Well-being and choice for older people – how can commissioners promote this? (original) (raw)
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Making home care for older people more flexible and person-centred
2005
Chapter 1 Origins of the project and its aims Aims of the project Chapter 2 Project design and methods Stage 1: Literature Review 3 Stage 2: Telephone interviews with 23 home care provider managers Stage Three: In-depth case studies of six provider and purchaser pairs Chapter 3 Summary of findings from Stages One and Two a) Outline findings from the literature review b) Outline findings from the telephone survey Chapter 4 Findings from the Stage Three in-depth case studies Independent agencies In-house Social Services providers Provider organisation and management-findings common to both sectors Social Services Care Management Service users' aspirations The importance of values, not methods or systems A notable shortcoming: can it be avoided? Chapter 5 Guidelines for promoting flexible person-centred care Chapter 6 Implications from the study Practicability of flexible, person-centred home care Relevance to established national policy Potential for development 'Independence, Well-being and Choice' and the future for flexible, person-centred home care 28 References Appendix 1 Publications from Stages One and Two of the project on flexible, person-centred home care for older people Appendix 2 Size and workload of the six home care providers in Stage 35 Three Appendix 3 Miscellaneous additional information about the project 37
Improving home care quality: An individual‐centred approach
Quality in Ageing and Older Adults, 2001
Evidence is presented for important individual differences between older people concerning what they value as high quality service from Home Care. A case is made for improving service quality through systematically consulting each service user about their own preferences and seeking to fulfil these requests on an individual basis. This contrasts with setting uniform quality standards for all older Home Care clients, based on most commonly expressed preferences. Evidence is cited from individual interviews with older Home Care service users and from an experiment in modifying older people's services through briefing Home Care staff on the preferences of individual clients. Issues in developing this approach are discussed.
The challenges of commissioning home care for older people in England: commissioners’ perspectives
Ageing & Society, 2020
Home care for older people in England is commissioned through local authorities working predominantly with independent providers of care. Commissioners operate in a market model, planning and procuring home care services for local populations. Their role involves 'managing' and 'shaping' the market, to ensure an adequate supply of care providers. Another imperative, emerging from the principles of personalisation, is the drive to achieve user outcomes rather than 'time and task' objectives. Little formal research has investigated the way commissioners reconcile these different requirements and organise commissioning. This study investigated commissioning approaches using qualitative telephone interviews with ten commissioners from different local authorities in England. The characteristics of commissioning were analysed thematically. Findings indicated (i) commissioning policy involved complex systems and processes, uniquely shaped for the local context, but frequently changed, suggesting a constant need for reframing commissioning arrangements; (ii) partnerships with providers were mainly transactional, with occasional examples of collaborative models, that were considered to facilitate flexible services more appropriate for commissioning for personalised outcomes; (iii) only a small number of commissioners had attempted to reconcile the competing and incompatible goals of tightly prescribed contracting and working collaboratively with providers. A better understanding of flexible contracting arrangements and the hallmarks of a trusting collaboration is required to move beyond the procedural elements of contracting and commissioning.
Health and Social Care in the Community, 2021
This paper presents findings from the evaluation of an Australian trial of self-managed home aged care. The self-management model was codesigned by advocacy organisation COTA Australia, consumers and service providers. The primary aim of the evaluation was to examine whether self-management improved consumers' perceptions of their choice, control, and wellbeing. The secondary aim was to examine whether provider prior experience with self-managed packages significantly influenced consumers' perceptions of choice, control and wellbeing, thereby confounded trial effects. A pre-test post-test quasi-experimental design and mixed-methods design were used to collect data over nine months in 2018-2019. The pre-trial methods and findings have been published. The post-trial evaluation replicated the pre-trial data collection method of an
Journal of Social Service Research, 2018
In Sweden, a policy shift towards more individualized eldercare, with an emphasis on consumer choice, has taken place. The aim of this study was to analyze the processes and practices of individualized eldercare, focusing on preconditions for older peoples' choice and control. Data consist of qualitative interviews with users of home care services (n-12) and staff (n-12) and participant observations (n-7) of meetings between staff and older people. The choice and control available to older users emerged as decisions about 'what' care and services, 'who' should provide the care and services, and 'how' the care and services should be performed. Three approaches to enable older people choice and control over their home care services were revealed: test and revise, services elaborated in close collaboration between users, care managers and home care staff; choices in the moment, users could choose services at each occasion; and quality improvement through competition, competing providers develop attractive services. The findings could guide policy makers in combining the strengths of these approaches to enable older people in need of support to become co-producers in designing, managing, as well as consuming, care and services. Future quantitative research is needed to achieve generalizable knowledge about the strengths and weaknesses of different ways to organize eldercare services.
QuaLiTy OF LiFe is … : The VieWs OF OLDer reciPieNTs OF LOW-LeVeL hOme suPPOr T
2008
A qualitative study explored the perceptions of quality of life of older people receiving low-level home support in a selected locale in New Zealand. The results shed light on the role that home support at the "lower" end of health resource allocation plays in elderly recipients' quality of life. They also provide insights into these elders' perceptions of current national policy, which advocates both for "ageing in place" and for targeting support to those with higher-level need. Six themes emerge from how these elders talk about and define what quality of life means to them: good people, day-to-day life, keeping healthy, living with loss, at my age, and the future. An in-depth understanding is thus presented of the views of this group of elders in relation to a question of high priority in current economic, health and social debates in New Zealand.
CARE REGIMES ON THE MOVE Comparing home care for dependent older people
Taking the reforms of the 1990s as its starting point, this report examines the dynamics of change experienced by Belgium, England, Germany and Italy in their home care sectors. Central to our analysis is the process of “marketisation”. This constitutes one of the major trends in all these four countries, yet its nature and impact show important national variations. The data referred to in this report relate to developments in and around various home care sectors, and cover both societal and organisational dynamics. Country-based research teams gathered the information, each team following identical methodological guidelines. After a brief description of the main public home care schemes in the four countries (set out in a preliminary chapter), this report uses official documents and grey literature from the care sector to analyse the discourses underpinning reforms in the field (Chapter 1). Chapter 2 compares national processes for setting and implementing service eligibility policies (covering eligibility by need and through financial means-testing), and their implications as demonstrated by quantitative indicators of population coverage and intensity of provision. In addition, the analysis contrasts key features of the support provided, such as: whether the resources are provided in cash or through services “in-kind”; the extent of user choice over the type of service and of provider commissioned; and the existence of systematic processes for assisting individuals in the design of their support plans. Chapter 3 addresses the question of whether the increasing multi-level governance of home-based support has induced regional disparities and/or hindered innovation. Chapter 4 looks at the channels of marketisation, one of the key trends that has affected the “personality” of European care regimes. We first examine the impact of marketisation through the lenses of the evolution of the welfare mix. Then, in order to assess its effects on the final user, we investigate how the “market” works. Finally, given these features, we analyse how the process of marketisation affects the cost paid by users. Chapter 5 looks at the welfare mix as applied to care arrangements at the individual’s level in Belgium, Germany and Italy. It examines the way dependant older people and their families cope with the need for care and how they combine formal and informal care1. The Share database, that gives information on older people’s living circumstances, will be used to identify the determinants of care use. Performance assessment is playing an increasing role in the governance of home care services in Europe. Chapter 6 discusses the consequences of performance assessment on the governance of the home care sector. The aim of this chapter is to explore how widely performance measurement and assessment techniques are being used within home care and to analyse their role in the context of differing system objectives and structures. Chapter 7 discusses the gender related aspects of these reforms and, in particular, looks into their impact in terms of defamilialisation on family care givers, professional care givers and cared-for. The final chapter (chapter 8) deals with the issue of converging (or diverging) care regimes in Europe by applying the “open method” of comparing institutional change to the four countries under study. The question of whether care regimes are or not embracing a transnational path departure is explored. The conclusions of this research will be of relevance for any country or region struggling to design a home care system for an ageing population. The coordinators of this research project have submitted a proposal for a special issue of Ageing and Society based on the main chapters of this report. Authors of the chapters will also submit articles to a range of journals.
Health Expectations, 2014
Background Taking the needs, wishes and experiential knowledge of clients into account is considered to result in a better fit between the supply and demand of modern health care, contributing to the improvement of individual care, organizations, institutions and policy. However, the current generation of the elderly have had little experience of consumer-oriented public services. They are said to be less likely to discuss their needs and wishes with individual caregivers and health-care organisations. As a result, they might not receive care matching their needs and wishes. Aim To examine how the elderly themselves refer to their age and their needs and wishes for individual and collective participation in home-based care to get a better understanding of their participation in their own health care. Methods Content analysis of 20 semi-structured in-depth interviews with elderly recipients of care in the Netherlands. Results The need and ability of the elderly to discuss their experiences are strongly affected by physical and mental limitations, social cultural characteristics and their experiences of life. As a result, the elderly encounter many limitations in discussing their experiences with their individual caregivers and their home-care organisation. However, this does not mean that the elderly do not have needs and wishes that they want taken into account. Conclusion The challenge is to create a more responsive environment and to find new, creative ways of facilitating the expression of the needs and wishes of the elderly, according to the specific values and norms of their generation.
Ageing and Society, 2019
As consumer-directed care programmes become increasingly common in aged care provision, there is a heightened requirement for literature summarising the experience and perspectives of recipients. We conducted rapid evidence reviews on two components of consumer experience of home- and community-based aged care: (a) drivers of choice when looking for a service (Question 1 (Q1)); and (b) perceptions of quality of services (Question 2 (Q2)). We systematically searched MEDLINE and EMBASE databases, and conducted manual (non-systematic) searches of primary and grey literature (e.g. government reports) across CINAHL, Scopus, PsychINFO, and Web of Science, Trove and OpenGrey databases. Articles deemed eligible after abstract/full-text screening subsequently underwent risk-of-bias assessment to ensure their quality. The final included studies (Q1: N = 21; Q2: N = 19) comprised both quantitative and qualitative articles, which highlighted that consumer choices of services are driven by a com...