Will Direct Payments Make Adult Residential Care more Personalized? Views and Experiences of Social Care Staff in the Direct Payments in Residential Care Trailblazers

Direct payments, i.e. cash payments made directly to the individual in lieu of social care services, have become an established option in council‐funded domiciliary care as a means to better personalize care and support. As part of its agenda to modernize social care, the Government tested their use in long‐term residential care in 18 trailblazing councils in England. This article presents findings from the independent evaluation of this initiative, using interviews with project leads seconded to the programme in all participating councils, and with council and care home staff involved in implementing direct payments in residential care in five sites. Interviews were conducted between September 2014 and November 2015. They explored professionals' views and experiences of personalization in residential care and their thoughts on the potential contribution of direct payments to promoting personalization. Whilst there was agreement that good care takes personal preferences into account and that many care homes could provide a more personalized service, doubts were voiced about whether direct payments were an appropriate mechanism to achieve this aim. This was seen as particularly pertinent in relation to residents with very high care needs and limited capacity to exercise choice and control. Interviewees also identified a number of risks and challenges to implementation, including financial risks to care homes. The findings from these interviews suggest that the contribution of direct payments to personalizing residential care may be more modest than expected.     

Staff-Family Relations and Institutional Care Policies

As institutional care providers increasingly recognize the importance of the family, the quality of staff-family relations has become a concern. This study investigated the relationship between selected facility care policies and staff-family relationships. Data secured from staff members and family members in rural nursing homes revealed a relationship between the family role that the care policy prescribed and the degree of staff-family integration. The study concluded that care policies viewing family members as clients will have positive consequences for staff and families and ultimately the residents.     

English Local Authority Powers, Responsibilities and Guidelines for Managing the Care Home Closure Process

In England, the majority of older people living in care homesare publicly funded and the majority of publicly funded placesare purchased from the independent sector. While the sectoris subject to regulation, there is currently no statutory guidanceaimed specifically at how care home closures are managed. Thisarticle reviews the powers and responsibilities of councilsand the rights of residents during care home closures, beforedescribing the prevalence and content of existing council guidelines.Just over a third of councils in England responded to inquiriesand, of these, two-thirds reported having guidelines. This suggeststhat a considerable proportion of councils have no guidelinesin place. Existing guidelines also varied. Differences includedapproaches to allocating responsibilities and providing help,and assessment to self-funding residents. The large number ofarrangements and activities described suggest that some sortof plan or guidance is warranted to support the task of frontline care managers. At the national level, the variation foundin the guidelines combined with the lack of national guidancespecific to closures suggests that clarification of councils’legal responsibilities and powers during a care home closureis needed. Clarification of the role and responsibilities ofthe national regulatory body would also be useful.     

An Attempt to Assess a New Design in Residential Homes for the Elderly

Summary A comparison of the residents of three county council homesfor the elderly is undertaken. The three homes differ both intheir architectural design, and in the role of the staff. Themeasures used are mainly concerned with the residents' dailyactivities, and information is collected both by questionnaireand by personal observation. The results show significant differencesin the three groups and tend to support the authors' predictionsconcerning the residents' behaviour, based on the differencesin the physical design and staff role in the homes     

The Family Group Within the Nursing Home:

An ongoing monthly family group was implemented in an intermediate care facility in hopes of improving communication between staff and families of long term care residents. Other objectives of the group were to provide families with information about policies and procedures, education about the aging process, and to facilitate an informal support group network where families could share problems and concerns. The feedback and evaluation process indicated that sharing feelings of anger, quiet, frustration and other emotions helped the families deal with the responsibilities of institutionalizing a relative and helped to facilitate better communication between staff and family members.     

Assessing the effects of neighborhood councils on urban policy and development: The example of Tacoma,Washington

Neighborhood councils form an important and sometimes problematic layer in the governance system of many cities across the USA. The literature on these institutions has focused mainly on their hypothesized role in facilitating citizen participation in neighborhood and city planning. Less work has explored the experiences of neighborhood councils as placed-based institutions theoretically embedded within, and therefore ostensibly reflective of, the overall social and political geography of the city. In particular, little research documents the actual local development priorities, fund-raising capacities, project achievements and scalar tensions associated with neighborhood councils operating in different neighborhoods of the same city. Using a perspective based on extant literatures in urban politics and public administration, this paper offers an analysis of the neighborhood council experience in Tacoma, Washington, USA. While these councils are still “segmented” from the core of urban politics, the paper argues, certain institutional reforms could unlock their long term potential as more “transformative” spaces of local governance.     

Family Visiting with Institutionalized Mentally Impaired Aged

The nature and frequency of interaction between 43 mentally impaired aged residents in a long term care facility and their relatives was studied. It was found that in most cases the frequency of visiting remained stable over time, and in addition, the relatives combined visiting with other tasks-gift giving, assistance with grooming, etc.-on behalf of their family members. The artice includes recommendations for institutional staff help to these relatives as they cope with the continuing decline of the aged person.     

Amalgamation in action: Participant perspectives on the Armidale regional council merger process

Under its Fit for the Future reform programme, in May 2016 the New South Wales (NSW) government forcibly merged a number of municipalities, including the Armidale Dumaresq Council and the Guyra Shire Council in the New England region of northern NSW. Whilst scholarly attention has focused on the likely impact of municipal mergers on council performance at the system‐wide level (Bell, Dollery & Drew 2016; Economic Papers: A journal of applied economics and policy, 35, 99), much less effort has been devoted to the analysis of the perspectives of council managers and employees involved in forced consolidation. In order to address this gap in the literature, in this paper we present a case study of compulsory council consolidation of the Armidale and Guyra councils based on interviews with senior managers as well as a survey of council workers.     

A good death for residents of long-term care: family members speak

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/ assisted living facilities. Structural components of care including staffing adequacy, training, and consistency as well as facility environment and size were important factors for family members interviewed. "Being there" and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

Political Experience and Fundraising in City Council Elections

Objective . Despite lack of attention from urban scholars, candidates' fundraising is a critical component of electoral politics in cities. In this research I evaluate the degree to which candidates' political experience is related to fundraising in city council elections. Methods . Multivariate regression is used to test models of city council fundraising in Chicago and Los Angeles. Results . In both cities, fundraising is a function of incumbency and prior experience as a political staff aide. Political endorsements are also important, especially those that come from incumbent politicians. The competitive environment also matters, as nonincumbents in open seat contests raise more than those who challenge incumbents. Conclusions . Fundraising in city council elections is shaped most notably by a combination of political experience and elite endorsements. For nonincumbents, the importance of prior experience on a political staff suggests a certain career trajectory for those seeking city council seats.     

A Conceptual Model of Family Surrogate End-of-Life Decision-Making Process in the Nursing Home Setting: Goals of Care as Guiding Stars

An increasing proportion of dying is occurring in America's nursing homes (NH). Family members are involved in (and affected by) medical decision-making on behalf of NH residents approaching the end of life, especially when the resident is cognitively impaired. This article proposes an empirically derived conceptual model of the key factors NH family surrogate decision-makers consider when establishing or changing goals of care and the iterative process as applied to the NH setting. This model also establishes the importance of family social role expectations toward their loved one as well as the concept, “stance toward dying,” as key in establishing or changing the main goal of care. NH staff and physicians can use the model as a framework for providing information and support to family members. Research is needed to better understand how to prepare staff and settings to support family surrogate decision-makers, in particular around setting goals of care. The model can be generalized beyond nursing homes.     

A Good Death for Residents of Long-Term Care

Abstract

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. “Being there” and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

Evidence of Empowerment in Resident Council Groups: An Examination of Two Leadership Models in Assisted Living

Individuals living in long-term care facilities and the professionals working with them are seeking methods to enhance resident choice and self-direction in personal care and internal community planning. This article presents findings from a study examining the incidence of empowerment opportunities in two resident council groups in assisted living facilities; one group used a resident leadership model and the other used an administrative leadership model by residents' choice. Results indicate that even with health and mental health challenges, residents were able to exercise choice in complicated situations under both leadership models, suggesting that resident council groups are a beneficial empowerment strategy.     

Calling the Question of “Possible Dying” Among Nursing Home Residents

Abstract

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as “dying” can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of “possible dying” by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

Calling the question of "possible dying" among nursing home residents: triggers, barriers, and facilitators

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as "dying" can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of "possible dying" by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

Investigating Barriers to Family Visitation of Nursing Home Residents: A Systematic Review

Families are integral in helping nursing home residents maintain feelings of social inclusion and an overall sense of belonging, thus reducing consequences of social exclusion. Preliminary research, particularly of the culture change movement in long-term care, shows there are barriers to family engagement and visitation of residents. The objective of this study is to: (1) identify and summarize the barriers most reported to family visitation and (2) synthesize the findings to determine which barriers are most often reported in literature, and which may pose the greatest challenges to family involvement. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a final sample of 15 articles across 11 databases report seven barriers to visitation: psychological, health, staff to family member relationship, employment/finances, travel time, access to transportation, and other. Findings suggest barriers to family visitation and point toward a need for further research as relationships between resident and family member is complex and warrants attention across professions. Interprofessional efforts between social work, allied professionals, and transportation planners are necessary to address this pressing concern experienced by residents in nursing homes, with the ultimate goal of lessening such barriers.     

A marketization process in dispute: An analysis of serviced housing for the elderly in Finland, 2000–14

Marketization can be viewed as a potential response to the economic challenges of the public sector. The present study is focused on the development of marketization in serviced housing for the elderly in municipalities within Finland. Marketization is approached by asking the question: What kind of municipality‐level factors are associated with marketization and its development? The data consist of 290 municipalities and cover the years 2000–14. According to the study, the size of the municipality, the political distribution of the municipality council, and the economic situation of the municipality are found to be associated with marketization. More preciesly, the municipality size was found to be a kind of prism, which creates two different realities when it is linked with political distribution and transfers. In the case of big municipalities, the big share of Green‐Left council members on municipality councils has been associated with a low level of marketization. However, in the case of small‐ and medium‐sized municipalities, the low level of marketization has been associated with the government statutory transfers between the state and municipalities, which has helped smaller municipalities to avoid fiscal stress. In a policy context, the present study suggests that the marketization process can be slowed down by supporting the economically weakest municipalities to avoid fiscal stress. On the other hand, the marketization process can be supported by creating bigger municipalities which are then attractive enough to create an effective market mechanism.     

Impact of municipal amalgamation on stakeholder collaboration: the case of Auckland,New Zealand

Local councils governing Auckland, New Zealand, underwent restructuring in 2010, amalgamating eight local authorities and establishing the Auckland Council as a unitary authority. Key objectives for Auckland’s amalgamation included achieving reform and a single direction in governance, facilitating democratic representation of local communities, overcoming prevalent problems of fragmentation in governance and addressing lack of engagement from local communities. Qualitative interviews with key public and private sector stakeholders suggest the amalgamation effected changes to collaborative practices in anticipation of the restructure and after the amalgamation occurred. The creation of one council eased many collaborative processes. At the same time, the amalgamation strained collaboration in several ways.     

The Role of the Nursing Home Social Worker in Terminal Care

This study examines the role of the nursing home social worker in terminal care. Questionnaires were distributed to 60 social workers in 14 nursing homes in the greater Milwaukee area. The hypothesis was that the presence of policies/procedures governing terminal care would be related to a decreased amount of stress for social workers. This correlation was not supported by the survey results. Although 71% of respondents indicated no policies were available to them, only 32.6% of social workers reported that terminal care was a source of stress. In fact, 59% reported that the social worker's role in terminal care had not been discussed in the social services department of their facility. Comparative lack of stress for social workers may be related to the lack of perception that social workers play a significant role in the terminal care of residents.     

Challenges to Treating the Elderly Latino Substance Abuser

Summary

The Friendly Companion Program was initiated in May of 1999 to enhance social support for VAMC Northport Nursing Home residents who have infrequent or no visitation by family, friends, or significant others. Friendly Companions are adult and youth volunteers who make a commitment to visit residents on a regular basis. The resulting relationship appears to stimulate increased social interaction and maximize quality of life for nursing home residents. The program is considered part of the overall patient clinical care with multi-disciplinary involvement for volunteer training, patient referral, and evaluation by staff and patients. Social Work Performance Improvement measures and outcomes are discussed.