Rothera et al., (2008) |
N = 82|
• 27 service users (people aged 65 with diagnosis of dementia or known to the service as having cognitive impairment)
• 18 family carers
• 17 home care workers
• 20 health/social care professionals, across both services
• Specialist multi-agency home care service for older people with dementia introduced in two areas of Nottingham in 1999.|
• Aimed to reduce high levels of care home placement and respond to statutory inspection recommendations
• In-depth semi-structured interviews (older people with dementia, family carers, care workers, health professionals and social services managers)|
• Focus groups (with family carers and care workers) and
• Small group interviews (with older people with dementia)
• Five overall categories emerged which summarised the major differences between the services, encompassed the views of all groups and provided a rationale for why the specialist service was better than the standard service. These categories were structure and function; responsiveness; control and autonomy; building relationships; and reducing carer burden.|
• The specialist service demonstrated greater flexibility and responsiveness to the particular needs and circumstances of service users and family carers, who were encouraged to take part in routine decision making and activities.
• By sharing responsibilities, the specialist service helped reduce carer stress and prevent crises.
• These outcomes depended on the configuration of the service, including multidisciplinary health and social services input, care worker autonomy and independence, continuous reassessment of clients’ circumstances and preferences and the capacity to develop long term relationships, through care worker continuity. The standard service, which used a task oriented approach, lacked these characteristics.
|This qualitative study provides evidence of the benefits of a specialist multi-agency home support service over standard home care in the opinions of service users, carers and care workers.|