See me, not just the dementia - Understanding people's experiences of living in a care home.

yesThis report looks at the experiences of people with dementia living in care homes in England, with a particular focus on whether their care offers dignity and respect. Most similar studies have relied on the views of carers, care staff and people in the early stages of dementia. This study examines directly the experiences of people including those with advanced dementia

'I was just gobsmacked': care workers responses to BBC Panoramas 'Undercover care: the abuse exposed': invoking mental states as a means of distancing from abusive practices

This paper draws upon discourse analytic techniques and discursive psychology to examine how care workers build accounts of viewing the BBC Panorama programme “Undercover Care: The Abuse Exposed” which graphically documented the abuse of people with learning disabilities in a residential care setting. 56 interviews were conducted as part of a project concerning adult safeguarding. The analysis considers how careworkers report their reactions and the interactional strategies they use to construct themselves as shocked and disbelieving and thus, as oppositional to the extreme practices in the programme. Their role as careworkers, and therefore as ‘insiders’ of the industry that allowed such abuse to happen, makes matters of stake and agency live issues for this particular group; and constructions of ‘shock’ and ‘disbelief’ are potential ways for participants to distance themselves from the abuse shown in the programme. More broadly, these data show how the invocation of mental states contributes to the management of other discursive business, namely, that of fending off any association with the aforementioned extreme practices

Council-managed personal budgets for older people : improving choice through market development and brokerage?

This paper presents findings from interviews with social care service development managers and brokers in three local authorities. It follows an earlier study exploring choice and flexibility in home care services for older people using council-managed personal budgets. That study found that local authorities were limiting the number of providers on framework agreements for home care services so that there were sufficient to encourage competition but not so many that providers risked having insufficient business to remain financially viable. It also found that communication issues were affecting the proper functioning of brokerage systems. The current study therefore revisited the same three local authorities to investigate changes in framework agreements and developments in brokerage systems. The findings showed little change in the number of providers on framework agreements and remaining communication challenges for brokers. However, lessons had been learned from unforeseen consequences of framework agreements, and progress was being made towards encouraging market development and diversification of service provision

Learning and development journeys towards effective communications with children

There are continuing concerns about the quality of social workers' communication and engagement with children. This has led to a focus in England on whether qualifying courses prepare students sufficiently for practice. Although research has uncovered the capabilities social workers need to engage and communicate effectively with children, there has continued to be limited evidence in relation to which pedagogical approaches might best enable students to develop capability. This paper attempts to address some of this deficit by reporting in-depth case study findings from a larger longitudinal study into the factors that supported a cohort of students in England in learning to communicate with children. Case analyses are presented in respect of two participants whose learning journeys were emblematic of many in the cohort. Their trajectories draw attention to the significant role that pre-course experience with children can play in the development of students' self-efficacy and in providing a rich source of experiential learning that can be built upon. Suggestions are made for how qualifying courses might provide alternative experiential learning opportunities, including role play, child observation and opportunities for reflection on pre-course experience with adults to help students establish the transferability of their learning

Good practice in social care for disabled adults and older people with severe and complex needs: evidence from a scoping review

This article reports findings from a scoping review of the literature on good practice in social care for disabled adults and older people with severe and complex needs. Scoping reviews differ from systematic reviews, in that they aim to rapidly map relevant literature across an area of interest. This review formed part of a larger study to identify social care service models with characteristics desired by people with severe and complex needs and scope the evidence of effectiveness. Systematic database searches were conducted for literature published between January 1997 and February 2011 on good practice in UK social care services for three exemplar groups: young adults with life-limiting conditions, adults who had suffered a brain injury or spinal injury and had severe or complex needs, and older people with dementia and complex needs. Five thousand and ninety-eight potentially relevant records were identified through electronic searching and 51 by hand. Eighty-six papers were selected for inclusion, from which 29 studies of specific services were identified. However, only four of these evaluated a service model against a comparison group and only six reported any evidence of costs. Thirty-five papers advocated person-centred support for people with complex needs, but no well-supported evaluation evidence was found in favour of any particular approach to delivering this. The strongest evaluation evidence indicated the effectiveness of a multidisciplinary specialist team for young adults, intensive case management for older people with advanced dementia, a specialist social worker with a budget for domiciliary care working with psycho-geriatric inpatients, and interprofessional training for community mental health professionals. The dearth of robust evaluation evidence identified through this review points to an urgent need for more rigorous evaluation of models of social care for disabled adults and older people with severe and complex needs. Keywords : comorbidity, dementia, disabled people, evidence, multidisciplinary teams, social care

Medication administration errors for older people in long-term residential care

Background Older people in long-term residential care are at increased risk of medication errors. The purpose of this study was to evaluate a computerised barcode medication management system designed to improve drug administrations in residential and nursing homes, including comparison of error rates and staff awareness in both settings. Methods All medication administrations were recorded prospectively for 345 older residents in thirteen care homes during a 3-month period using the computerised system. Staff were surveyed to identify their awareness of administration errors prior to system introduction. Overall, 188,249 attempts to administer medication were analysed to determine the prevalence of potential medication administration errors (MAEs). Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Analysis compared data at residential and nursing home level and care and nursing staff groups. Results Typically each resident was exposed to 206 medication administration episodes every month and received nine different drugs. Administration episodes were more numerous (p < 0.01) in nursing homes (226.7 per resident) than in residential homes (198.7). Prior to technology introduction, only 12% of staff administering drugs reported they were aware of administration errors being averted in their care home. Following technology introduction, 2,289 potential MAEs were recorded over three months. The most common MAE was attempting to give medication at the wrong time. On average each resident was exposed to 6.6 potential errors. In total, 90% of residents were exposed to at least one MAE with over half (52%) exposed to serious errors such as attempts to give medication to the wrong resident. MAEs rates were significantly lower (p < 0.01) in residential homes than nursing homes. The level of non-compliance with system alerts was low in both settings (0.075% of administrations) demonstrating virtually complete error avoidance. Conclusion Potentially inappropriate administration of medication is a serious problem in long-term residential care. A computerised barcode system can accurately and automatically detect inappropriate attempts to administer drugs to residents. This tool can reliably be used by care staff as well as nurses to improve quality of care and patient safety

Integrating the teaching, learning and assessment of communication with children within the qualifying social work curriculum

Qualifying social work education must provide students with a variety of experiential, personalized, participatory, didactic and critically reflective learning opportunities across both the taught curriculum and in practice placements if deep learning of the capabilities needed for effective communication with children and young people is to be ensured. At present, programmes in England are not consistent in the curriculum structures, content and pedagogical approaches they are employing to teach and assess this topic. This paper discusses first how current proposals for the reform of qualifying education in England do not address the ambiguities and discretion in regulatory guidance, which have meant that the place and relevance of this topic within the curriculum remain uncertain and contested. It then draws on a model of the sequencing of students' learning and development in qualifying training, developed through the author's recent empirical research, to present an integrated and coherent approach to the teaching, learning and assessment of this topic. It is proposed that this strategy will enable students to develop the generic, ‘child-focused’ and ‘applied child-specialist’ capabilities they need for the ‘knowing’, ‘being’ and ‘doing’ of effective communication with children

Residential care for children and young people : priority areas for change

Abuse in residential childcare has been of concern to the public and the profession for a number of years. This article highlights a Scottish Institute for Residential Child Care's (SIRCC) response to the Scottish Government which was requested following allegations of abuse in Glasgow City Council's Kerelaw residential school and secure unit. It offers priority actions to address the challenges of residential childcare and ensure the safety of children and young people as far as is practicably possible. It contextualises the residential childcare task, and explores four interrelated areas in which change is strongly recommended: (1) organisations' cultures; (2) workforce challenges including the status of the sector, staff selection standards, the role of residential childcare workers in relation to their level of autonomy and their education levels; (3) abuse allegations, in particular the sector's growing fearfulness of false allegations, support for practitioners' anonymity when accused of abuse and a reconsideration of criminal record certificate information; and (4) service delivery related to behaviour management and advocacy support. The intersection between the SIRCC and the subsequent Kerelaw Inquiry reports is outlined. Finally, it concludes with a scan of the immediate strategic policy horizon which indicates an unprecedented momentum for change. While based in the Scottish context, it reflects lessons which are applicable internationally

A realistic evaluation of fines for hospital discharges: Incorporating the history of programme evaluations in the analysis

Programmes and policies transform over time and locations. Evaluation projects can apprehend only temporal and contextualized sections of the social world. This article uses a realist evaluation of financial incentives in English hospital discharge policy to illustrate how previous evaluations of the same programme theory were inspected for evidence to construct context, mechanisms and outcomes. Following the discharges of a reduced number of patients with a case study approach, the preliminary programme theory ('fines reduce delays') was modified into a redefined theory on how fines operate locally in practice. This identified other mechanisms contemporaneous to the fines which are more or as likely to reduce delays. This article aims to contribute to the development of the realist evaluation strategy by introducing programme's transformations as key evidence when trying to understand how complex interventions work in particular contexts

Older Workers and Care-Giving in England: the Policy Context for Older Workers’ Employment Patterns

This article considers recent changes in the incidence of caring among people aged 50-64 in England and the policy context in which these have occurred. After introducing the topic, research questions addressed and methods used, it outlines findings from other research on how older workers experience and manage caring roles. It then sets out relevant public policy developments since carers were first accorded rights to recognition and services in 1995, focusing on workplace support, local services and financial help for people who reduce or quit their paid work to care. The article presents new analyses of the population censuses conducted in England in 2001 and 2011, focusing on people aged 50-64 and especially on those aged 60-64, the group in which the largest changes were seen. Theses show growth in caring at higher levels of intensity for older workers, and increases in the incidence of caring alongside paid work. To deepen understanding of these changes, the analysis also draws on data from a government survey of carers conducted in 2009-10. The concluding discussion argues that although the modest policy changes implemented since 1995 have provided some support to older workers managing work and care, more policy attention needs to be given following the sharp increase in the incidence of caring seen among people aged 50-64 in England between 2001 and 2011