Housing adaptations for ageing in the UK : policy, legislation and practice

Demographic change has imposed financial strains on the healthcare system in the UK. In face of such a challenge, the concept of “ageing in place” was introduced as national policies to support older people living independently in their own homes. Housing adaptation was characterised as a very foundation for successful independent living and has been given a greater political priority. However, so far there is no legislation or guidance that identifies one primary organisation responsible for the delivery of adaptations. Instead, different local authorities are allowed to decide their own guidelines, procedures and eligibility criteria. Consequently, housing adaptation practice varied significantly across the country and sometimes confusing. This study is aimed at reviewing the current status of housing adaptation in different parts of the UK, assessing the effectiveness of the existing practice and making relevant suggestions for its improvement. A mix-methods sequential explanatory research strategy was employed for this study. In the first quantitative phase, a questionnaire survey was carried out, involving all 378 local authorities in England, Scotland and Wales. It focused on finding out how local authorities plan, organise and monitor their adaptation services. The second qualitative phase included twelve interviews and a focus group meeting with stakeholders, including social worker, occupational therapists, housing officers, staff from care and repair and older service users; the aim was to explore the statistical results in more depth from different perspectives. The results from the survey indicate some good practices, such as partnership guidance, the key caseworker, regular progress reports and agreement on the specification. However, the current implementation of adaptation policies is limited in most local areas. There is a relatively small number of adaptations with low levels of spending, compared with the potential needs from an aging population. There are noticeable differences between the different nations in the UK. Overall, Welsh government gave more attention to adaptation services and made them a higher political priority than England and Scotland; and provided a higher level of funding. In Scotland, local authorities focus primarily on middle- and small-scale adaptations with a cost up to £3,000. In England, the adaptation service is complex with the involvement of two tier government – district and county councils. Some common deficiencies have caused inefficiencies and ineffectiveness of the service, presenting important implications for policies related to healthy aging and community care. First, the way of setting adaptation budget based on the previous year’s spending is problematic; it does not reflect the changing needs. As the general population aging, demands for housing adaptation are set to increase. Local authorities should adopt ways of assessing the real need before setting adaptation budget. Currently, multiple organisations are involved in the adaptation delivery process. Poor cooperation between partnering organisations is a major barrier to timely and effective service delivery. Practical guidance should be provided to improve joint working in partnership particularly across different local authorities. Besides, there are many inconsistencies and inequities in the adaptation process between local authorities, including initial referral, assessment arrangements and eligibility criteria. To ensure equal access to adaptation services across the whole country, it is important to introduce a unified national approach for housing adaptations with a minimum eligibility threshold applied in all local areas. Furthermore, delays are often found in the delivery of adaptations. Some priority systems lead to faster processing of urgent cases. However, a reasonable maximum waiting time should be set even for non-urgent applicants. Finally, although performance management is widely adopted, different monitoring methods and a variety of performance indicators are used in different local authorities. A standard framework in this regard will be useful in driving up overall performance of adaptation service delivery

Service planning and delivery outcomes of home adaptations for ageing in the UK

In response to the impact of demographic change on the healthcare system, ‘ageing in place’ was introduced as a national policy to support elderly people living independently in their homes. Housing adaptation is essential for successful independent living and has been given increased political priority. However, adaptation policies and practice vary regionally, reflecting statutory limits, policy choices and local planning. This study investigated the current status of adaptation provision in different regions in the UK and assessed the effectiveness of local service planning and management. A mixed-methods sequential explanatory research strategy was employed. In the first quantitative phase, a questionnaire survey was carried out involving all 378 local authorities in England, Scotland and Wales. This was followed by a second qualitative phase involving individual interviews with five professionals and two clients and a focus group meeting with six key stakeholders. The study found that the current number of adaptations was relatively small compared with potential demands in most local areas, as was funding for adaptations. On the operational side, the adaptation process was fragmented, involving different service groups in many local authorities. There were disconnections between these groups, which often caused inefficiencies and poor effectiveness. Moving forward, local authorities need to have a clear vision of the overall need for adaptations and allocate sufficient resources. Practical guidelines are also needed for better integrated working and performance management

Patterns of Living Lost? Measuring Community Participation and Other Influences on the Health of Older Migrants in China

Community participation is a key element of active aging that promotes a new paradigm to enhance health and well-being as people age. However, social isolation is often a concern for older migrants. In this study, we aimed to investigate the current status of older migrants’ community participation and assess the main influences on three forms of welfare, development, and organizational participation. We adopted a quantitative research design for this study. A questionnaire survey was completed by 1216 older migrants in 4 cities; 1105 valid responses were received, representing a response rate of around 91%. The research findings showed that the current participation of older migrants in community activities was limited. By comparison, full self-care capability and non-chronic illness positively affected general and welfare participation. Educated at primary school had a negative influence on general, development, and organizational participation, whereas knowledge of the local language was a significant predictor of general and development participation. Urban inclusion and resident friendship had positive effects on general, welfare, and development participation. The study also revealed direct influences of socioeconomic characteristics on different types of participation. Moving forward, actions are needed to maximize older migrants’ participation in public events and community life

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.</p

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes