Care Home Sector Research Articles

Is There Time Enough? Temporal Resources and Service Performance in the Danish Home Care Sector

Reflecting on the temporal conditions of home care work, care workers are fairly critical, stressing that time frames are inflexible and time is limited and occasionally insufficient, altogether constituting a time pressure in work performance. Besides from the immediate consequences of time scarcity in the daily work performance, care workers relate the issue of time to a more fundamental discussion of what the performance of care does and should entail. The purpose of the article is to examine care workers’ perceptions of the temporal conditions of care work, investigating how time pressure constitutes a challenge to care workers’ own sense and valuation of their work. The article is informed by two theoretical perspectives: standardization of care services and performance of care work in private homes. Empirically, the article examines how care workers perceive the relations between the temporal framing and the possibilities to perform care work. Methodologically, the article is based on qualitative data, collected through focus group interviews and participant observation, and analyzed within the perspective of reflexive interpretation, using grounded theory method and hermeneutic approaches of analysis. A central focus of analysis is the concept of “additional care services.” The use of the concept reflects different understandings of care. Relying on the logic of standardization, managers articulate additional services as definite items, which could (and should) be left out of the performance of care work. Care workers do, however, not accept this notion. Relying on their experience of work, they perceive additional services as an ambiguous concept, which recognizes the multiple character of care work. Conclusions are that time scarcity constitutes a pressure on work performance as a whole, reducing care workers’ flexibility, challenging their authority, but still keeping them in a position of responsibility. Ultimately, the battle on time reflects the ambivalences in care work—ambivalences that are becoming increasingly difficult for care workers to handle in work performance.

How organizational factors interact to influence the quality of care of older people in the care home sector.

To examine how organizational factors affect good care and mistreatment of older people in care homes. Eight residential care homes for older people (including private sector, local authority and NHS providers) took part in a participatory observation-based study of organizational factors affecting care quality. Grouping organizational factors into infrastructure, management and procedures, staffing, resident population characteristics and culture, we show the context-sensitive nature of interactions between these factors. These interactions could enhance care quality where factors combined positively. Conversely, they could amplify difficulties where one factor came to undermine another, thereby limiting care quality. This analysis provides empirical insights into how and why similar sector-wide changes to care provision have differential effects at the care home level. It indicates the situated and unpredictable ways in which organizational factors interact, implying the need for locally contextualized quality assessment and improvement actions.

Household attributes and the future demand for retirement housing

PurposeAgeing populations provoke the question of how much bespoke housing should be provided for the elderly. Older people are generally reluctant to move but as they age health circumstances may encourage moves into specialised accommodation. This paper aims to report on an exercise in estimating the future demand for specialised independent living housing and the extent to which that demand will be for owner occupied accommodation or renting, using data for England.Design/methodology/approachThe most important predictor of demand for specialised housing is the extent of the requirement for at least some degree of long‐term care due to loss of mobility. Therefore, the forecast is formulated around a behaviour‐based model centred on demographic, personal physical mobility and housing tenure factors.FindingsThe forecasts indicate a substantial increase in demand, growing at a faster rate than the population as a whole. If supply does not rise to meet these demands, serious problems arise in the quality of life of, and cost of caring for, older people with implications for health care and social services. Moreover, some of the greatest growth is going to be amongst those aged 75 to 84 and amongst the very old 85+ group.Research limitations/implicationsThe forecast is based on ELSA estimates. Data on activity and ageing are available from the English Longitudinal Survey of Ageing's (ELSA) Wave 4 2008 data set.Practical implicationsThe implication is that in the future far more provision of housing for the elderly will have to take place in the private sector. However, the market provision of specialised retirement housing is likely to be very inadequate for predicted needs. A significant cause of this is a chronic planning‐induced land shortage which keeps the price of retirement accommodation high.Social implicationsThe continuing shortage of specialised housing will mean that hundreds of thousands of the elderly will continue to live in their existing accommodation when bespoke property would better suit their needs. This will further exacerbate general housing shortages, especially as the empty nester elderly do often own substantial family homes. It will also put pressures on care home sector because, in the absence of an appropriate intermediate stage, more will be pushed into care.Originality/valueIt could be argued that the assumptions made in this forecasting exercise contain a number of essentially arbitrary statements. But that is to miss the point of this exercise, which is to suggest that a large potential demand exists on plausible estimates of who might benefit from living in specialised retirement housing.

Explaining governmental involvement in home care across Europe: An international comparative study

The involvement of governments in the home care sector strongly varies across Europe. This study aims to explain the differences through the conditions for the involvement of informal care and governments in society; wealth and the demographic structure. As this study could combine qualitative data and quantitative data analyses, it could consider larger patterns than previous studies which were often based on ideographic historical accounts. Extensive data were gathered in 30 European countries, between 2008 and 2010. In each country, policy documents were analysed and experts were interviewed. International variation in regulation and governmental funding of personal care and domestic aid are associated with differences in prevailing values on family care, tax burden and wealth in a country. Hence, this study provides evidence for the obstacles – i.e. country differences – for transferring home care policies between countries. However, longitudinal research is needed to establish whether this is indeed the causal relationship we expect.

Deciding if Home Care Is Right for Me

As the location of health care delivery continues to shift from inpatient settings into the community understanding the experience of the home care workforce is important. Challenges related to recruitment and retention of nurses in home care has resulted in agencies hiring new graduate nurses. While Extensive research exists exploring experiences of new graduates in hospital settings, experiences of new graduates in home care are not well understood. Given the contextual differences between hospital and home care, research exploring new graduate nurses’ experiences in the home care sector is warranted. A phenomenological approach was used. “Deciding if home care is right for me” emerged as a way of understanding new graduate nurses’ experiences in home care.

Controlling the confusion: using barrier analysis in the care home sector

SummaryThe provision of mental health teaching and training to staff in the care home sector by a dedicated educational team was established in Bridgend in 2003. A multiprofessional old age liaison psychiatry team was created in 2009 specifically to link closely with the teaching staff, further building on previous work on referral coordination and a single point of access. This article describes the application of barrier analysis to deliver both this new service and mental health education to the care home sector. Imaginative uses of information technology and multimedia to support the efforts of all staff are described, as are some pitfalls and hazards to avoid. The most effective elements of these developments are discussed, using barrier analysis as the explanatory model, with an emphasis on aspects that could be adopted more widely.

Using a practice development project to improve standards of care for people with dementia.

A multidisciplinary NHS specialist education and training team was set up to work with staff in the care home sector who are caring for older people with dementia. The team focused on personalised care planning and assessment, interventions to help people with distressing non-cognitive symptoms and end of life care. Generally, the response from staff to the project was positive, however, formal evaluation was difficult because it ran for a fixed term of one year. This limited period did not allow for conclusive data about some possible outcomes to be collected, such as prevention of inappropriate admissions to hospital and reduction in antipsychotic medication use.

Best Practices for Heart Failure

Heart failure (HF) is a progressive condition and is associated with high patient mortality rates and frequent hospitalizations. This article provides an overview of clinical, self-management support, and care transitions best practices for HF care in the home care sector. Clinicians armed with competencies in HF management are positioned to meet the 3-part aim of healthcare reform: improved health, better care, and lower cost.

Associated factors of different nutrition indicators in German nursing home residents

Malnutrition is one of the most important care problems in the nursing home care sector. The subject of this analysis is the investigation of associative factors for different indicators of malnutrition of residents in nursing homes in Germany. A secondary data analysis was conducted using data from 4,478 nursing home residents. Unintended weight loss or reduced intake and BMI ≤ 20 were analysed as indicators for malnutrition. The influence of age, sex, co-morbidities and care dependency were investigated in logistic regression models. Residents with a high care dependency had a higher risk of suffering weight loss/reduced intake. With regard to BMI ≤ 20, residents aged > 85years, female gender, cancer, musculoskeletal disease as well as high care dependency had a higher risk. In both models, care dependency plays a major role in explaining malnutrition. Associative factors for malnutrition must be interpreted according to the indicators used to define malnutrition.

Home care in Austria: the interplay of family orientation, cash-for-care and migrant care

This article discusses the development of the home care sector in Austria. It analyses what impacts the interplay of the traditional family orientation to care, a universal cash-for-care scheme (reaching about 5% of the population) and a growing migrant care sector have on formal home care in Austria. The article is based on an analysis of research papers, policy documents and statistical data covering the period from the introduction of the cash-for-care scheme in 1993 up to 2011. Some authors have argued that generous cash benefits with no direct link to service use - as in the case of Austria - limit the development of home care, particularly in countries with a traditionally strong family orientation towards long-term care. Additionally, a tradition of family care and an emphasis on cash benefits may be conducive to the employment of migrant carers in private households, as a potential substitute for both family care and formal care. Despite this context, Austria has seen a substantial increase in formal home care over the past two decades. This has been driven by clients using their increased purchasing power and by policy priorities emphasising the extension of home care. Migrant care work was regularised in 2007, and the analysis suggests that while migrant care has usually worked as a substitute for other care arrangements, migrant care can also become a more integral element of care schemes. The article concludes that family orientation, unconditional cash benefits and the use of migrant carers do not necessarily preclude the development of a strong social service sector. However, there is a risk that budgetary limitations will primarily affect social service development.

Caretelization revisited and the lessons of Southern Cross

‘Caretelization’ is a term coined to describe the process, in a substantially privatized care home sector, whereby large corporate providers have gained greater market share through the process of mergers, acquisitions and takeovers. It has been argued that this process has reduced choice and weakened accountability for older people as consumers and local authorities as commissioners. The care regulator has also had difficulty in keeping up with complex and changing ownership patterns. In an earlier article it was predicted that with market concentration likely to increase, such problems would intensify. Prompted by the market failure of Britain’s largest private care home provider, Southern Cross, in 2011, this commentary reflects on the perils of relying on a privatized and marketized system of care homes for vulnerable older people, particularly as the regulator appears powerless to take effective action in such circumstances.

Quels diplômes pour le secteur de l’aide à la personne ?

En depit de besoins eleves et croissants dans le secteur de l’aide aux personnes, et avant tout aux personnes âgees, il n’existe, en France, aucune filiere de formation specifique. Cet article, qui s’appuie sur des recherches sur l’aide aux personnes a domicile, interroge ce paradoxe. Ainsi, la polyvalence des formations, orientees a la fois vers les tout-petits et les personnes âgees, est en contradiction avec la realite du travail offert, qui ne concerne quasiment que les personnes âgees. Des lors, elle constitue un frein a la qualification et a la reconnaissance de l’experience professionnelle des salariees. De nouvelles voies de formation, qui rapprochent l’aide et le soin et questionnent les frontieres tracees entre le sanitaire et le social, sont proposees et discutees.

Who will pay the price of cuts in residential care funding?

Erin Dean’s analysis article (August 17) asks ‘Can the care home sector cope with growing future challenges?’ Never mind future challenges – the here and now is pretty fraught.

Developing competencies for end of life care in care homes

IntroductionEnd of life care is provided by generalists, often in the care home sector. Inadequate training and support can lead to suboptimal end of life care in care homes. The...

Can the care home sector cope with growing future challenges?

Can the care home sector cope with growing future challenges?

Can the care home sector cope with growing future challenges?

Can the care home sector cope with growing future challenges?

A new case management concept to decrease the rehospitalisation rate in heurischemic

The treatment of patients suffering from the neuroischemic diabetic foot syndrome (DFS) comprises arterial revascularization (e.g. below-knee bypass surgery), minor amputations, debridements, as well as long-term specialized wound care. Following premature discharge to the homecare sector, the quality of postoperative care is often inadequate. Many patients are readmitted. We studied the influence of a trans-sectoral case management (CM), ensuring outpatient care according to our clinical standards, on the readmission rate, length of hospital stay (LOS) and the hospital's costs/benefit situation.

Mapping a Research Agenda for Home Care Safety: Perspectives from Researchers, Providers, and Decision Makers

The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health care providers, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be described; consequently, gaining insight from various stakeholders about safety issues relevant to the home care sector is necessary in order to inform strategic directions for future research. To begin to map a research agenda, a three-part environmental scan was conducted: (a) a pilot study with home care recipients and providers; (b) key informant interviews with researchers, health care providers, policy makers, and decision makers; and (c) a review of literature in three topic areas. Only the results of the key informant interviews are reported here.

‘Early days’: Knowledge and use of the Mental Capacity Act 2005 by care home managers and staff

The Mental Capacity Act (MCA) was fully implemented in England and Wales in October 2007 and has relevance for the care home sector through its focus on decision-specific assessments of capacity. This article reports on research that forms part of a five year programme exploring evidence-based interventions in dementia and this article draws on part of the research that was designed to identify issues relating to implementation of the Act. Specific research questions for this study pertain to staff abilities to incorporate a new legal framework addressing mental capacity into care of people with dementia. Qualitative interviews with 32 staff in one group of care homes in Southern England demonstrated that, regardless of knowledge of MCA, the daily working ethos of staff appeared to be within the remit of Act. Training could therefore continue to build on these principles. However, considerable variation in understanding of terms and principles of the MCA was found. Few participants were aware of specific legislative points and offered ‘common sense’ explanations for their actions and decision-making. This level of knowledge may not meet regulators’ requirements or the needs of residents.

Learning and development in care homes: A regional approach

AbstractThis project explored higher education learning and development in the Shropshire care home sector. The overall research question was:What are the challenges, barriers, opportunities, and successes both internally and externally which influence learning and development in Shropshire nursing and residential homes?This question was explored using a variety of methods: •. literature review (published within this issue of the journal);•. staff questionnaires (open and closed questions) to evaluate the last course attended, what courses staff would like to attend, whether staff would consider progressing to higher education and whether staff perceive any barriers to learning;•. semi-structured telephone interviews with training providers, key local authority staff, care home managers, care home staff, and family carers. All relevant data protection and ethical approvals were out in place prior to the beginning of data collection. The quantitative data from questionnaires (n = 15) were analysed using de...