Helping older people to use quality information to choose residential care

Context: The availability of data about the quality of care homes has increased in England since the late 1990s, as in other countries, but it is widely underused by people choosing providers. Objectives: To examine older people’s understandings of a high-quality care home, their preferences for quality indicators, and how they would use comparative quality information about care homes to select one for themselves or a relative. Method: Five group workshops were conducted with 27 older people with experience of social care services and relatives of care home residents in three local authority areas in England. Different methods were used to collect data: an open discussion, a card sorting exercise, and use of a scorecard to compare fictitious homes. Findings: The most popular indicators among participants in the workshops were linked to residents’ quality of life. Indicators we may think of as being about clinical issues were valued the least. The value of some indicators was more widely recognised after discussion highlighted their relevance to choosing a care home for someone. Comparing quality information was said to be useful to shortlist homes to visit and inform visits, and many strategies were used to manage the data to select a home. Concerns were raised about the trustworthiness of some data and sources. Limitations: The nature and scale of the work mean we cannot claim it to be a representative sample and this limits the generalisability of the findings. The findings are, nevertheless, illuminating in terms of factors to consider when making available information to assist in choosing a care home. Recruitment challenges for the workshops and the implications of the difficulties participants had managing the data are discussed. Implications: Quality indicators are likely to be ineffective at promoting comparison across care homes unless older people are supported to understand their significance. Policymakers and providers of quality indicators need to beware of user preferences, build in decision-making support, find ways to better communicate complex measures and encourage people to identify their own views before reviewing published indicators. Methodological implications for further work in this area are also considered

Information and choice of residential care provider for older people: a comparative study in England, the Netherlands and Spain

This study compared how older people use quality information to choose residential care providers in England, the Netherlands and Spain (Catalonia). The availability of information varies between each country, from detailed inspection and survey information in the Netherlands, through to a lack of publicly available information in Catalonia. We used semi-structured interviews and group workshops with older people, families and professionals to compare experiences of the decision-making process and quality information, and also to explore what quality information might be used in the future. We found that most aspects of the decision-making experience and preferences for future indicators were similar across the three countries. The use of quality information was minimal across all three, even in England and the Netherlands where information was widely available. Differences arose mainly from factors with the supply of care. Older people were most interested in the subjective experiences of other residents and relatives, rather than 'hard' objective indicators of aspects such as clinical care. We find that the amount of publicly available quality information does not in itself influence the decisions or the decision-making processes of older people and their carers. To improve the quality of decisions, more effort needs to be taken to increase awareness and to communicate quality in more accessible ways, including significant support from professionals and better design of quality information

Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article

Gwen Harwood

© Stephanie Trigg Scanned for the University of Melbourne ePrints Repository with permission of Oxford University Press. Unauthorised reproduction prohibited.The poetry of Gwen Harwood is famously passionate and sensual. Some readers have sought to interpret the dramatic situations of her poems as autobiographical narratives. Conversely, when these scenarios seem too suggestive, Harwood's more personal poems are sometimes allegorised into safer, more neutral statements about art and poetics. In this lively book Stephanie Trigg argues that greater attention to Gwen Harwood's ability to impersonate or improvise a range of voices can liberate the reader from the tyranny of the biographical equation. Trigg pays tribute to the passion and eroticism of Harwood's love poetry without seeking to probe the more private mysteries of its composition. In doing so, she posits a new way of reading one of Australia's finest poets. Harwood's fascination with the nature of art is also taken up in a study of her affiliations with poetic tradition. These relations are never straightforward, and this book suggests that feminist literary theory can help us read Harwood's complex, dynamic relations with the poetry of the past. Its conclusions will surprise many readers