‘I Haven’t Forgotten About You’ ‐ Critical Lessons Learned in Negotiating Access into the Field of Care Management

Abstract

Based on a case study, this paper discusses the issues raised and problems faced when trying to negotiate access to the system of statutory reviews for older people residing in care homes in England. Efforts to recruit participants proved to be more difficult than anticipated. However, the prolonged period of field negotiation yielded its own set of data with which to better understand the adult social care system in England. The paper provides a critical reflection on the reasons behind the care managers' reluctance to participate and the strategies employed to deflect attention or resist involvement. The discussion provides a broader context in order to allow for wider applicability of the findings across other similar situations.Keywords: Access, care management, participation. …research in group or organisational contexts raises some additional considerations, and negotiating access to the setting will be a key part of early stages of the research. It requires patience and sensitivity. (Lewis, 2003, p. 62) This paper emerges from a UK-based doctoral study. The research questions were focused on the way statutory reviews were carried out for older people in care homes. The older care home population in England, as elsewhere, is characterised by complex care needs which often follow from varying degrees of chronic ill health (mental and physical), disability and sensory impairment (Office of Fair Trading, 2005). In England, older people who are supported by public funding are required to have their placements reviewed at least annually. The purpose of the review includes establishing whether the older person's needs are being met and whether the care plan needs to be changed. Although the care manager is usually required to follow a pre-determined format, the review should provide an opportunity for the older person, or their representative, to comment on any aspect of their life in the home.The research was focused on a 'shire county' in which there were 68 care homes accommodating over 2000 older people as residents. Roughly two-thirds were financially supported in some way by the local authority. The project was designed as a qualitative case study using methods of observation, semi-structured interviews and documentary analysis to gain a better sense of how the system of residential reviews worked from multiple perspectives. Related questions included trying to gain a sense of whether those involved felt reviews were useful and in what way, how they should be conducted, whether they were effective, and to obtain a better understanding of how care managers tried to engage with the older person in a meaningful way, and also to what extent the older person's understanding and experiences of the review matched that of the reviewer.Despite a reasonably successful pilot study, subsequent efforts to recruit care managers prepared to participate proved to be largely unsuccessful. Whilst causing a significant degree f frustration, the prolonged period of field negotiations yielded its own set of data wit...