Regulating physician associates (PAs) and anaesthesia associates (AAs): a rapid review

A Physician Associate (PA) is a ‘new healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision’ (Health Education England, 2012). While there are far fewer Anaesthesia Associates (AAs) (formerly known as Physician Assistants (Anaesthesia) until July 2019) this review also covers this role, distinguishing it where possible. AAs are defined as a separate profession ‘with a different set of competencies which enable them to work under the supervision of anaesthetists within the operating theatre environment’ (Royal College of Physicians)

Professionals' views on the “optimal time” for people living with dementia to move to a care home

Objective The decision about the best time for a person living with dementia to move to a care home involves the individual and others, particularly family. However, little is known about care professionals' views on the best time to move, particularly those with decision‐making authority. This study investigated social workers' and care home managers' views on whether there is an “optimal time” for a move. Methods A qualitative, phenomenological approach was employed, using semi‐structured interviews with 20 social workers and 20 care home managers in England; all with experience of advising people living with dementia about a care home move and making decisions about funding or acceptance. Interviews were audio‐recorded, transcribed, and analyzed thematically. Results Four overarching themes emerged from the data: (1) staying at home for as long as possible but avoiding crisis, (2) balancing risks proactively and anticipating triggers, (3) desires for the person living with dementia to be involved in the decision, and (4) the significance of funding in enabling choices about a care home move. Conclusions Deciding on the timing of a care home move is context and person specific. Two professional groups with substantial experience of this among their client group both recommended proactive deliberation but funding was overall the deciding factor in the extent to which they considered choice was possible. Future research should avoid seeing all care home moves as negative and explore how practitioners can best encourage discussions prior to crisis point about care home options

Gaps in understanding the experiences of homecare workers providing care for people with dementia up to the end of life : a systematic review

This systematic review of the literature explores the perspectives and experiences of homecare workers providing care for people with dementia living at home up to the end of life. A search of major English language databases in 2016 identified 378 studies on the topic, of which 12 met the inclusion criteria. No empirical research was identified that specifically addressed the research question. However, synthesis of the findings from the broader literature revealed three overarching themes: value of job role, emotional labour and poor information and communication. The role of homecare workers supporting a person with dementia up to the end of life remains under-researched, with unmet needs for informational, technical and emotional support reported. The effective components of training and support are yet to be identified

‘The time has come’: reflections on the ‘tipping point’ in deciding on a care home move

Objectives Often perceived as a last resort, a care home move for a person living with dementia is often undertaken when all other options have been exhausted. Deciding the right or optimal time is to move remains an important question for many families. To investigate factors that are weighed up in deciding to make a care home move. Method Qualitative in-depth interviews with 21 family carers and 5 care home residents living with dementia in England. Thematic analysis was applied to all transcripts to extract key themes and sub-themes; a summation is provided here. Results Participants emotionally recollected an accumulation of stressors, exhausting other options of care, a risk/benefit analysis, wishes of person living with dementia, and a readiness to move as indicators of when a ‘tipping point’ was reached. They also felt strongly that early planning, prior experience of care homes, understanding funding arrangements and having support with decision-making would help. Conclusion Deciding to move to a care home is complex, contextual and deeply personal. Early planning in the form of joining waiting lists, using day centres and respite services may help in creating relationships with intended care homes for the future. There is growing need for support with financial advice and funding arrangements, for both self- and publicly funded individuals

Working with colleagues and other professionals when caring for people with dementia at end of life : homecare workers' experiences

Caring for people with dementia often necessitates inter-professional and inter-agency working but there is limited evidence of how home care staff work as a team and with professionals from different agencies. Through analysis of semi-structured interviews, we explored the experiences of home care workers (n = 30) and managers of home care services (n = 13) in England (2016‐17). Both groups sought to collaboratively establish formal and informal practices of teamwork. Beyond the home care agency, experiences of interacting with the wider health and care workforce differed. More explicit encouragement of support for home care workers is needed by other professionals and their employers

Caring in Covid-19: Personal Assistants’ Changing Relationships with their Clients’ Family Members

Context: The impact of Covid-19 on people working as personal assistants (PAs) or directly employed care workers potentially affects not only themselves and their clients but sometimes clients’ family members or carers. Objectives: This interview-based study aimed to hear directly from PAs of their experiences during the pandemic to inform policy and practice. Methods: A sample of 41 PAs working in England were interviewed by telephone during the early months of Covid-19 (April–June 2020) in England. Interview data were analysed thematically and accounts of PAs’ engagement with their clients’ family members were explored. Findings: Study findings illustrate the fluidity of relationships at this time within four dimensions: 1) some family members working more closely with PAs, 2) the development of tensions between PAs and family members, 3) displacement by family members of PAs and other care services, 4) PA accounts of working with clients who had little or no family contact or other assistance during the pandemic. Limitations: This study did not interview family members to hear their views of the relationships and circumstances discussed by the PAs. Implications for research include a need to hear from other care workers operating as live-in PAs and from family members and employers and to follow-up with PAs as the pandemic progressed. Policy implications include the need to encourage contingency planning and to ensure support for PAs. Practice implications are for staff responsible for individualised funding to ensure PAs are known to their systems to enable their support