Outcomes-based commissioning for social care in extra care housing: is there a future?

Smith, Randall; Darton, Robin; Cameron, Ailsa M; Johnson, Eleanor; Lloyd, Liz; Evans, Simon; Atkinson, Teresa; Porteus, Jeremy

doi:10.1108/hcs-03-2017-0003

Cited by 10 publications

(15 citation statements)

References 9 publications

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“…It is also important to recognise that the broader health and social care context within which ECH sites has changed dramatically since it first emerged. Smith et al. (2017), for example, have drawn attention to some of the complex challenges faced by those commissioning adult social care for residents in ECH, highlighting the central importance of reduced funding, meeting only higher eligibility criteria, increasing costs as a result of demographic change and the introduction of the national living wage (a mandatory pay rate for workers aged 25 and over).…”

Section: Introductionmentioning

confidence: 99%

Can extra care housing support the changing needs of older people living with dementia?

Evans¹,

Atkinson

Cameron³

et al. 2018

Dementia

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With over two-thirds of people with dementia living in the community and one-third of those living alone, it is important to consider the future housing needs of this population, particularly as symptoms of cognitive impairment increase. Policy in England has focused on enabling people living with dementia to remain in their own homes for as long as possible, often with the support of a family carer. However, many people struggle to maintain an acceptable quality of life in their own homes as their dementia advances, often due to the design limitations of mainstream housing and the challenge of finding specialist domiciliary care that is affordable and of sufficient quality. Extra care housing offers a model that aims to support older people living in their own apartments, whilst also offering specialist person-centred care as and when it is needed. This paper reports on a longitudinal project that explored how extra care housing can respond to the changing social care needs of residents, including those living with dementia. Participants included residents and staff from four extra care housing schemes, one of which was a specialist dementia scheme, in two regions of England. Interviews were carried with 51 residents across 4 rounds at 5 month intervals between October 2015 and June 2017. Interviews were also carried out with 7 managers, 20 care staff and 2 local authority commissioners of housing for older people. Key factors included person-centred care and support, flexible commissioning and staffing, appropriate design of the environment and suitable location of the scheme within the wider community. The challenge of delivering services that addresses these issues during a period of reduced public spending is acknowledged. Further research is suggested to compare different approaches to supporting people with dementia, including integrated and separated accommodation, and different stages of dementia.

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Section: Introductionmentioning

confidence: 99%

Can extra care housing support the changing needs of older people living with dementia?

Evans¹,

Atkinson

Cameron³

et al. 2018

Dementia

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“…More recently, with the intention to provide a more personalised service with a more flexible response to need, service users and their carers have the opportunity to take more control in the planning and organisation of their own via self‐direct support and personal budgets. This has the potential to increase the complexity of commissioning at the operational level . However, it has been suggested that, particularly for older people with dementia, there will be a preference to minimise their responsibility in decisions regarding the purchasing of services and equipment and the creation of complex care packages .…”

Section: Discussionmentioning

confidence: 99%

Commissioning social care for people with dementia living at home: Findings from a national survey

Davies

Hughes

Ahmed

et al. 2019

Int J Geriat Psychiatry

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Objective: To explore the complexities, circumstances, and range of services commissioned for people with dementia living at home. Methods:A national survey was used to collect data from English local authorities in 2015. Commissioners of services for older adults were invited to complete a questionnaire. An exploratory cluster analysis of nominal data was conducted using aTwoStep procedure to identify distinct groups.Results: A total of 122 authorities (83%) responded to the request. Four approaches to commissioning were identified, reflecting commissioning practices at the organisational, strategic, and individual service user levels. Commissioning at the service user level was most apparent. Bivariate analysis found that these configurations were not associated with the types of dementia specific services provided but were related to the number available. Authorities delivered a greater range of specialist services when joint commissioning between social care and health partners was undertaken. However, the joint commissioning of services was less observed in services specifically for people with dementia than in generic services for all older people. There was limited evidence that local circumstances (population configuration and deprivation levels) were associated with this approach to commissioning. Conclusions:The significant role of health partners in the delivery of social care services to support older people living with dementia in their own homes is evident.As the population with dementia ages and physical health needs increase, how dementia specific services differ from and complement those services available to all older people warrants further investigation. KEYWORDS adult social care, commissioning, dementia, home care, survey | INTRODUCTIONWith the population ageing globally, dementia presents a significant health and social care challenge. 1 This is apparent in primary (preventing development), secondary (offering early-stage treatment), and tertiary prevention-ameliorating difficulties and enhancing wellbeing. With regard to the latter, the need for appropriate care for those close to the end of life, in the context of comorbidity and frailty, has been emphasised. 2 Internationally, the tertiary care of people with dementia is often portrayed as a clinical pathway. 3-6 However, people with dementia in the oldest age groups have needs characterised by complexity which are often inadequately addressed in existing disease-based models of tertiary care. 7 Meeting the needs of people with dementia and their carers often requires substantial social care

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“…For residents at Sites A, B and C, the move into ECH was therefore more likely to be a reactive one in which they were given less choice. This reaffirms that there is a disparity of experiences between older people who are tenants living in ECH schemes which act as providers of social housing and older people who are able to actively choose to become outright owners of apartments in luxury ECH schemes (Smith et al ., 2017).…”

Section: Discussionmentioning

confidence: 99%

Ageing in extra-care housing: preparation, persistence and self-management at the boundary between the third and fourth age

et al. 2019

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Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents’ attempts to manage this boundary.

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Outcomes-based commissioning for social care in extra care housing: is there a future?

Cited by 10 publications

References 9 publications

Can extra care housing support the changing needs of older people living with dementia?

Can extra care housing support the changing needs of older people living with dementia?

Commissioning social care for people with dementia living at home: Findings from a national survey

Ageing in extra-care housing: preparation, persistence and self-management at the boundary between the third and fourth age

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