Emerald | Quality in Ageing and Older Adults | Table of Contents

Care coordination: translating policy into practice for older people

Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Purpose - We present findings from our research on the implementation of Unified Assessment (UA) policy and the work of care coordinators who oversee the delivery of support to older people with complex needs.Design/methodology/approach - A mixed methods approach included staff interviews (n=95) and focus groups (n=3).Findings - The care coordinator role is controversial and the lack of common terminology across health and social care obscures its importance. It is seen as a social care responsibility. Limited ownership amongst healthcare professionals leads to tensions in practice. The challenges of breaking down silo thinking embedded in established professional practices are highlighted as are infrastructural and capacity deficits. Disparities between policy intentions and practice means that UA is failing to meet core objectives relating to the delivery of seamless support. Research limitations/implications - Further research is needed to develop and evaluate evidence-informed interventions that test solutions to the problems faced in practice and support the delivery of more effective arrangements.Practical implications - Practice development may be supported by: guidelines that are more prescriptive and include a formal role definition; joint training to promote shared understanding of key concepts; investment in administrative and IT infrastructures; and, more coordinated direction at strategic level. Originality/value - Over a decade has elapsed since the publication of UA Policy Guidance; however, there is limited published evidence on the effectiveness of UA policy and its translation into practice.

Developing a simple set of measures for local whole system working: outcomes, cost and use of resources supporting referral management.

literatinetwork@emeraldinsight.com (David Walton, Seraphim J.Rose Patel) — Thu, 28 Mar 2013 00:00:00 +0000

Abstract

Purpose - Whole system working is critical to improving health and social care services supporting in referral management, whilst using scarce resources more efficiently and this article looks at the urgent need to develop measures for it. It describes the development of a simple, practical, set of measures for benchmarking and analysing local use of key whole system resources as the basis for discussion and planning. Practical and usable tools are needed urgently as national measures are not available at present and key resource decisions need to be made now. Design/methodology/approach - Looks at a simple framework for looking at integration in localities and some proposed measures as the basis for discussion. Describes the development and application of a simple, practical set of measures to use locally in the absence of a national set. Uses nationally available, comparable measures wherever possible to minimise work. Briefly describes how the comparative data enables localities to identify key differences in use of resources and outcomes and areas for improvement supporting in referral management processes.Findings - Taking a whole system, whole person approach and applying it across localities provides a useful framework to help local health and social care systems focus on improving patient outcomes while reducing unnecessary costs when relooking at their services that deal with referral management– particularly unnecessary use of high cost institutional care. The measures including the Audit Commission whole system measures identified key issues re different use of resources, costs and outcomes between localities. This article looks ahead to the implications of greater personalisation of services and the need to develop more effective information systems based on the individual patient which allow more rigorous measurement of service effectiveness including outcomes as well as activity.Research limitations/implications - n/aPractical implications - In the absence of national measures of whole system integration, describes how a simple, practical framework and measures were developed to analyse use of resources and identify key areas for improvement supporting in improving the referral management system. This can be used by localities to provide a quick benchmark of use of resources and outcomes (especially whole system use of expensive institutional resources) to support value for money and service effectiveness work. Describes how it worked in practice and looks at how information systems could be further developed in line with personalisation to allow ongoing improvement based on individual outcomes, costs and service effectiveness.Originality/value - This study describes the need to develop whole system measures to show the effectiveness of moves towards integration supporting the referral management system. In the absence of national measures, describes the development of a simple set of local whole system outcome measures based on a framework based on recent work on whole system integration. Uses both health and social care evidence and summarises key elements that work. Shows how the measures have been applied in practice in localities as a first step in a local system improvement programme

The Eden Principles in Dementia Respite Care: Carers’ Experience

literatinetwork@emeraldinsight.com (Sandra Downes) — Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Purpose - To report on outcomes for carers of people with dementia who use the services of Hawthorn House: a day respite centre in rural Western Australia that is based on the Eden Principles.Design/methodology/approach - Quantitative and qualitative data were collected from carers and analysed. Quantitative data included the General Health Questionnaire-12, Zarit Burden Interview, and Eden survey. Qualitative data were from semi-structured interviews. Validation was confirmed and then simple statistics were generated from the quantitative data. Thematic analysis was used with the qualitative data.Findings - Carers of people with dementia who use the services of Hawthorn House confirm that the Eden Principles are an integral part of Hawthorn House and report better than average health, less stress/burden and better quality of life. Many attribute this to the services they receive from Hawthorn House.Research limitations/implications - Participants for the study were self-selecting.Practical implications - Provides verification that the Eden Principles can lead to meaningful and important benefits for carers of people with dementia.Originality/value - This paper is the first to report on the use of the Eden Principles in a non full-time respite centre for people with dementia in rural Australia. Further, it draws upon quantitative and qualitative data on quality of life outcomes for carers as a result of being associated with the centre.

Life Story Work – Overcoming Issues of Consent and Confidentiality

Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Not available.

OLDER EXPERTS VERSUS YOUNG ENTHUSIASTS: WHOM DO KAZAKHSTANI EMPLOYERS PREFER?

Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Purpose - This study examines and discusses the opportunities and barriers older employees face in the recruitment process in comparison with younger candidates. The paper aims to analyze Kazakhstani employer preferences in terms of the age of their employees.Design/methodology/approach - The study draws on an analysis of the existent literature, statistical data, and the observations and experiences of the authors.Findings - The results suggest that both younger and older employees in Kazakhstan face barriers in the recruitment process. While recent graduates lack experience and a knowledge level capable of meeting the requirements of businesses, older employees are heavily trained and less adaptable to change in the environment. Employers in Kazakhstan are more willing to hire young employees rather than older workers. The recruitment process is primarily based on personal contacts.Practical implications - By describing the barriers older employees face in the recruitment process, the paper appeals to the Kazakhstani government to revise policies and develop new measures to safeguard older workers. In addition, given the inconsistency of higher education with business requirements, policy makers should revise strategies and controls in higher education system.Originality/value - The paper fulfills the literature gap and analyses Kazakhstani employer preferences in recruiting older versus younger employees. The obstacles older employees face in the recruitment process are outlined and discussed.

The effect of funding status on duration of stay for inpatients with dementia

Fri, 14 Jun 2013 00:00:00 +0100

Abstract

Purpose - This study is a follow up to a previously published paper (Ball et al, 2004). The purpose of the study was to examine the effect of funding changes on the duration of stay over the 3 years since the introduction of the National Framework for Continuing Health Care (CHC) provision in October 2007Design/methodology/approach - This study examined consecutive dementia patients (n=175) admitted to an organic elderly mental health assessment ward over a 3 year period between January 2008 to December 2010. The majority of patients in the study had vascular dementia (34%) or Alzheimer’s disease (31%) with an average score of 11.5 in the Mini-Mental State Examination. The assessment tools used in this study were good indicators as part of the dementia care pathway to predict the rehabilitation outcome. Findings - The mean duration of stay of patients was 8.4 weeks but this was extended to 18.3 weeks for the 15% of patients subject to CHC funding. Patients who require CHC funding can expect to stay in hospital for more than 10 weeks before a placement is made. Duration of stay was longer for those patients with behavioural and psychological complications, but the strongest independent predictor of duration of stay was CHC funding which accounted for 23% of the duration of stay in hospital, independently of any clinical parameters in the patient. Research limitations/implications - This is not a randomised controlled trialPractical implications - Closer integrated working is need by the Continued Health Care funding commissioners and hospital staff and carersOriginality/value - This study provides evidence of the effect of current funding procedures in the discharge of inpatients with dementia from an assessment ward.