Linkage of social care and hospital admissions data to explore non-delivery of planned home care for older people in Scotland

Purpose: As part of a pilot study assessing the feasibility of record-linking health and social care data, we examined patterns of non-delivery of home care among older clients (>65 years) of a social home care provider in Glasgow, Scotland. We also assessed whether non-delivery was associated with subsequent emergency hospital admission. Design: After obtaining appropriate permissions, the electronic records of all home care clients were linked to a hospital inpatient database and anonymised. Data on home care plans were collated for 4,815 older non-hospitalised clients, and non-delivered visits examined. Using case-control methodology, those who had an emergency hospital admission in the next calendar month were identified (n=586), along with age and sex-matched controls, to determine whether non-delivery was a risk factor for hospital admission. Findings: There were 4,170 instances of ‘No Access’ non-delivery among 1,411 people, and 960 instances of ‘Service Refusal’ non-delivery among 427 people. The median number of undelivered visits was two among the one third of clients who did not receive all their planned care. There were independent associations between being male and living alone, and non-delivery, while increasing age was associated with a decreased likelihood of non-delivery. Having any undelivered home care was associated with an increased risk of emergency hospital admission, but this could be due to uncontrolled confounding. Research Implications: This study demonstrates untapped potential for innovative research into the quality of social care and effects on health outcomes. Practical Implications: Non-delivery of planned home care, for whatever reason, is associated with emergency hospital admission; this could be a useful indicator of vulnerable clients needing increased surveillance

Understanding the training and education needs of homecare workers supporting people with dementia and cancer: a systematic review of reviews

Many people with dementia, supported by family carers, prefer to live at home and may rely on homecare support services. People with dementia are also often living with multimorbidities, including cancer. The main risk factor for both cancer and dementia is age and the number of people living with dementia and cancer likely to rise. Upskilling the social care workforce to facilitate more complex care is central to national workforce strategies and challenges. Training and education development must also respond to the key requirements of a homecare workforce experiencing financial, recruitment and retention difficulties. This systematic review of reviews provides an overview of dementia and cancer training and education accessible to the homecare workforce. Findings reveal there is a diverse range of training and education available, with mixed evidence of effectiveness. Key barriers and facilitators to effective training and education are identified in order to inform future training, education and learning development for the homecare workforce supporting people with dementia and cancer

Right at home: living with dementia and multi-morbidities

Dementia is recognised as the biggest health crisis of our time in terms of high personal and social costs and wider impact on health and social care systems. Increases in people living with dementia and multimorbidities presents critical challenges for homecare worldwide. Healthcare systems struggle to provide adequate home-care services, delivering limited care restricted to a single-condition focus. This study explored the experiences and expectations of homecare from the multiple perspectives of people living with dementia and multimorbidities and homecare workers providing support. Findings draw from qualitative semi-structured interviews with people with dementia (n=2), their partners (n=2), other partners or family carers (n=6) and homecare workers (n=26). Three themes are identified: (a) the preference for and value of home; (b) inadequate homecare provision and enhanced care-burden; (c) limited training and education. Despite continued calls for homecare investment, the focus on reduction in costs hides key questions and further dialogue required exploring how people with dementia can be supported to live independently and flourish at-home. This study considers these complex experiences and care requirements through the prism of disability and human rights frameworks. This paper concludes with consideration of more recent human social rights debate. We critically discuss what this may mean for people living with dementia and consider the implications for corequisite policy development to optimise available homecare support. Keywords: dementia, multimorbidities, homecare, independent-living, social right

Non-delivery of Homecare for Older People in Scotland: A multi-method study

Background: A large homecare service provider for older people in one region in Scotland reported concerns of an increasing incidence of non-delivery of homecare for older people. Non-delivery denotes planned care that care workers attempted to deliver but, for whatever reason, were not able to gain access to the service user to provide care. Concerns exist that, if not addressed, incidences will continue to increase, with negative implications for the wellbeing of older people and for service provision. This thesis presents an account of the research performed to address these concerns. Aims: To identify the extent of non-delivery of homecare for older people, to establish the characteristics of those most likely to refuse or avoid homecare, and to explore the reasons why, for some older people, care was more likely to be refused or avoided. Methods: Using a multi-method approach, and in two studies this doctoral thesis was designed to answer the research question: ‘What is known about non-delivery of homecare for older people in Scotland?’ The first study adopted a quantitative approach, linking data from a large homecare service provider in one region in Scotland, to individual-level hospital in-patient data (SMR01) to help establish the extent of non-delivery of homecare and to characterise those most likely to refuse or avoid care delivery within a discrete three-month time-period. The second study employed a qualitative design, drawing on individual interviews and a focus group discussion with older people receiving homecare, to explore in depth the reasons why, for some older people, care might be refused or avoided. Findings: This is the first study to explore the patterns and reasons for non-delivery of planned homecare. This research established that non-delivery of homecare was a problem for a few older people only. Using framework analysis, the findings revealed an unexpected propensity to accept rather than refuse homecare. Moreover, the presiding values of older people are to live at home, to be independent and to remain connected, and homecare was viewed as a means to protect these values. However, homecare did not always meet these expectations, and the findings revealed that older people would accept the compromises involved in being a homecare recipient in order to live at home rather than relinquish this independence. Three key findings, which presented as paradoxes are: i) older people would refuse homecare if it was unsatisfactory, yet, despite having this experience, very few actually refused; ii) older people valued their independence above staying at home, yet they would inadvertently relinquish their independence to the care service to stay at home; and iii) whilst non-delivery of homecare places older people at risk, these same assumed risks are those associated with the provision of poor quality care. Ultimately, although independence was considered important, living at home was crucial and the presiding motivating factor to accept homecare. The findings of this study are timely and relevant as they link into current governmental initiatives to keep people at home for as long as possible with appropriate and sustainable homecare at the core of national outcomes. Recommendations: Based on these findings, the study will inform future research, practice and policy, and all those interested in improving homecare for older people, notably: homecare service providers, local authorities, and government bodies. This study is particularly relevant considering the effects of COVID-19, the impact of which has affected the way in which care is delivered. As for now, living at home is the most effective way of shielding vulnerable people