John Crossland

The role of the home environment in dementia care and support: Systematic review of qualitative research:

Background The domestic home is the preferred site for care provision for people with dementia and their families, therefore creating a dementia and caring friendly home environment is crucial. This systematic review synthesised qualitative studies to explore the role of the home environment and identify potential barriers and facilitators in home dementia care and support to inform future practice and research. Methods A systematic search in 12 databases identified international qualitative literature on perceptions and experiences of community-dwelling people with dementia, family and formal carers regarding the role of the home environment and ways to tackle daily challenges. Results Forty qualitative studies were included and analysed using thematic synthesis. The main three themes were: ‘home as a paradox’, ‘there is no magic formula’ and ‘adapting the physical space, objects and behaviour’. Findings indicate that home is an important setting and is likely to change significantly responding to the changing nature of dementia. Themes were later validated by family carers of people with dementia. Conclusions The home environment is an important setting for care and needs to remain flexible to accommodate changes and challenges. Family carers and people with dementia implement and often improvise, various environmental strategies. Continuous and tailor-made support at home is required.

Exploring the Care Act’s potential for anti-discriminatory practice with lesbian, gay, bisexual and trans older people

Purpose – The planning and provision of care for older people in the lesbian, gay, bisexual and trans (LGBT) communities is an increasing challenge to traditional welfare systems. The purpose of this paper is to explore the potential of the newly implemented Care Act 2014 in England for developing an anti-discriminatory approach. Design/methodology/approach – The review draws on existing research and conceptual literature to identify how key provisions of the new act can be interpreted in light of current knowledge. Findings – Overall the provisions of the Care Act lend themselves well to positive interpretation in relation to the needs of older LGBT people and their support networks. A potential tension, however, arises in the locality focus of the legislation that could constrain good practice with geographically dispersed communities. There is also a need to challenge both heteronormative and ageist assumptions that lead to older LGBT people remaining unrecognised. Practical implications – Applied with...

Care in the community for older people: an English perspective on the German care system

I was recently awarded a TH Marshall Fellowship at the London School of Economics and spent four months in Berlin, supported by the Volkswagen Foundation. Hosted by the Katholische Hochschule fur Sozialwesen Berlin, a higher education institute for applied social science, I spent half of each week in the local office of a Berlin-wide project providing case management for older people (www.koordinierungsstellen-rundumsalter. de), researching case management within the context of the structures and processes of the German care system. This task led me to look for points of similarity and difference with the British system of community care that has shaped my professional life since the implementation of the NHS (National Health Service) and Community Care Act 1990. Since devolution, the community care policy in the UK differs between England and Wales, Scotland and Northern Ireland, particularly in relation to the provision of free long-term care.

Insider or outsider? The salience of researcher identity in the context of a qualitative study of early help for families where there is child neglect

This methodologically focused case arises from the lead author’s professional doctorate in social work at the University of Portsmouth that was supervised by the two co-authors. It considers issues that are encountered in the context of professional doctorate research, particularly changes in the research context during the study, working across professional practice and academic settings, and insider–outsider researcher issues. A change of job and work location for the lead author part-way through the study provided an opportunity to compare researching organizational issues as an “insider” (in the early stages of the study) and as an “outsider” (in the latter stages). Analysis of the differences between the findings generated from each of these perspectives highlights how the positioning of the researcher in relation to the organization under investigation can impact on the research process. The study was a qualitative investigation of access to early help for families where there is neglect of young (pre-school) children. It was conducted from a social constructionist perspective, and the findings were considered using ideas from ecological analysis and street-level bureaucracy. Data collection involved semi-structured interviews of parents, focus groups of children’s services practitioners, and a focus group of community volunteers. Data analysis used NVivo 11 coding and thematic network analysis. Practical strategies that the lead author found helpful in the research are outlined, for example, negotiating commissioning decisions, maintaining reflexive research logs, peer shadowing and debriefing, achieving clarity around dual supervision arrangements, using a research design evaluation framework, ways of monitoring organizational change, and negotiating with reluctant gatekeepers.

THE JOURNEY WITH DEMENTIA FROM THE PERSPECTIVE OF BANGLADESHI FAMILY CAREGIVERS IN ENGLAND

of insanity” and “Alzheimer’s disease results from a curse”. We compared responses between persons living in rural and urban settings in Mexico and the U.S. settings using chi-square tests. Results:Urban participants (n 1⁄4 31) had higher levels of education (14.7 vs. 10.6 years, p<0.05), and a higher mean age (41.5 vs. 35.6, p<0.05) relative to rural participants (n 1⁄4 79). Rural participants were significantly more likely to endorse that AD can result from a curse (23.5% vs. 0%, p<.0.01), is a form of insanity (45.6% vs 3.8%, p<0.01), can be caused by traumatic life experiences (19.2% vs. 0%, p<0.01), and that AD can arise as “God’s will” (21.4% vs. 4.2%, p<0.05). Conclusions: In order to ethically conduct ADAD prevention studies, it is critical that potential participants are educated regarding the biological nature of the disease and the potential options for medical interventions. However, our study shows that misconceptions and myths about AD are prevalent, particularly in rural Mexico. Families at-risk for AD need additional education regarding AD in order to understand the potential impact of AD on their lives and inform decisions regarding research participation.

Perception and attitude toward ageing and dementia among the Bangladeshi community in England

Background: Worldwide, an increasing ageing population mean more people may suffer from dementia. Despite a rapid growth of older Bangladeshi immigrants living in the UK, there is little evidence about how community members (who are not affected by dementia) understand and view the process of ageing and dementia. Yet, Bangladeshis have a higher risk of developing type 2 diabetes and heart disease; both important indicators of developing dementia in old age. In previous research, conducted with immigrant South Asians, the concept of stigma and its impact on the understanding of dementia has been commonly acknowledged as a big challenge to seeking service support. This study aimed to explore and analyse the perception, knowledge, and attitude of ageing and dementia among the Bangladeshi community.

Translating case management in a service for older people in Berlin

Case management is a coordinating process designed to align service provision more closely to the identified needs of people requiring assistance in the context of complex care systems. It is an approach that has crossed the borders of different national welfare systems where it has been adopted to address ostensibly similar problems. This empirically based but primarily methodological article draws on the authors doctoral research during which he spent an extended period in Berlin investigating a citywide case management service for older people in the context of German long-term care policy and legislation. It explores the extent to which a specific case study can illuminate how case management adapts in differing national welfare systems and highlights the particular methodological challenges of ‘translation’ and ‘equivalence’ in cross-national research. The article outlines how institutional context both shaped and constrained the Berlin case management service and highlights the necessity in cross-country research for a critical contextual examination of apparently similar features. This is particularly relevant where English words and expressions are directly absorbed into the local language, an important yet rarely addressed complicating factor.