Developing a Scale of Care Work-Related Quality of Life (CWRQoL) for Long-Term Care Workers in England.

BACKGROUND: Long-term care (LTC) workers are subjected to structural and inherent difficult conditions that are likely to impact their quality of life at work; however, no agreed scale measures it. This study aims to develop a scale to measure the work-related quality of life among LTC workers in England (CWRQoL). The study establishes the domains/sub-domains of CWRQoL, investigates the tool's utility and collates information on existing supporting strategies for CWRQoL. METHODS: We adopt a mixed-methods approach employing inductive/deductive processes at three stages: (1) a scoping review of the literature; (2) interviews and focus groups with frontline LTC workers, managers and LTC stakeholders; and (3) a content validity consensus survey. RESULTS: CWRQoL is composed of seven domains (and 23 sub-domains). Additional domains to those in the literature include financial wellbeing, sufficient time for building relations, managing grief and emotions associated with client death and end of life care. Stakeholders identified several benefits and challenges related to the CWRQoL tool's utility. COVID-19 significantly impacted LTC workers' mental wellbeing and spillover between work and home. CONCLUSIONS: The study highlighted the complex nature of CWRQoL and provided a solid ground for developing and validating a CWRQoL scale.

Understanding and measuring the work-related quality of life among those working in adult social care: A scoping review.

The main aim of this scoping review was to understand how work-related quality of life (WRQoL) in adult social care has been defined and measured in the literature and to map key components of WRQoL among those working in adult social care and similar contexts. The scoping review included studies that: 1- focused on WRQoL/work-related wellbeing (and their synonyms); and 2- included adult social care or community health care. We searched existing evidence from November 2019 until July 2020 through an electronic literature search of eight major databases complemented by the grey literature, searching the reference lists and by contacting our existing network of experts in the field. In addition, we repeated the searches to identify any relevant literature published in 2021. Reporting followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist. In total, we included 68 publications. These publications indicate that there is an absence of agreement on a definition and measurement of WRQoL in adult social care. Based on a thematic analysis we identified six key components of WRQoL: organisational characteristics; job characteristics; mental wellbeing and health; physical wellbeing and health; spill-over from work to home; and professional identity. In summary, at the moment, there is no agreement on what WRQoL is and how to measure it in adult social care. As a result, there is very limited evidence on how to improve WRQoL among people working in adult social care. However, this scoping review suggests that there are six key components of WRQoL that researchers may consider to include in their future studies.

Complements or substitutes? Associations between volumes of care provided in the community and hospitals.

Policymakers often suggest that expansion of care in community settings may ease increasing pressures on hospital services. Substitution may lower overall health system costs, but complementarity due to previously unidentified needs might raise them. We used new national data on community and primary medical care services in England to undertake system-level analyses of whether activity in the community acts as a complement or a substitute for activity provided in hospitals. We used two-way fixed effects regression to relate monthly counts of community care and primary medical care contacts to emergency department attendances, outpatient visits and admissions for 242 hospitals between November 2017 and September 2019. We then used national unit costs to estimate the effects of increasing community activity on overall system expenditure. The findings show community care contacts to be weak substitutes with all types of hospital activity and primary care contacts are weak substitutes for emergency hospital attendances and admissions. Our estimates ranged from 28 [95% CI 21, 45] to 517 [95% CI 291, 7265] community care contacts and from 34 [95% CI 17, 1283] to 1655 [95% CI - 1995, 70,145] GP appointments to reduce one hospital service visit. Primary care and planned hospital services are complements. Increases in community services and primary care activity are both associated with increased overall system expenditure of £34 [95% CI £156, £54] per visit for community care and £41 [95% CI £78, £74] per appointment in general practice. Expansion of community-based services may not generate reductions in hospital activity and expenditure.

Older people receiving family-based support in the community: a survey of quality of life among users of 'Shared Lives' in England.

Shared Lives (adult placement) is a model of community-based support where an adult who needs support and/or accommodation moves into or regularly visits the home of an approved Shared Lives carer, after they have been matched for compatibility. It is an established but small service which has been used mainly by people with learning disabilities but which has the potential to offer an alternative to traditional services for some older people. However, there is little research on the outcomes for older users of Shared Lives. This paper presents findings from a survey of 150 older people using Shared Lives support across 10 Shared Lives schemes in England, which took place between June 2013 and January 2014. The aim was to identify outcomes for older users of Shared Lives and compare these to outcomes for older users of other social care services. In the absence of an ideal study design involving randomised allocation, statistical matching was used to generate a comparison group from the Adult Social Care Survey from 2011/12, with 121 cases matched to 121 Shared Lives cases. The main outcome measures were Social Care-Related Quality of Life (measured by the ASCOT) and overall quality of life. Findings indicated that Shared Lives can deliver good outcomes for older people, particularly for overall quality of life. In comparison to the matched group of older people using other forms of support, there was some evidence that Shared Lives may deliver better outcomes in some aspects of quality of life. Limitations to the research mean, however, that more work is needed to fully understand the role Shared Lives could play in supporting older people.