Outcomes for Older Telecare Recipients: The Importance of Assessments

The article explores both telecare in relation to its composition of assistive technologies, including sensors; and associated services that use such technologies as a means by which, often vulnerable, people can obtain help through their activation - with signals being routed to monitoring centres. The context is one where there are changes to such technologies and ongoing growth in the use of telecare services - despite there being no indicated benefits from a major study (the Whole System Demonstrators). The 'curious' investment in such technologies and services by Adult Social Care Departments in England is investigated through an interview survey that elicited over 100 valid responses. Iy gave particular attention to the assessment process by which effective targeting (to those who would be most likely to benefit) would, it had been assumed, have taken place. Key outcomes point to needed improvements to social care practice - including the need to balance a narrow focus on risk (determined in a largely top-down way) with other telecare offerings that could more proactively address (e.g. loneliness) and involve the user more proactively in relation to technology and service options. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Summary This article explores the role of telecare assessment, review and staff training in meeting the needs of older people living at home. Using original empirical data obtained from an online survey of English local authorities it reveals considerable variation in assessment and review practice and in training given to social work and other staff who assess and review, which may impact on outcomes for telecare users. The study findings are situated within an English policy context and earlier findings from a large, government funded randomised controlled trial. This trial concluded that telecare did not lead to better outcomes for users. Findings Our survey findings suggest that it may be the way in which telecare is used, rather than telecare itself that shapes outcomes for people who use it, and that ‘sub-optimal’ outcomes from telecare may be linked to how telecare is adopted, adapted and used; and that this is influenced by staff training, telecare availability and a failure to regard telecare as a complex intervention. Application The findings may help to reconcile evidence which suggests that telecare does not deliver better outcomes and local authority responses to this which either discount or contest its value. The article suggests that to use telecare to achieve optimal outcomes for older people, social workers, care managers and other professionals involved in assessing for telecare will need to be given enhanced training opportunities, and their employers will need to perceive telecare as a complex intervention rather than simply a ‘plug and play’ solution

What is the housing with care ‘offer’ and who is it for? Written for the Housing Learning and Improvement Network (LIN)

Published to coincide with the International Day of Older Persons, this viewpoint explores some of the findings from Adult Social Services Environments and Settings (ASSET), a research project that was funded by the NIHR School for Social Care Research from February 2012 to April 2014. The project explored how adult social care services are commissioned and delivered in extra care housing and retirement villages. It is a timely paper, coming hot off the heels of the recent Commission on Long Term Care, chaired by former Care Services Minister, Paul Burstow MP. This recommended greater clarification on what constitutes housing with care

Making Use of Evidence in Commissioning Practice: Insights into the Understanding of a Telecare Study’s Findings

The paper draws on (100+) survey responses from social services authorities in England. It established their generally minimal understandings of (largely negative) outcomes of the government promoted (Whole System Demonstrator (WSD) project. The WSD project involved over 5000 mainly older people - half of whom were, following assessment, assigned telecare equipment (others telehealth). The robustness of the outcomes are discussed; issues about the effectiveness of assessments are raised; and the appropriateness of the methodology (an RCT) is questioned. In sum the paper provides an example where shortcomings of RCTs are exposed in a context where technological changes impact on ‘traditional’ (health and) social care service frameworks. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.In less than a generation, telecare has become a significant new resource for local authority (LA) Adult Social Care Departments (ASCDs) in England and other European countries to offer to people eligible for social care and support. All English ASCDs either have directly managed, or commissioned, telecare services, and telecare is often used as a 'first line' service (that is, before other forms of intervention). The Whole Systems Demonstrator Project (WSD), a very large clinical trial funded by the English Department of Health (DH) concluded that it does not deliver better outcomes. Despite this, and in the context of unprecedented reductions in adult social care expenditure over the last decade (Innes and Tetlow, 2015), investment in telecare has continued in the UK. This article explores the extent and nature of the evidence used in LAs to support investment in telecare

A community hub approach to older people’s housing

Purpose. This paper explores the potential of housing with care schemes to act as a community hubs. The analysis highlights a range of benefits, barriers and facilitators. Design/methodology/approach. Data is presented from the ASSET project (Adult Social Services Environments and Settings) which used a mixed methods approach including a review of the literature, surveys and in-depth case study interviews. Findings. Most housing with care schemes have a restaurant or café, communal lounge, garden, hairdresser, activity room and laundrette, while many also have a library, gym, computer access and a shop. Many of these facilities are open not just to residents but also to the wider community, reflecting a more integrated approach to community health and adult social care, by sharing access to primary health care and social services between people living in the scheme and those living nearby. Potential benefits of this approach include the integration of older people’s housing, reduced isolation and increased cost effectiveness of local services through economies of scale and by maximising preventative approaches to health and wellbeing. Successful implementation of the model depends on a range of criteria including being located within or close to a residential area and having onsite facilities that are accessible to the public. Originality and Value. This paper is part of a very new literature on community hub models of housing with care in the UK. In the light of new requirements under the Care Act to better coordinate community services, it provides insights into how this approach can work and offers an analysis of the benefits and challenges that will be of interest to commissioners and providers as well as planners. This was a small scale research project based on four case studies. Caution should be taken when considering the findings in different settings

Housing and Ageing:Let’s get serious-“how do you plan for the future while addressing immediate chaos?"

This article presents findings from the Housing and Ageing programme conducted in 2018 that investigated how the housing sector can effectively plan for an ageing population. The project took a transdisciplinary approach to focus on new, critical insights into the process of decision making concerning housing and ageing across Scotland, England and Wales. A ‘Serious Game’ methodology was developed that explored over 200 policy maker, practitioner and service user perspectives. This was used as a framework to capture priorities, decisions, negotiations and processes that indicate how a ‘sense of place’ and ‘place belonging’ can influence the development of suitable housing for older people. Key housing provision challenges identified were tackling inequality, preserving autonomy, in(ter)dependence, empowerment and accessibility. Such challenges need consideration when strategically planning for the future. The findings recommend placing housing at the heart of service integration to support the co-production of decisions that emphasise the importance of working together across boundaries within social policy, service and stakeholder groups. A place-based approach can support the perception that we are all stakeholders in ageing

Ageing in Extra Care Housing: Preparation, Persistence and Self-Management at the Boundary Between the Third and Fourth Age

Extra 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 (UK). 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

Outcomes-based Commissioning For Social Care in Extra Care Housing: Is There a Future?

Purpose: This paper provides an overview of the process of commissioning adult social care services in England. It reflects the literature on commissioning at the strategic level followed by a section on operational or micro-commissioning. The rest of the paper focuses on the emergence of ideas about outcomes based commissioning(OBC)in the field of adult social care and ends with critical consideration of the effectiveness of OBC in adult social care as applied to support and care provided in extra care housing. Design/methodology/approach: The review of strategic and operational commissioning in adult social care in England(and Scotland in brief)is based on both policy documents and a review of the literature,as are the sources addressing outcomes based commissioning in adult social care particularly in extra care housing settings. Findings: The core of this paper focuses on the challenges to the implementation of OBC in adult social care in the context of provision for residents in extra care housing. Of central importance are the impact of the squeeze on funding,increasing costs as a result of demographic change and the introduction of a national living wage plus the focus on the needs of service users through the idea of person-centred care and resistance to change on the part of adult social care staff and workers in pther relevant settings. Originality/value: Addressing the implementation of OBC in adult social care in England in the context of extra care housing

Can Extra Care Housing support the changing needs of older people living with dementia?

With over two thirds of people with dementia living in the community and one third of those living alone, it is important to consider the future housing needs of this population, particularly as symptoms of cognitive impairment increase. Policy in England has focused on enabling people living with dementia to remain in their own homes for as long as possible, often with the support of a family carer. However, many people struggle to maintain an acceptable quality of life in their own homes as their dementia advances, often due to the design limitations of mainstream housing and the challenge of finding specialist domiciliary care that is affordable and of sufficient quality. Extra care housing (ECH) offers a model that aims to support older people living in their own apartments, while also offering specialist person-centred care as and when it is needed. This paper reports on a longitudinal project that explored how ECH can respond to the changing social care needs of residents, including those living with dementia. Participants included residents and staff from four ECH schemes, one of which was a specialist dementia scheme, in two regions of England. Interviews were carried with 51 residents across 4 rounds at 5 month intervals between October 2015 and June 2017. Interviews were also carried out with 7 managers, 20 care staff and 2 local authority commissioners of housing for older people. Key factors included person-centred care and support, flexible commissioning and staffing, appropriate design of the environment and suitable location of the scheme within the wider community. The challenge of delivering services that addresses these issues during a period of reduced public spending is acknowledged. Further research is suggested to compare different approaches to supporting people with dementia, including integrated and separated accommodation, and different stages of dementia

Housing and Ageing: Linking future strategy to future delivery for Scotland, Wales and England 2030

First paragraph: In May 2018, we held a series of events with practitioners, older adults and policy makers from diverse areas of Scotland, England and Wales that share similar housing and ageing issues. Our goal was to create a set of co-designed recommendations for the UK, Scottish and Welsh governments, which would identify specific priorities and recommendations for the housing and ageing agenda – as a driver to get housing ready for the increasing future generations of older people. We must act now if we are going to meet the housing needs of future generations by 2030. The programme shared possible practice between Scotland, England and Wales, and recommendations that were developed by advisory groups within each jurisdiction. Event participants shared their knowledge, analysed policy challenges and priorities, sought to understand how policy is experienced by older people, and discussed what we can do to prepare for 2030. They also played a Serious Game, where they explored the potential long-term impacts of different policies, to help examine the issues we face and decide what to do about them

Using longitudinal qualitative research to explore extra care housing

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 twenty 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