To review the evidence for home support approaches directed at tertiary prevention; ameliorating ... more To review the evidence for home support approaches directed at tertiary prevention; ameliorating difficulties and enhancing well-being. With population ageing dementia represents a significant care challenge with 60% of people with dementia living at home. However, little is known about existing forms of home support and their relative effectiveness. A two-stage design: First, an overview of systematic reviews of psychosocial interventions for dementia to identify their components; second, a systematic review of the effectiveness of home support interventions to older people with dementia/their carers. We will search electronic databases using specific search terms with additional searches of other known studies. Data will be extracted by two reviewers according to pre-determined categories. An initial synthesis will elicit components of interventions from stage 1 and operationalize them in terms of specific techniques. These will then be used in synthesis of data in stage 2, to determine the extent to which each home support intervention relies on these components and distill evidence concerning outcomes. Studies from stage 2 are expected to be methodologically diverse; if so, a narrative approach to synthesis will be taken. Study findings will be explored with Patient, Public and Carer Involvement groups. The review seeks to develop a theory of home support: how and why interventions may work; in what contexts; and for whom. We will identify effective home support approaches, informing policy-makers and establishing how they might be experienced by people with dementia and their carers.
Mental health problems in older people are common and costly, posing multiple challenges for comm... more Mental health problems in older people are common and costly, posing multiple challenges for commissioners. Against this backdrop, a series of initiatives have sought to shift resources from institutional to community care in the belief that this will save money and concurs with user preferences. However, most of this work has focused on the use of care home beds and general hospital admissions, and relatively little attention has been given to reducing the use of mental health inpatient beds, despite their very high cost. The study employed a 'Balance of Care approach' in three areas of North-West England. This long-standing strategic planning framework identifies people whose needs can be met in more than one setting, and compares the costs and consequences of the possible alternatives in a simulation modelling exercise. Information was collected about a six-month cohort of admissions in 2010/11 (n = 216). The sample was divided into groups of people with similar needs for care, and vignettes were formulated to represent the most prevalent groups. A range of key staff judged the appropriateness of these admissions and suggested alternative care for those considered least appropriate for hospital. A public sector costing approach was used to compare the estimated costs of the recommended care with that people currently receive. The findings suggest that more than a sixth of old age psychiatry inpatient admissions could be more appropriately supported in other settings if enhanced community services were available. Such restructuring could involve the provision of intensive support from Care Home Outreach and Community Mental Health Teams, rather than the development of crisis intervention and home treatment teams as currently advocated. Estimated savings were considerable, suggesting local agencies might release up to £1,300,000 per annum. No obvious trade-off between health and social care costs was predicted. There is considerable potential to change the mix of institutional and community services provided for older people with mental health problems. The conclusions would be strengthened by further studies and the incorporation of evidence about relative outcomes. However, the utility of the approach in challenging established patterns of resource allocation and building local ownership for change is apparent.
International journal of geriatric psychiatry, Jan 11, 2015
This study aimed to identify the factors determining carer burden in a group of carers supporting... more This study aimed to identify the factors determining carer burden in a group of carers supporting people with dementia (PwD) deemed to be at high risk of moving to long-term residential or nursing home care. National data collected as part of the European RightTimePlaceCare project were analysed. This included 81 dyads of community-dwelling people with dementia and their informal carers. Structured face-to-face interviews were conducted in North West England between June 2011 and April 2012. Interviews collected data relating to the person with dementia (cognitive functioning, activities of daily living, neuropsychiatric symptoms and formal and informal dementia care resource use) and carers' level of burden (22-item Zarit Burden Index), hours spent caring and availability of additional informal support. Logistic regression analysis identified five factors associated with high carer burden: neuropsychiatric symptomatology in the PwD, intensive supervision of the PwD by the carer...
To explore inter-country variation of factors associated with institutionalization of people with... more To explore inter-country variation of factors associated with institutionalization of people with dementia. There is an urgent need for evidence on whether factors associated with admission to institutional dementia care are applicable across healthcare systems, as increasing evidence suggests that these factors could be country-specific. A prospective cohort study. Primary data were collected in eight European countries, at baseline and after 3 months follow-up (November 2010-April 2012). The sample included 2014 dyads of people with dementia and their informal caregivers; 791 patients were recently institutionalized, 1223 patients lived at home and were at risk of institutionalization. Associations between care setting (institution vs. home) and factors shown to influence institutionalization (e.g. cognition, independence in activities of daily life, behaviour) were studied. Considerable differences were found between the eight countries in characteristics of people with dementia ...
ABSTRACT Care management has developed in a variety of forms. This diary study explores differenc... more ABSTRACT Care management has developed in a variety of forms. This diary study explores differences in the approach taken to care management in three distinct social service settings: community-based older people's teams, hospital social work teams also for older ...
Purpose–The purpose of this paper is to raise issues around the involvement of clinicians relevan... more Purpose–The purpose of this paper is to raise issues around the involvement of clinicians relevant to current policies for integrated care by reviewing a previous policy to integrate assessments. Design/methodology/approach–This paper is a review of data from a survey ...
This paper explores the associations of different arrangements for care management in mental heal... more This paper explores the associations of different arrangements for care management in mental health services with case-mix, service use and staff time use. The method describes: the development of categories of care management; the selection of local authorities; fieldwork in selected authorities; and data analysis. Differences in care management arrangements were associated with service use. The degree of targeting on
To investigate agreement between: (1) expected reasons and actual reasons for admission of people... more To investigate agreement between: (1) expected reasons and actual reasons for admission of people with dementia according to informal caregivers; (2) scores on measurement instruments prior to admission and the actual reasons for admission according to informal caregivers. Timely admission of people with dementia is a crucial issue. Information is highly warranted on whether informal caregivers are capable of prior identification of causes of admission and, can thus be considered a reliable prospective source on causes of admission. A cohort study among informal caregivers of people with dementia who made a transition to institutional long-term care. Qualitative data on the expected and actual reasons for admission were collected via open-ended questions at baseline and follow-up. Furthermore, at baseline, data were collected using measurement instruments to measure pre-admission characteristics. Interviews took place between November 2010-April 2012. After categorizing the answers, the agreement between the expected and actual reasons was calculated. Furthermore, bivariate associations were calculated between the actual reasons for admission and scores on corresponding measurement instruments. For most informal caregivers, there was agreement between their statements on the expected reason and the actual reason for admission. A third of the caregivers showed no conformity. Bivariate associations showed that there is also agreement between the actual reasons for admission and scores on corresponding measurement instruments. Informal caregivers can be considered reliable sources of information regarding what causes the admission of a person with dementia. Professional care should anticipate informal caregivers' statements and collaborate with them to strive for timely and appropriate admission.
... (Diwan, 1999). The importance of the distribution of staff time is that it can affect the out... more ... (Diwan, 1999). The importance of the distribution of staff time is that it can affect the outcome of care. The length of time between admission and the commencement of assessment in hospital has been shown to have a strong influence upon length of stay (Tracey et al., 1998). ...
*Corresponding author Personal Social Services Research Unit (PSSRU) Faculty of Medical and Human... more *Corresponding author Personal Social Services Research Unit (PSSRU) Faculty of Medical and Human Sciences Dover Street Building University of Manchester M13 9PL christian.brand@manchester.ac.uk ... Social Policy Association Conference Edinburgh ...
Coordinated Care, Care Management, Service Integration and Partnerships David Challis, Jane Hughe... more Coordinated Care, Care Management, Service Integration and Partnerships David Challis, Jane Hughes, Siobhan Reilly, Caroline Sutcliffe and Chengqui Xie Integrated services: what is their impact on care coordination? There are developments designed to achieve greater ...
Why can many older persons with relatively high needs age successfully at home, while others with... more Why can many older persons with relatively high needs age successfully at home, while others with similar needs require residential long-term care (LTC)? How can healthcare investments best be balanced to ensure that older persons have access to the most appropriate, cost-effective care?
ABSTRACT Social workers in adult social care are at particular risk of job-related stress, althou... more ABSTRACT Social workers in adult social care are at particular risk of job-related stress, although the contribution of different organisational and policy changes to this phenomenon is subject to debate. This paper explores a theoretical framework from the occupational psychology literature (the Job Demand/Control Model) to identify the characteristics of those most at risk of stress, in a sample of 249 social workers and other care managers working in English adult social services from the Individual Budget (IB) pilots. It finds that it is the particular combination of high work pressures, with a lack of control over decision making and resources needed to do the work, that are detrimental to job satisfaction. The study also finds that staff involved in delivering IBs were over twice as likely to be at risk of stress compared to those without any IB holders on their caseload. In-depth interviews with forty-eight care managers identified widespread complaints of additional pressures relating to IBs, but also the possibility that these may lessen as the policy evolves. The paper concludes that the Job Demand/Control Model is a helpful framework for evaluating the job-related impact of social work changes, particularly when part of a multi-methods approach.
... Manthorpe, Jill and Stevens, Martin and Challis, David and Netten, Ann and Glendinning, Carol... more ... Manthorpe, Jill and Stevens, Martin and Challis, David and Netten, Ann and Glendinning, Caroline and Knapp, Martin and Wilberforce, Mark and Jacobs, Sally and Jones, Karen and Moran, Nicola and Fernandez, Jose-Luis (2008) Individual budget projects come under the ...
To review the evidence for home support approaches directed at tertiary prevention; ameliorating ... more To review the evidence for home support approaches directed at tertiary prevention; ameliorating difficulties and enhancing well-being. With population ageing dementia represents a significant care challenge with 60% of people with dementia living at home. However, little is known about existing forms of home support and their relative effectiveness. A two-stage design: First, an overview of systematic reviews of psychosocial interventions for dementia to identify their components; second, a systematic review of the effectiveness of home support interventions to older people with dementia/their carers. We will search electronic databases using specific search terms with additional searches of other known studies. Data will be extracted by two reviewers according to pre-determined categories. An initial synthesis will elicit components of interventions from stage 1 and operationalize them in terms of specific techniques. These will then be used in synthesis of data in stage 2, to determine the extent to which each home support intervention relies on these components and distill evidence concerning outcomes. Studies from stage 2 are expected to be methodologically diverse; if so, a narrative approach to synthesis will be taken. Study findings will be explored with Patient, Public and Carer Involvement groups. The review seeks to develop a theory of home support: how and why interventions may work; in what contexts; and for whom. We will identify effective home support approaches, informing policy-makers and establishing how they might be experienced by people with dementia and their carers.
Mental health problems in older people are common and costly, posing multiple challenges for comm... more Mental health problems in older people are common and costly, posing multiple challenges for commissioners. Against this backdrop, a series of initiatives have sought to shift resources from institutional to community care in the belief that this will save money and concurs with user preferences. However, most of this work has focused on the use of care home beds and general hospital admissions, and relatively little attention has been given to reducing the use of mental health inpatient beds, despite their very high cost. The study employed a 'Balance of Care approach' in three areas of North-West England. This long-standing strategic planning framework identifies people whose needs can be met in more than one setting, and compares the costs and consequences of the possible alternatives in a simulation modelling exercise. Information was collected about a six-month cohort of admissions in 2010/11 (n = 216). The sample was divided into groups of people with similar needs for care, and vignettes were formulated to represent the most prevalent groups. A range of key staff judged the appropriateness of these admissions and suggested alternative care for those considered least appropriate for hospital. A public sector costing approach was used to compare the estimated costs of the recommended care with that people currently receive. The findings suggest that more than a sixth of old age psychiatry inpatient admissions could be more appropriately supported in other settings if enhanced community services were available. Such restructuring could involve the provision of intensive support from Care Home Outreach and Community Mental Health Teams, rather than the development of crisis intervention and home treatment teams as currently advocated. Estimated savings were considerable, suggesting local agencies might release up to £1,300,000 per annum. No obvious trade-off between health and social care costs was predicted. There is considerable potential to change the mix of institutional and community services provided for older people with mental health problems. The conclusions would be strengthened by further studies and the incorporation of evidence about relative outcomes. However, the utility of the approach in challenging established patterns of resource allocation and building local ownership for change is apparent.
International journal of geriatric psychiatry, Jan 11, 2015
This study aimed to identify the factors determining carer burden in a group of carers supporting... more This study aimed to identify the factors determining carer burden in a group of carers supporting people with dementia (PwD) deemed to be at high risk of moving to long-term residential or nursing home care. National data collected as part of the European RightTimePlaceCare project were analysed. This included 81 dyads of community-dwelling people with dementia and their informal carers. Structured face-to-face interviews were conducted in North West England between June 2011 and April 2012. Interviews collected data relating to the person with dementia (cognitive functioning, activities of daily living, neuropsychiatric symptoms and formal and informal dementia care resource use) and carers' level of burden (22-item Zarit Burden Index), hours spent caring and availability of additional informal support. Logistic regression analysis identified five factors associated with high carer burden: neuropsychiatric symptomatology in the PwD, intensive supervision of the PwD by the carer...
To explore inter-country variation of factors associated with institutionalization of people with... more To explore inter-country variation of factors associated with institutionalization of people with dementia. There is an urgent need for evidence on whether factors associated with admission to institutional dementia care are applicable across healthcare systems, as increasing evidence suggests that these factors could be country-specific. A prospective cohort study. Primary data were collected in eight European countries, at baseline and after 3 months follow-up (November 2010-April 2012). The sample included 2014 dyads of people with dementia and their informal caregivers; 791 patients were recently institutionalized, 1223 patients lived at home and were at risk of institutionalization. Associations between care setting (institution vs. home) and factors shown to influence institutionalization (e.g. cognition, independence in activities of daily life, behaviour) were studied. Considerable differences were found between the eight countries in characteristics of people with dementia ...
ABSTRACT Care management has developed in a variety of forms. This diary study explores differenc... more ABSTRACT Care management has developed in a variety of forms. This diary study explores differences in the approach taken to care management in three distinct social service settings: community-based older people's teams, hospital social work teams also for older ...
Purpose–The purpose of this paper is to raise issues around the involvement of clinicians relevan... more Purpose–The purpose of this paper is to raise issues around the involvement of clinicians relevant to current policies for integrated care by reviewing a previous policy to integrate assessments. Design/methodology/approach–This paper is a review of data from a survey ...
This paper explores the associations of different arrangements for care management in mental heal... more This paper explores the associations of different arrangements for care management in mental health services with case-mix, service use and staff time use. The method describes: the development of categories of care management; the selection of local authorities; fieldwork in selected authorities; and data analysis. Differences in care management arrangements were associated with service use. The degree of targeting on
To investigate agreement between: (1) expected reasons and actual reasons for admission of people... more To investigate agreement between: (1) expected reasons and actual reasons for admission of people with dementia according to informal caregivers; (2) scores on measurement instruments prior to admission and the actual reasons for admission according to informal caregivers. Timely admission of people with dementia is a crucial issue. Information is highly warranted on whether informal caregivers are capable of prior identification of causes of admission and, can thus be considered a reliable prospective source on causes of admission. A cohort study among informal caregivers of people with dementia who made a transition to institutional long-term care. Qualitative data on the expected and actual reasons for admission were collected via open-ended questions at baseline and follow-up. Furthermore, at baseline, data were collected using measurement instruments to measure pre-admission characteristics. Interviews took place between November 2010-April 2012. After categorizing the answers, the agreement between the expected and actual reasons was calculated. Furthermore, bivariate associations were calculated between the actual reasons for admission and scores on corresponding measurement instruments. For most informal caregivers, there was agreement between their statements on the expected reason and the actual reason for admission. A third of the caregivers showed no conformity. Bivariate associations showed that there is also agreement between the actual reasons for admission and scores on corresponding measurement instruments. Informal caregivers can be considered reliable sources of information regarding what causes the admission of a person with dementia. Professional care should anticipate informal caregivers' statements and collaborate with them to strive for timely and appropriate admission.
... (Diwan, 1999). The importance of the distribution of staff time is that it can affect the out... more ... (Diwan, 1999). The importance of the distribution of staff time is that it can affect the outcome of care. The length of time between admission and the commencement of assessment in hospital has been shown to have a strong influence upon length of stay (Tracey et al., 1998). ...
*Corresponding author Personal Social Services Research Unit (PSSRU) Faculty of Medical and Human... more *Corresponding author Personal Social Services Research Unit (PSSRU) Faculty of Medical and Human Sciences Dover Street Building University of Manchester M13 9PL christian.brand@manchester.ac.uk ... Social Policy Association Conference Edinburgh ...
Coordinated Care, Care Management, Service Integration and Partnerships David Challis, Jane Hughe... more Coordinated Care, Care Management, Service Integration and Partnerships David Challis, Jane Hughes, Siobhan Reilly, Caroline Sutcliffe and Chengqui Xie Integrated services: what is their impact on care coordination? There are developments designed to achieve greater ...
Why can many older persons with relatively high needs age successfully at home, while others with... more Why can many older persons with relatively high needs age successfully at home, while others with similar needs require residential long-term care (LTC)? How can healthcare investments best be balanced to ensure that older persons have access to the most appropriate, cost-effective care?
ABSTRACT Social workers in adult social care are at particular risk of job-related stress, althou... more ABSTRACT Social workers in adult social care are at particular risk of job-related stress, although the contribution of different organisational and policy changes to this phenomenon is subject to debate. This paper explores a theoretical framework from the occupational psychology literature (the Job Demand/Control Model) to identify the characteristics of those most at risk of stress, in a sample of 249 social workers and other care managers working in English adult social services from the Individual Budget (IB) pilots. It finds that it is the particular combination of high work pressures, with a lack of control over decision making and resources needed to do the work, that are detrimental to job satisfaction. The study also finds that staff involved in delivering IBs were over twice as likely to be at risk of stress compared to those without any IB holders on their caseload. In-depth interviews with forty-eight care managers identified widespread complaints of additional pressures relating to IBs, but also the possibility that these may lessen as the policy evolves. The paper concludes that the Job Demand/Control Model is a helpful framework for evaluating the job-related impact of social work changes, particularly when part of a multi-methods approach.
... Manthorpe, Jill and Stevens, Martin and Challis, David and Netten, Ann and Glendinning, Carol... more ... Manthorpe, Jill and Stevens, Martin and Challis, David and Netten, Ann and Glendinning, Caroline and Knapp, Martin and Wilberforce, Mark and Jacobs, Sally and Jones, Karen and Moran, Nicola and Fernandez, Jose-Luis (2008) Individual budget projects come under the ...
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