Measuring the outcomes of long-term care for unpaid carers: Comparing the ASCOT-Carer, Carer Experience Scale and EQ-5D-3L

Background: The ASCOT-Carer and Carer Experience Scale are instruments designed to capture aspects of quality of life ‘beyond health’ for family carers. The aim of this study was to compare and validate these two carer care-related measures, with a secondary aim to compare both instruments to the three-level EQ-5D (EQ-5D-3L) measure of health-related quality of life. Methods: An interview survey was conducted with 387 carers of adults who used long-term care (also known as social care) support in England. Construct validity by hypothesis testing was assessed using Pearson correlation coefficient. Exploratory factor analysis was also applied to investigate the dimensionality of the combined items from the ASCOT-Carer and CES (as measures of carer quality of life ‘beyond health’) and the EQ-5D (as a measure of health-related quality of life). Results: In the construct validity analysis, hypothesised differences in correlations were observed with two exceptions. The exploratory factor analysis indicated that the ASCOT-Carer, CES and EQ-5D-3L items loaded onto three separate factors. The first factor comprised the seven ASCOT-Carer items plus two CES items (activities outside caring, support from friends and family). The second factor comprised three of the six CES items (fulfilment from caring, control over caring and getting on with the person you care for). The third factor included four of the five EQ-5D-3L items. Conclusion: The findings indicate that the ASCOT-Carer, CES and EQ-5D-3L capture separate constructs of social care-related quality of life (ASCOT-Carer) and carer experience (CES), which partially overlap in relation to activities outside caring and social support, and health-related quality of life (EQ-5D-3L). The ASCOT-Carer and CES are both promising measures for the evaluation of social care support for carers that capture aspects of quality of life ‘beyond health’. The choice of whether to use the ASCOT-Carer or CES depends on the study objectives

The Effects of Minimum Wage Policy on the Long‐Term Care Sector in England

The increase in the National Minimum Wage rate in October 2015 and the introduction of the National Living Wage in April 2016 led, in a short period of time, to an aggregated increase in the wage floor of over 10 per cent for workers in England aged 25 and over. The long‐term care (LTC) sector is a labour intensive, low pay sector, and as such, can be substantially affected by changes in minimum wage. We assessed the effects of this exogenous wage increase on independent LTC providers by looking at effects on wages, employment, weekly hours, and employment contracts. Using data from the Adult Social Care Workforce Data Set (ASC‐WDS) and applying a ‘before‐after’ analysis, we found that the substantial increase in minimum wage had a strong and positive effect on wages in the LTC sector, but with substantial compression of the wage distribution at the lower end. Although, as in other studies, the employment effect was rather elusive, we found that for care homes this can be partially explained by a negative effect on total weekly hours. We also found positive but short‐term effects on employment without guaranteed working hours (i.e. zero‐hour contracts) for both residential and domiciliary care