Rowan Jasper

People with dementia and carers’ experiences of dementia care and services: Outcomes of a focus group study

An ageing population and an associated increase in the prevalence of dementia are of increasing concern in the United Kingdom and worldwide. Recently, the United Kingdom and other European countries implemented national dementia strategies to address this. This paper reports on the outcomes of a focus group study involving people with dementia and carers on their experiences of dementia care and support services in relation to government and third sector agencies’ objectives and recommendations. Three focus groups comprising carers and people with dementia (n = 27) were undertaken covering topics related to experiences, service receipt, information sharing and service development. Some participants experienced difficulties or delays in receiving a dementia diagnosis and in accessing appropriate care. The provision of training, timeliness of information, access to appropriate advice, and consistent and flexible services were deemed important. The findings suggest that some issues raised by participants were highlighted in earlier policy objectives and recommendations but remain of central concern. The projected growth in the number of people with dementia coupled with reduced availability of informal care and increased demand for services emphasises the need to transform dementia care in the United Kingdom.

Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England

To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission.

Care coordination in adult social care: Exploring service characteristics within the non-statutory sector in England

Summary As a result of national policy in respect of social care of adults in England, the non-statutory sector is increasingly more evident in the provision of care services previously undertaken by local government, including the delivery of care coordination for older people. However, little is currently known about the scope, content, or quality of services providing care coordination within this sector. This article reports the findings from a postal survey undertaken in January 2014 of non-statutory organisations in England providing care coordination services and investigates variations in their key attributes. Organisations providing care coordination services were identified using various strategies to create a database of services. Questionnaires encompassing several areas of enquiry were mailed to managers of care coordination services identified from the database. Findings There was similarity in the operation of the care coordination services sampled. Many were small-scale services, contract-funded, and providing short-term support. Volunteer staff were a feature of most services. All services worked to written protocols and standards and almost all levied no charge. Many shared information with healthcare or local authority staff with user consent. Service user satisfaction was measured and used for service improvement. Application This is one of the first studies undertaken in England to investigate the provision of care coordination by the non-statutory sector and to identify patterns of variation in key service attributes. Implications for commissioners, service providers, workforce, and social workers are further discussed. The findings provide baseline data against which future developments can be measured.

Community mental health teams for older people: variations in case mix and service receipt (II)

To determine the extent to which services provided to older people via community mental health teams (CMHTs) vary in duration, composition and intensity. In particular, to identify the degree to which differences between teams are due to casemix.

Accessing care coordination information: the non-statutory sector contribution

Purpose The provision of information and advice for older people arranging their own care is a policy objective. The purpose of this paper is to explore the range and scope of web-based information about care coordination activities for older people in the non-statutory sector in England. Design/methodology/approach Non-statutory organisations were identified through a structured internet search. Services were screened to identify those providing at least one care coordination activity. A postal survey of services was conducted in 2014 and results compared with the initial findings of the web search. Findings Almost 300 services were identified, most of which were provided by three organisations: Age UK; Alzheimer’s Society; and the British Red Cross. Brokerage was the most frequently reported care coordination activity; the majority of services focussed on help to stay at home; and carers and older people (including those with dementia) were the target groups most often identified. Comparison of the two information sources revealed a significant agreement between two care coordination’s activities: compiling support plans and monitoring and review. Research limitations/implications Findings are based on a purposive sample of organisations and therefore care must be exercised in generalising from them. Originality/value This study is one of the first to systematically explore the nature and extent of information about care coordination activities provided by the non-statutory sector in England. It was conducted when policy advocated both an increased role for the non-statutory sector and an increase in self-directed support.

Care coordination for adults and older people: The role and contribution of the non-statutory sector’

Purpose The purpose of this paper is to provide new insights into the contribution and experiences of non-statutory sector (voluntary) services delivering care coordination. Design/methodology/approach This qualitative study, based on face-to-face semi-structured interviews with 17 managers from a range of non-statutory sector services, used thematic data analysis supported by a framework approach. Findings Four themes emerged: commissioning arrangements undermined non-statutory sector development; working relationships between statutory and non-statutory services required time and energy to navigate and sustain; the establishment of a niche role in the larger network of provision; and tensions relating to future developments. The non-statutory sector was found to provide a mix of services, including specialist provision targeting specific communities that complemented or substituted for those provided by the state. Managers wanted their services to be recognised by the statutory sector as equal partners in the delivery of care coordination and were also keen to retain their independence. Practical implications Findings provide information for service commissioners and managers from statutory and non-statutory sectors indicating a complex set of experiences and views regarding the role of the latter. This is particularly salient in a political landscape which has increasing expectations of their involvement in the provision of care coordination. Originality/value This study considers the work of the non-statutory sector in the delivery of care coordination to adults and older people, an area under-reported to date. It suggests that there are opportunities available for these services to become embedded within a wider social care system and to excel by retaining or developing specialist roles and services.

Identifying standards for care coordination in adult social care: a multinational perspective:

Introduction Standards for care coordination in adult social care can support the delivery of high-quality services. Methods A content analysis of 20 guidance documents produced over the last 30 years was undertaken to consider their utility for current practice. a mix of convenience and purposive sampling was used. Data were extracted on document design and substance and were analysed in relation to a conceptual framework that articulated standards as principles of practice situated within elements of care coordination such as assessment. Results A total of 24 standards were repeatedly found across the documents. the most frequently cited were user participation, a network approach and person-centred practice. Most documents contained ‘standards’ as identified by the framework above. Variation was found regarding how standards were operationalised in relation to elements of care coordination. Principles were most frequently linked to assessment and care/support planning and least often to referrals and case closures. User participation was the most cited principle, operationalised in relation to all elements of practice in seven documents. a total of 16 standards related to individual practice and eight to agency level responsibilities. Discussion The findings indicate a set of core standards that have demonstrated utility over a 30-year period and to gaps in relation to both the operationalisation of certain principles and particular elements of care coordination. the application of the definition of a standard developed by this study could support the delivery of comprehensive high-quality services across the care coordination pathway. Further research is needed to validate its use in different settings.

Occupational therapists in Community Mental Health Teams for older people in England: findings from a five year research programme

Introduction This English study is the first to focus on the contribution of occupational therapists to the work of community mental health teams for older people. Method A mixed methods study comprising: a national survey of community mental health team managers; caseload audit; qualitative interviews; and a practitioner survey provided information on team membership and functions, user characteristics, accounts of occupational therapists’ roles and experiences, and work characteristics. Findings Occupational therapists worked mainly with people with dementia and were involved in both generic and specialist tasks, with the latter focusing largely on maintaining functionality. They had found ways to balance their roles for the benefit of the team without loss of professional identity. Some differences of opinion between clinical leads and occupational therapists were reported. Stress levels among occupational therapists were similar to those of professional colleagues. Conclusion Some findings contrast with earlier studies of community mental health teams for working-age adults, offering new insights into the nature of the occupational therapists’ experiences. To ensure that occupational therapists in these settings are able to contribute effectively, a shared understanding of their role is required between them and their clinical leads.

Inter-professional perspectives of dementia services and care in England: Outcomes of a focus group study

Many people living with dementia are supported at home using a variety of health and social care services. This paper reports the findings from a focus group study undertaken with staff in community mental health teams to explore areas for improvement in relation to national policies and recommendations for dementia care. Two focus groups were held with staff (n = 23) in 2011 to discuss topics including service delivery, information and communication, and provision of health and community care for people with dementia. Respondents identified problems with information sharing and incompatible electronic systems; inflexibility in home care services; and poor recognition of dementia in hospital settings. General practitioners had developed a greater awareness of the disease and some community services worked well. They felt that budgetary constraints and a focus on quality indicators impeded good dementia care. Key areas suggested by staff for improvements in dementia care included the implementation of more flexible services, dementia training for health and social care staff, and better quality care in acute hospital settings.

Care co‐ordination for older people in the third sector: scoping the evidence

The third sector has played a significant role internationally in the delivery of adult social care services for many years. Its contribution to care co-ordination activities for older people, however, in England and elsewhere, is relatively unknown. A scoping review was therefore conducted to ascertain the character of the literature, the nature and extent of third sector care co-ordination activity, and to identify evidence gaps. It was undertaken between autumn 2013 and summer 2014 and updated with additional searches in 2016. Electronic and manual searches of international literature using distinct terms for different approaches to care co-ordination were undertaken. From a total of 835 papers, 26 met inclusion criteria. Data were organised in relation to care co-ordination approaches, types of third sector organisation and care recipients. Papers were predominantly from the UK and published this century. Key findings included that: a minority of literature focused specifically on older people and that those doing so described only one care co-ordination approach; third sector services tended to be associated with independence and person-centred practice; and working with the statutory sector, a prerequisite of care co-ordination, was challenging and required a range of features to be in place to support effective partnerships. Strengths and weaknesses of care co-ordination practice in the third sector according to key stakeholder groups were also highlighted. Areas for future research included the need for: a specific focus on older peoples experiences; an investigation of workforce issues; detailed examination of third sector practices, outcomes and costs; interactions with the statutory sector; and an examination of quality assurance systems and their appropriateness to third sector practice. The main implication of the findings is a need to nurture variety within the third sector in order to provide older people and other adults with the range of service options desired.