural aspects. Dependent individuals aspired to preserve their personal and social identity, self-image, independence, autonomy, control and dignity, which suggests that LTC preferences are a function of the perceived ability of a specific LTC arrangement to satisfy peoples’ basic physiological and mental/social needs. Research on LTC preferences would greatly profit from a standardisation of respective concepts and methods.
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Locus of Control and Trait Anxiety in Aged Adults: the Mediating Effect of Intolerance of Uncertainty. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9860-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Verbeek H, Tucker And S, Wilberforce M, Brand C, Abendstern M, Challis D. What makes extra care housing an appropriate setting for people with dementia? An exploration of staff decision-making. DEMENTIA 2017; 18:1710-1726. [PMID: 28875736 DOI: 10.1177/1471301217724966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extra care housing facilities in the UK are intended to offer a community-based alternative to care home placement. However, little is known about staff’s views of the appropriateness of extra care housing for people with dementia. This paper describes a mixed-methods study which explored this issue using statistical modelling of frontline staff’s recommendations of the best care setting for care home entrants; thematic analysis of transcripts from a simulated Resource Allocation Management Panel meeting; and content analysis of care coordinators’ reasons for not considering extra care housing in actual care home applications. Frontline practitioners saw extra care housing as a valuable alternative for a significant minority of care home entrants. However, extra care housing was not recommended if people needed care at night. Social care managers expressed general support for the idea of extra care housing, but appeared overwhelmingly focused on maintaining people at home and unsure where in the care pathway extra care housing sat. More evidence is needed on whether extra care housing can be an alternative to care homes and how services should be arranged to meet the needs of people living in extra care housing.
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Affiliation(s)
| | | | | | - Christian Brand
- University of Manchester, UK; London School of Hygiene and Tropical Medicine, UK
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Coast J, Kinghorn P, Mitchell P. The development of capability measures in health economics: opportunities, challenges and progress. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:119-26. [PMID: 25074355 DOI: 10.1007/s40271-014-0080-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent years have seen increased engagement amongst health economists with the capability approach developed by Amartya Sen and others. This paper focuses on the capability approach in relation to the evaluative space used for analysis within health economics. It considers the opportunities that the capability approach offers in extending this space, but also the methodological challenges associated with moving from the theoretical concepts to practical empirical applications. The paper then examines three 'families' of measures, Oxford Capability instruments (OxCap), Adult Social Care Outcome Toolkit (ASCOT) and ICEpop CAPability (ICECAP), in terms of the methodological choices made in each case. The paper concludes by discussing some of the broader issues involved in making use of the capability approach in health economics. It also suggests that continued exploration of the impact of different methodological choices will be important in moving forward.
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Affiliation(s)
- Joanna Coast
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Public Health Building, Birmingham, B15 2TT, UK,
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Steffansson M, Pulliainen M, Kettunen A, Linnosmaa I, Halonen M. The Association between Freedom of Choice and Effectiveness of Home Care Services. Int J Integr Care 2016; 16:5. [PMID: 27616949 PMCID: PMC5015554 DOI: 10.5334/ijic.2448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. METHODS A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients' subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. RESULTS As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. CONCLUSION Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients' opinions and to thereby improve the effectiveness of home care services.
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Affiliation(s)
- Marina Steffansson
- Research and Development Services for Social and Health Economics,
Diaconia University of Applied Sciences, Pieksämäki, Finland
| | - Marjo Pulliainen
- Research and Development Services for Social and Health Economics,
Diaconia University of Applied Sciences, Pieksämäki, Finland
| | - Aija Kettunen
- Research and Development Services for Social and Health Economics,
Diaconia University of Applied Sciences, Pieksämäki, Finland
| | - Ismo Linnosmaa
- Centre for Health and Social Economics – CHESS, National Institute
for Health and Welfare – THL, Helsinki, Finland
| | - Miikka Halonen
- School of Computing, University of Eastern Finland, Joensuu,
Finland
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Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study. PLoS One 2015; 10:e0137803. [PMID: 26489096 PMCID: PMC4619446 DOI: 10.1371/journal.pone.0137803] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/21/2015] [Indexed: 11/19/2022] Open
Abstract
Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Methods Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through “Embrace,” an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Results Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes “Struggling with health,” “Increasing dependency,” “Decreasing social interaction,” “Loss of control,” and “Fears;” and 2) Experiences with Embrace, with the themes “Relationship with the case manager,” “Interactions,” and “Feeling in control, safe, and secure”. The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants’ ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. Conclusion The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.
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Not ageing in place: Negotiating meanings of residency in age-related housing. J Aging Stud 2015; 35:55-64. [PMID: 26568215 DOI: 10.1016/j.jaging.2015.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/01/2015] [Accepted: 07/14/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE This article explores the experience of residing in age-related housing. The focus is on the negotiations around the multiple meanings assigned to place of residency among older people - in a situation where the official policy objectives of growing old in one's own home are not achieved. DESIGN AND METHODS Narrative analysis is employed to study the experiences of older people aged 75 or older living in special types of housing due to actual or anticipated difficulties associated with age. The interviews are part of a larger body of data gathered in MOVAGE Moving in Old Age: Transitions in Housing and Care research project. FINDINGS The storyworld was structured by the romantic canonical narrative associated with the policy of 'ageing in place'; growing old at home is idealised and moving is constructed as a disruption. This breach was resolved through explaining deviance from canonical expectations by causes constructed as legitimate, through encountering trouble by constructing oneself as a non-typical resident, and through creating counter stories of natural transitions and choices. As a result, despite the commonly negative meanings associated with the residency in age-related housing, positive storylines respecting values embedded in the canonical narratives of home and endurance were achieved. IMPLICATIONS A living environment that is experienced as suitable, and that has adequate formal help available, supports and enables wellbeing and independence. This is true within age-related housing as well as in other forms. Thus, even though the important meaning of a long-term home should continue to be acknowledged, various other kinds of forms of housing should be made available in order to enhance older people's sense of security and feeling that they are autonomous, independent agents in their everyday life in accordance with their subjective life experiences.
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