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.

Feeling in control: comparing older people's experiences in different care settings.

The promotion of choice and control for older people is a policy priority for social care services in the United Kingdom and is at the heart of recent drives to personalise services. Increasingly, we are seeing a move away from institutionalised care (e.g. in care homes) towards enablement, with more services being delivered in community-based settings. Extra care housing has been promoted as a purpose-built, community-based alternative to residential care for older people. However, whilst accounts of users' experiences in particular service types are plentiful, the use of different instrumentation and measures makes comparison between settings difficult. We combined data from four studies where participants were older people either living in care homes or extra care housing or receiving care at home. All of these studies asked participants to rate their control over daily life, using the Adult Social Care Outcomes Toolkit (ASCOT). This paper presents the results of an ordinal logistic regression analysis indicating that, after controlling for differences in age, ability to perform activities of daily living and self-rated health, setting had a significant effect on older people's sense of control. Residents in care homes and extra care housing report similar levels of control over daily life but consistently report feeling more in control than older people receiving care at home. Implications for policy and practice are discussed.

The characteristics of residents in extra care housing and care homes in England.

Extra care housing aims to meet the housing, care and support needs of older people, while helping them to maintain their independence in their own private accommodation. It has been viewed as a possible alternative, or even a replacement for residential care. In 2003, the Department of Health announced capital funding to support the development of extra care housing and made the receipt of funding conditional on participating in an evaluative study. This paper presents findings on the characteristics of the residents at the time of moving in, drawing on information collected from the 19 schemes in the evaluation, and a recent comparable study of residents who moved into care homes providing personal care. Overall, the people who moved into extra care were younger and much less physically and cognitively impaired than those who moved into care homes. However, the prevalence of the medical conditions examined was more similar for the two groups, and several of the schemes had a significant minority of residents with high levels of dependence on the Barthel Index of Activities of Daily Living. In contrast, levels of severe cognitive impairment were much lower in all schemes than the overall figure for residents of care homes, even among schemes designed specifically to provide for residents with dementia. The results suggest that, although extra care housing may be operating as an alternative to care homes for some individuals, it is providing for a wider population, who may be making a planned move rather than reacting to a crisis. While extra care supports residents with problems of cognitive functioning, most schemes appear to prefer residents to move in when they can become familiar with their new accommodation before the development of more severe cognitive impairment.

Aboriginal maternal and infant care workers: partners in caring for Aboriginal mothers and babies.

INTRODUCTION: Aboriginal Maternal and Infant Care (AMIC) workers and midwives work in intellectual and inter-cultural partnerships in a new perinatal care model the Anangu Bibi Family Birthing Program that aims to provide culturally focussed perinatal care for Aboriginal mothers and families at two sites in regional South Australia. This study investigated the views of the AMIC workers and midwives about their roles, their partnership and the program, following the first 45 births. METHODS: Semi-structured interviews with all five AMIC workers and four of the five midwives working in the program were conducted. Tapes were transcribed and main themes extracted. RESULTS: The AMIC workers' role included clinical, cultural, social and aspects from the confirmation of pregnancy through to 6-8 weeks after the birth. Themes relating to their work role included: clinical work; social and emotional support; language and advocacy for the partnership: mutually equivalent roles and for the program: clinical benefits and cultural safety. The midwives' role included clinical practice, skill-sharing and mentoring. Midwives were guided by AMIC workers' social, cultural and community knowledge. Themes that emerged for the midwives on the partnership were: time and commitment to working inter-culturally; issues with the new AMIC worker role; clinical skill sharing and mentoring; resistance of some hospital midwives; respect for AMIC workers' cultural knowledge and community links; and two-way learning. Themes of perceived benefit were: increased use of services and cultural benefits. CONCLUSIONS: The study provides a snapshot of a living, developing, inter-cultural partnership established to tackle the vitally important issue of Aboriginal mothers' and babies' health. Development of the partnership took commitment and time. There were issues initially with resistance from hospital staff. Skill sharing and two-way learning engendered mutual respect. Clear benefits of the care model were highlighted by both the AMIC workers and midwives while cultural safety was maintained for the Aboriginal mothers and families. The AMIC worker role will continue to require acknowledgement, support and development. This equivalent inter-cultural partnership model has the potential for much wider application and evaluation. Future programs should factor in the time required to build and sustain partnership relationships.