Professional Perspectives on Decision Making about the Long-term Care of Older People

Taylor, Brian J.

doi:10.1093/bjsw/bch322

Cited by 54 publications

(32 citation statements)

References 30 publications

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“…Several researchers have found also that care managers think that they spend too much time on risk management (e.g. Ceci & Purkis, 2009;Green & Sawyer, 2010;Taylor & Donnelly, 2006). This contrasts sharply with the type of work that they engaged on when they spent a considerable amount of their time on building relationships with their clients as they strive to create a supportive and therapeutic environment for them.…”

Section: Research On Care Managers' Decision-making Processes Within mentioning

confidence: 99%

Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest

Olaison

Torres

Forssell

2018

Journal of Social Work Practice

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Research has explored how care managers in elder care -who often function as 'street-level bureaucrats' -regard professional discretion. The way in which length of work experience affects care managers' use of professional discretion remains, however, unexplored. This article present findings from 12 focus groups with 60 care managers. By bringing attention to how care managers experience the needs assessment process, this article sheds light on how these 'street-level bureaucrats' struggle when they try to balance their clients' needs against institutional frameworks and local guidelines. Length of work experience seems to play a role in how care managers claim to use professional discretion. Experienced care managers describe how they deviate from the guidelines at times in order to create an increased scope of action in their decision-making process. Those with less time in the profession describe greater difficulties in this respect. Findings suggest that research should explore if length of work experience plays a role in the actual way in which care managers assess needs and make decisions. As such, they contribute to our understanding of how needs assessment processes are navigated by professionals while also pointing towards the nature of professional discretion in gerontological social work.

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Section: Research On Care Managers' Decision-making Processes Within mentioning

confidence: 99%

Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest

Olaison

Torres

Forssell

2018

Journal of Social Work Practice

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“…This illustrates the complex morbidity of this client group, and also highlights the number of placements arranged in the context of crises, as identified elsewhere in the literature. 175 This made assessment of individuals' potential functioning more difficult, and gave little time to organise home care packages or garner support from informal carers. In recognition of this, the SSD has recently commissioned a number of beds in the local community hospital for assessment purposes, as suggested by the experts in this study.…”

Section: Implications For Local Service Providersmentioning

confidence: 99%

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Challis

Tucker

Wilberforce

et al. 2014

Programme Grants for Applied Research

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BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…An action might be regarded as acceptable as a way for a relative to enable an older person to continue living at home, while the same action might be regarded as unacceptable if it were done with malice (Taylor & Donnelly, 2006b). The motivation of those involved and the individual's circumstances were thought to determine if an act or inaction was abusive.…”

Section: Personhood or Societal Abusementioning

confidence: 99%

Older People’s Conceptualization of Elder Abuse and Neglect

Taylor

Killick

O’Brien³

et al. 2014

Journal of Elder Abuse & Neglect

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This qualitative study used data from eight focus groups involving 58 people aged over 65 years in both urban and rural settings across Northern Ireland and the Republic of Ireland. Following training, four older people assisted in facilitation and analysis as peer researchers. Increasing lack of respect within society was experienced as abusive. The vulnerability of older people to abuse was perceived as relating to the need for help and support, where standing up for themselves might have repercussions for the person's health or safety. Emotional abusiveness was viewed as underpinning all forms of abuse, and as influencing its experienced severity. Respondents' views as to whether an action was abusive required an understanding of intent: some actions that professionals might view as abusive were regarded as acceptable if they were in the older person's best interests. Preventing abuse requires a wide-ranging approach including rebuilding respect for older people within society. Procedures to prevent elder abuse need to take into account the emotional impact of family relationships and intent, not just a description of behaviors that have occurred.

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Professional Perspectives on Decision Making about the Long-term Care of Older People

Cited by 54 publications

References 30 publications

Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest

Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Older People’s Conceptualization of Elder Abuse and Neglect

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