Flexible, person-centred home care for older people: What methods, management and resources make it bloom?

Researchers: Charles Patmore

Funder: Department of Health Policy Research Programme

Duration: October 2001 to March 2005

What methods, management and resources make it bloom?

This research and development project examines how to organise home care services so that they can respond flexibly to important, dearly held values among older people as individuals. Responding to service users' requests on an individual basis may offer a much better route to high quality home care than applying a single definition of quality to all service users. Sometimes a response to an individual's request can bring major gains for a service user's morale or quality of life. "Individuals are the experts on their own situation", according to the guidance on assessment for Fair Access to Care (2002). Addressing individuals' requests and priorities, which this project explores, is a way of treating service users as experts in this sense.

The project aims to:

make practical recommendations to services nationally about teamwork models, management methods, purchasing arrangements and resources which enable home care to respond flexibly, yet within realistic resources, to heartfelt personal priorities expressed by the older people for whom they care.
examine how individuals’ requests and priorities can be incorporated in the review process

The project is conducted by the Social Policy Research Unit (SPRU) and funded by the Department of Health. The Research Group of the Association of Directors of Social Services has recommended it to Social Services.

Issues to be examined include

A person-centred approach requires that information about what matters most to each client be systematically collected, kept up to date, and communicated to staff. What are effective ways for doing this? Do keyworker systems help? What are helpful systems for listening to service users? What are useful questions at reviews?
How services organise staff rotas and cover for staff absences affects their ability to meet certain common requests, like service from staff members whom a client knows well. Are there some systems which are better than others?
Sometimes customer requests are not met because of some services’ rules against things like taking service users outside their homes, changing light-bulbs, providing basic pet care or finding private cleaning or repair services. Certainly there are some genuine problems which such rules are intended to prevent. But are there working examples of more flexible policies which sometimes fulfil such requests while still avoiding problems?
Meeting some customer requests requires communication between home care providers and the Social Services Care Managers who commission the service. What Care Management policies and systems for communicating with providers prove helpful for this purpose?
It might be easier for hard-pressed home care services to do the things which matter most to individuals, if service users make compromises like fitting in with staff on other aspects of their service. Are there working examples of how staff and service users can devise compromises which suit both parties?

The latter stages of the research examine how some different Home Care teams, chosen for the variety of their approaches, can respond to requests which are important to service users. This should illuminate what service models, resources or Care Management policies make it easier to respond to older people’s requests.

Methods

Stage 1

A literature search on :
- Different ways of organising home care services for older people
- Adjusting older people’s services to the values and choices of individual service users
A national telephone survey of a small sample of home care providers to obtain a picture of:
- Varieties of ways in which Home Care providers are organised and managed.
- The variety of common policies and practices concerning how Home Care services respond to service users’ requests.
- Types of service user preferences and requests which providers regard as easy or difficult to meet.

Stage 2 In-depth information gathering

SPRU will work with a small sample of selected home care providers and with the Care Managers who purchase their services. Both independent sector and Social Services in-house providers will be involved. SPRU will seek customer viewpoints on each home care provider in the study through interviews with approximately six older service users at each. Interviews will include each service user’s personal priorities and requests - both those which are already met and those currently unmet. Methods will be explored for rating the importance of an individual’s request. Information will also be gathered about how each provider organises service through interviews with provider staff, attendance at meetings and study of servcie documents. Information will likewise be gathered about the policy and practice of Social Services Purchasers through interviews with Care Managers and senior Purchasers.

Results of the study and their applications

SPRU will produce publications which examine aspects of service organisation, resources and commissioning arrangements which assist a home care service to respond to older people’s individual values, preferences and requests.
Publications from Stage 1 are released as soon as available. Publications from Stage 2 will appear during 2004.

Publications

2006

A visit from your flexible friend, 2006
Patmore, C., The Guardian, March 1.

Bringing well-being and choice into everyday home care, 2006
Patmore, C., Working with Older People, 10, 3, 24-7.

Well-being and choice for older people - how can commissioners promote this?, 2006
Patmore, C., pp. 1-17 in Commissioning e-book, Care Services Improvement Partnership.

2005

Caring for the Whole Person: Home care for older people which promotes well-being and choice, 2005
Patmore, C. and McNulty, A., Well-being and Choice Website.

Flexible, person-centred home care for older people, 2005
Patmore, C. and McNulty, A., Research Works, 2005-04, Social Policy Research Unit.

Making Home Care for Older People More Flexible and Person-centred: Factors which promote this, 2005
Patmore, C. and McNulty, A., Social Policy Research Unit.

Power of the purchaser, 2005
Patmore, C. and McNulty, A. , Community Care, 6-12 October, 34-35.

That little bit extra, 2005
Patmore, C. and McNulty, A. , Community Care, 13-19 October, 36-37.

2004

Are payment regimes precluding best care?, 2004
Patmore, C., The Homecarer, January 2004.

Quality in home care for older people: factors to pay heed to, 2004
Patmore, C., Quality in Ageing, 5, 1, 32-40.

2003

Managing all your home care - all the time, 2003
Patmore, C., The Homecarer, May, 6-7.

Understanding Home Care Providers, 2003
Patmore, C., Social Policy Research Unit.

2002

Towards Flexible, Person-centred Home Care Services: A guide to some useful literature for planning, managing or evaluating services for older people, 2002
Patmore C., Social Policy Research Unit.

Morale and quality of life among frail older users of community care: key issues for the success of community care, 2002
Patmore, C., Quality in Ageing, 3, 2, pp30-38.

2001

Improving home care quality an individual-centred approach, 2001
Patmore, C., Quality in Ageing, 2, 3, 15-24.

Supporting morale among frail older users of home care an emerging challenge for social care, 2001
Patmore, C. in Tester, S., Archibald, C., Rowlings, C. and Turner S. (eds.) Quality in Later Life Rights, Rhetoric and Reality Proceedings of the British Society of Gerontology's 30th Annual Conference, Stirling.

Further publications

Patmore, C. (2002) Towards Flexible, Person-centred Home Care Services: A guide to some useful literature for planning, managing or evaluating services for older people. (172KB PDF)Research report DH 1865a (07.02).

Patmore, C. (2002) 'Morale and quality of life among frail older users of community care: Key issues for the success of community care' (55KB PDF)Quality in Ageing, 3, 2, 30-38

Patmore, C. (2001) 'Improving home care quality: An individual-centred approach' (54KB PDF)Quality in Ageing, 2, 3, 15-24

Patmore, C. (2001) 'Can managers research their own services? an experiment in consulting frail, older, community care clients' (102KB PDF)Managing Community Care, 9, 5, 8-17

Research Works (2000) Briefing home care staff about older people's individual needs (359KB PDF)
The development and use of a form designed to brief front-line home care providers about intended outcomes, user preferences and required actions.

Research Works (2000) Learning from older community care clients (333KB PDF)
The implementation of a programme of "customer visits" to enable senior managers to see first hand the outcomes of services and directly discuss them with service users.

Associated publications

Ian Sinclair, Ian Gibbs and Leslie Hicks (2000), 'The Management and Effectiveness of the Home Care Service' Social Work Research & Development Unit, University of York: York
Available online at :http://www.york.ac.uk/inst/swrdu/Projects/homecare.html

This project explores how to design a Home Care service, for publicly funded clients, which can respond flexibly to important, dearly held values among individual service users

Professional Press

The Homecarer, March 2006, p. 6-7. The real buzz is getting it right.

Journal of Dementia Care, November/December 2005, p.38. Flexible, person-centred home care.

Help the Aged Policy Update, December 2005, p.7. Report emphasises need to provide flexible, person-centred home care

If you require further information about the project, please contact the Information Office