Abstract

Objective: The North-West Balance of Care Study focuses on older people with mental health problems (primarily dementia), many of whom can be cared for in alternative settings (e.g. at home, in extra care housing, or in care homes). Long-term policy guidance has emphasised the desire to prevent care home entry whenever possible and prioritise care home places for the most dependent individuals. However, the same policy guidance has not freed local service planners as well as health and social care professionals from the task of steering service users towards the ‘optimal’ care setting. As a balance of care approach is essentially about optimising provision of services for a population with particular needs, a crucial objective contained in it is to develop valid methods for identifying the ‘right’ service users for any particular setting. One part of the study was to evaluate recent admissions to care homes which had been approved by a local authority ‘resource allocation panel’, assess whether there could have been scope for substitution and identify those service users for whom care home entry was definitely appropriate. To this end, we involved distinct panels of frontline health and social care professionals, senior service managers, nationally recognised experts in social care practice and research, as well as service users, carers and members of the voluntary sector.

Data and methods: Keyworkers/care coordinators provided detailed service user data for 197 first time care home entrants (excluding respite stays) and 507 older people supported in the community. Service users in both samples were grouped into mutually exclusive case types based on physical dependency, cognition and challenging behaviours. From these empirically-based groupings we developed vignettes describing the ‘typical’ service users captured by this approach. Small groups of frontline health and social care professionals evaluated the vignettes with a view towards developing alternative community care packages where appropriate. Vignettes and alternative care packages were then further assessed by a simulated ‘resource allocation panel’ composed of senior managers (who act as gatekeepers to resources), and finally their recommendations were reviewed by panels of service users/carers, Age UK volunteers and national experts.

Results: The decision where and how an older person with care needs should be cared for is not a clear-cut one and views are shaped by professional and personal experience as much as by a decision maker’s position in their organisational structure. In particular, views of service users and their carers may differ markedly from those of professionals. Therefore, the presentation will focus on the observed variability in decisions both within and between groups.

Policy implications: A one-size-fits-all approach to important care decisions combined with a strong desire to minimise the total number of care home admissions may not do justice to the full complexity of personal living situations and care needs. The fact that many actual care home entrants were found to be ‘divertible’ in principle by the very decision makers who were involved in their care home placement raises questions about the appropriateness of available community care services.

Slides