Focusing on outcomes helps to ensure that services meet the needs of the people who use them rather than the people who run them. Research into services for older people has identified several outcomes that older people themselves believe are central to their independence and well-being. Broadly speaking, older people from a diverse range of backgrounds desire the same outcomes. However, the priority given to different outcomes may vary according to background. For example, older people from minority ethnic communities highly value service provision that meets their cultural and religious needs.
Outcomes can be divided into three different groups:
● Outcomes involving change – relating to improvements in physical, mental or emotional functioning. For example, improving mobility or getting effective treatment for depression
● Outcomes involving maintenance or prevention – relating to maintaining health, well-being and quality of life. For example, ensuring safety and security, having a clean and tidy home environment, social contact and control over daily routines.
● Service process outcomes – relating to service users’ experiences of seeking, obtaining and using services. For example, ensuring that older people feel valued and respected, that they are treated as individuals and that they have a say and control over services. Service process outcomes also include compatibility with, and respect for, cultural and religious preferences.
There is relatively little evidence on the specific outcomes desired by minority ethnic older people much of the research literature focuses on the barriers to care. However, the evidence that is available shows that people from ethnic minority backgrounds value the same range of outcomes across the three different groups, although these outcomes may not be achieved if service providers do not take cultural background into account.
Research shows that services provided by those with a common language and food provision are important to many older people from ethnic minorities. Culturally appropriate services, methods of working, language and communication (including non-verbal communication) are also highlighted in a study of minority ethnic older people with dementia (although information was obtained from professionals rather than older people themselves).
Older people themselves may find outcomes-focused assessments difficult, with their ability to identify outcomes restricted by their perceptions of social services’ responsibilities of the help they think is legitimate to request and of the services they think are available. Older people from ethnic minorities are particularly disadvantaged in knowing what services are available and in any case may not use services if they are perceived as culturally inappropriate.
While assessments may identify activities with which help is needed, they may fail to specify the ways in which older people wish help to be given, including practices consistent with personal, cultural or religious preferences. Outcomes-focused assessments therefore need to include these issues and incorporate them into the care plans that are agreed with service providers.
Individualised approaches to communication and consultation can help people with dementia to articulate their views and preferences.
Maximising their control over opportunities for communication, using pictures, using the older person’s own vocabulary and interpreting non-verbal communication can be effective, although they require time and competence on the part of staff. Recommendations from a Health Action Zone project for improving outcomes for minority ethnic elders with dementia include working in partnership with religious communities and reassuring families that services will respect confidentiality and anonymity.
Again these initiatives focus more generally on improving access to services rather than achieving desired outcomes.
There are older people from all communities who have difficulties in accessing or accepting social care services. Some find the name itself off-putting. In addition, older people from minority ethnic communities may have to overcome language barriers. Social services could address this problem of access by developing closer links with voluntary organisations such as Age Concern, who are likely to be more easily accessible to many older people.
People from ethnic minority communities should benefit from the increasing personalisation of services because the aim of personalisation is to provide care according to individual needs and preferences. If personalisation succeeds, the problem of current standardised provision failing to meet different cultural needs should be resolved.
Outcomes desired by service users
Reviews of Asian and other minority ethnic older people in care homes and of black communities and social care show that older people from minority ethnic groups value services that respect their cultural background. They want services that provide:
● Sensitivity to religious beliefs and practices.
● Staff from similar backgrounds.
● Same-sex workers for intimate personal care.
● Halal, vegetarian and other culturally appropriate food.
● Opportunities to meet others from similar backgrounds.
● Interpreting services.
This article is published in the 3 July issue of Community Care magazine under the headline ‘Outcome-focused services for older people from ethnic minorities’
RESEARCH ABSTRACTS: older people from minorities
Author Policy Research Institute on Ageing and Ethnicity
Title Black and minority ethnic elders in the UK: health and social care research findings
Publisher Policy Research Institute on Ageing and Ethnicity, 2005. 21p
Abstract While a steadily increasing population of minority ethnic elders has been growing in significance and visibility in Europe, the path to recognising that old age is an issue for Europe’s minorities has not been straightforward. Individuals working in the fields of race and ageing have, for some time, been raising the need for policy makers, social planners and professionals to examine the plethora of issues thrown up by the ageing of minority ethnic populations across Europe. It is to that need and those concerns that the MEC project addresses itself. MEC stands for minority elderly care.
Author GLENDINNING Caroline, et al
Title Progress and problems in developing outcomes-focused social care services for older people in England
Reference Health and Social Care in the Community, 16(1), January 2008, pp54-63
Abstract Social care services for adults are increasingly required to focus on achieving the outcomes that users aspire to, rather than on service inputs or provider concerns. This paper reports a study aimed at assessing progress in developing outcomes-focused services for older people and the factors that help and hinder this. It describes the current policy context and discusses the social care service outcomes desired by older people. The study found progress in developing outcomes-focused services was relatively recent and somewhat fragmented. Developments in intermediate care and re-ablement services, focusing on change outcomes, were marked however, there appeared to be a disjunction between these and the capacity of home care services to address desired maintenance outcomes. The paper concludes by discussing some of the challenges in developing outcomes-focused social care services.
Author LANE Pauline HEARSUM Sue
Title The mental health and well being of black and minority ethnic elders: a foundational report on the research literature and a mapping of national resources
Publisher Care Services Improvement Partnership. 2007. 88p
Abstract This report is part of a one year national project that aims to promote the mental health and well being of minority ethnic elders and to improve access to mental health services. The project will result in a range of practical resources to improve the access and quality of mental health and care services for elders and their families/carers. These resources will include: a foundational report on research in the field of elder’s mental health and mapping some of the leading community groups for elders and national mapping of projects and resources for elders.
Author Improvement and Development Agency
Title Engaging with older people
Publisher Improvement and Development Agency, 2007. 32p
Series (The Older People’s Shared Priority no. 2)
Abstract Improving the quality of life for older people was one of the priorities agreed between central government and the Local Government Association (LGA). About 50 local authorities and their partners participated in the shared priority work, through action learning sets. These tools and insights and can help in engaging and implementing the vision for modernising older people’s services.’