Research Abstracts: Outcomes for Older people

Title: Progress and problems in developing outcomes-focused social care services for older people in England.
Author: GLENDINNING Caroline et al.
Reference: Health and Social Care in the Community, 16(1), January 2008, pp.54-63.

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. Process outcomes were addressed across a range of re-ablement, day care and residential services. The paper concludes by discussing some of the challenges in developing outcomes-focused social care services.

Title: A journey through the years: ageing and social care.
Author: JONES Ray
Reference: Ageing Horizons, Issue 6, 2007, (published online).

Abstract:
The paper analyses the history of English social care philosophy, policy and institutions since the late seventies.
During this period there have been fundamental changes in attitudes to people who use care services, moving from a doing “to” people approach (containing and controlling as well as caring), to doing “for” (paternalistic but often also patronisingly assuming “cosiness” in looking after people), to doing “with” (partnership and participation), and, finally, to people doing “for themselves” but with assistance when needed. Since 1989, policy and institutions have been adapted to reduce the dependence on institutions and increase control and choice for the service user. From 1998, policy was designed to accelerate and secure greater consistency in development based on the national policy principles through performance management including rewards and incentives. From 2005, the challenge was defined more in terms of improving the broad wellbeing of older people and finding new ways of contributing to it, particularly in ways which would reduce the subsequent need for services. Pressures on public budgets have throughout been and continue to be a major concern of field agencies.

Title: Making home care for older people more flexible and person-centred: factors which promote this
Author: PATMORE Charles MCNULTY Alison
Publisher: York: University of York. Social Policy Research Unit, 2005. 37p.

Abstract:
This report examines the factors which make possible a flexible, person-centred approach to providing home care for older people. Findings include that flexible person-centred care for older people may depend at least as much on the staff values and the ethos promoted within an organisation as from the particular assessment, service planning or review procedures. In respect of staff values and ethos, the values of service purchasers merit as much attention as those of providers. The values and priorities of senior purchasers may be particularly influential. Also, some older people would benefit from approaches to home care which bring some of the freedom to direct and customise one’s own services, which come from Direct Payments, but without the service user responsibilities involved in the latter.

Title: Reviewing residential care reviews for older people.
Author: SCOURFIELD Peter
Reference: Practice, 19(3), September 2007, pp.199-209.

Abstract:
Since the introduction of care management in the early 1990s, older people in care homes are supposed to have their ‘care packages’ reviewed on at least an annual basis. The current system of reviewing needs to be understood in the context of an increasingly bureaucratised, deskilled and routinised system of statutory social care. By taking a very narrow consumerist approach to reviews, not only are both Review Officer and service user often alienated from the process, but the system can often add to rather than combat disempowerment. Care home residents are one of the most powerless groups in society with few opportunities to gain control over their living circumstances. The discussion raises the issue of whether residential care home reviews should always seek to involve independent advocates as policy allows but seldom happens in practice. If this is the case, then this raises further issues of how to ensure such a service is available to all.