Adapting the adult social care outcomes toolkit (ASCOT) for use in care home quality monitoring: conceptual development and testing

Background: Alongside an increased policy and practice emphasis on outcomes in social care, English local authorities are now obliged to review quality at a service level to help in their new role of ensuring the development of diverse and high-quality care markets to meet the needs of all local people, including self-funders. The Adult Social Care Outcomes Toolkit (ASCOT) has been developed to measure the outcomes of social care for individuals in a variety of care settings. Local authorities have expressed an interest in exploring how the toolkit might be used for their own purposes, including quality monitoring. This study aimed to explore how the care homes version of the ASCOT toolkit might be adapted for use as a care home quality indicator and carry out some preliminary testing in two care homes for older adults. Methods: Consultations were carried out with professional and lay stakeholders, with an interest in using the tool or the ratings it would produce. These explored demand and potential uses for the measure and fed into the conceptual development. A draft toolkit and method for collecting the data was developed and the feasibility of using it for quality monitoring was tested with one local authority quality monitoring team in two homes for older adults. Results: Stakeholders expressed an interest in care home quality ratings based on residents’ outcomes but there were tensions around who might collect the data and how it might be shared. Feasibility testing suggested the measure had potential for use in quality monitoring but highlighted the importance of training in observational techniques and interviewing skills. The quality monitoring officers involved in the piloting recommended that relatives’ views be collected in advance of visits, through surveys not interviews. Conclusions: Following interest from another local authority, a larger evaluation of the measure for use in routine quality monitoring is planned. As part of this, the ratings made using this measure will be validated against the outcomes of individual residents and compared with the quality ratings of the regulator, the Care Quality Commission

Quality of life in dementia:a study on proxy bias

<p>Background: Measurement of health-related quality of life (HRQoL) in dementia is difficult. At some point people with dementia become unable to meaningfully assess their own HRQoL. At such a point in time researchers need to rely on other types of information such as observation or assessments from informal caregivers (proxies). However, caregiver assessments may be biased by several mechanisms. The current study explores whether caregivers project part of their own HRQoL in their assessments of patient HRQoL.</p><p>Methods: The participants in the current study were 175 pairs, consisting of community-dwelling persons with dementia and their caregivers. The EQ-5D, the EQ-VAS and the QoL-AD were administered to collect HRQoL measurements from patients and caregivers at baseline, 6 months and 12 months. Two linear mixed models were used to investigate factors that bias proxy ratings, one with the EQ-VAS as dependent variable, and one with the EQ-5D utility as dependent variable. The independent variables were caregiver age, caregiver sex and caregiver QoL-AD items.</p><p>Results: The linear mixed model with EQ-VAS as dependent variable indicated that 3 caregiver characteristics, namely caregiver age, money (caregiver's financial situation) and valuation of life as a whole were significant predictors of the patient-by-proxy VAS scores. The linear mixed model with utility value as the dependent variable showed that caregiver age and valuation of the ability to do things for fun were significant predictors of the patient-by-proxy EQ-5D utility values.</p><p>Conclusions: The current study was a first step in identifying factors that bias patient-by-proxy HRQoL assessments. It was discovered that caregivers project part of their own HRQoL onto patients when assessing patient HRQoL. This implies that patient-by-proxy HRQoL values should be interpreted with caution and not be used as a direct substitute for patient self-assessment, even when patients are no longer able meaningfully assess themselves.</p>

The needs of people with dementia living at home from user, caregiver and professional perspectives: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Few reports have been published about differences in perspectives on perceived needs among community-residing people with dementia, their family caregivers, and professionals. The aim of this study was to compare these perspectives.</p> <p>Method</p> <p>During 2006 and 2007, one-hundred and fifty two interviews of people with dementia and their caregivers about the needs of the person with dementia were performed by four professionals using The Camberwell Assessment of Need for the Elderly (CANE). Professionals’ views on met and unmet needs of people with dementia were obtained for the total sample, family caregivers’ perspectives were gained for 125 people with dementia, and people with dementia’s views on their own needs were obtained for 125 persons with dementia.</p> <p>Results</p> <p>People with dementia reported fewer needs compared with the reports of their caregivers and the professionals. The most frequent unmet needs reported by people with dementia, caregivers and professionals were in the areas of daytime activities, company, and psychological distress; however, people with dementia rated psychological distress as the commonest unmet need.</p> <p>Conclusions</p> <p>Since the priorities of people with dementia can be different from those of caregivers and professionals, it is important to consider all perspectives when making care plans. Thus, compliance with treatment of people with dementia and also their quality of life could be potentially improved by a more collaborative partnership with them.</p

Kwaliteit van leven bij dementie

In de literatuur worden verschillende definities van ‘kwaliteit van leven’ gevonden. Dit roept de vraag op welke domeinen als belangrijk worden gezien door mensen met dementie zelf. In een exploratieve studie werden de meningen van mensen met dementie (thuiswonend en verblijvend in verpleeghuizen) vergeleken met die van professionele zorgverleners en met meetinstrumenten voor kwaliteit van leven bij dementie. Gegevens werden verzameld door middel van interviews, focusgroepen en literatuurstudie. De meeste kwaliteit- van-levendomeinen die door mensen met dementie belangrijk werden gevonden, werden ook genoemd door de professionele zorgverleners en gevonden in meetinstrumenten. Sommige domeinen werden echter niet genoemd door professionals (‘gevoel voor esthetiek’, ‘financiële situatie’, ‘nuttig zijn/zingeving’ en ‘spiritualiteit’) of niet gevonden in de meetinstrumenten (‘veiligheid en privacy’, ‘zelfbeschikking en vrijheid’, ‘nuttig zijn/ zingeving’ en ‘spiritualiteit’). Dit wijst op mogelijke verschillen in perspectief tussen mensen met dementie enerzijds en hun zorgverleners en onderzoekers anderzijds. Vervolgens is onderzocht in hoeverre professionals zich richten op de kwaliteit-vanlevendomeinen die mensen met dementie belangrijk vinden. Zorgverleners van 29 afdelingen en 3 dagbehandelingen van 13 verpleeghuizen en 12 ontmoetingscentra vulden een vragenlijst in (N=374). Zij gaven aan zich tenminste in enige mate te richten op de meeste domeinen die als relevant werden genoemd door mensen met dementie, maar in beperkte mate op ‘financiële situatie’ en ‘nuttig zijn/ zingeving’. Zorgverleners die betrokken zijn bij dagbesteding richtten zich meer dan zorgverleners die 24-uurszorg leveren op de domeinen ‘gehechtheid’, ‘plezier in activiteiten’, ‘gevoel voor esthetiek in leefomgeving’ en ‘nuttig zijn, zingeving’