The relationship between independence, inclusion and wellbeing: the perspective of older citizens living in Coventry, UK

Independence inclusion and wellbeing are commonly seen in a complementary relationship in policy and research literature. This paper examines the meaning of these terms for older citizens living in Coventry and the implications for policy implementation. The data presented, obtained from a large community survey of citizens of 55 years and over living in Coventry, found that although most survey participants were able to function independently, participate in ordinary community life and enjoyed reasonable physical and mental health, many others experienced a series of significant barriers to inclusion and well-being. The paper concludes that there is there is no automatic convergence between independence, inclusion and well-being at the level of the individual citizen and that to address this issue, more socially inclusive rather than individualistic forms of independence may be more appropriate goals for local public agencies

Knowledge and Skills Sets for Telecare Service Staff in the Context of Digital Health

Telecare services have an established place within the United Kingdom. Through using online technologies to help mostly older people to remain at home, they are recognised as having a support role for health as well as social care. This positions telecare services within the broader realm of ‘digital health’. As that position becomes more embedded, it poses questions about the nature of tasks that are (or should be) undertaken by telecare staff, and regarding the knowledge and skills that are required. A convergence of telecare and telehealth services is indicated together with a need for some kind of accord or accommodation. This paper summarises the United Kingdom policy context; references the technologies that are provided by telecare services or can be linked to them; notes briefly the impact of the COVID-19 pandemic; and proposes six knowledge and skills sets. Outcomes of the UTOPIA study undertaken in England from 2016 to 2017 are drawn upon: this study provided important information from over 100 local authority telecare managers.   &nbsp

The case for investment in technology to manage the global costs of dementia

Worldwide growth in the number of people living with dementia will continue over the coming decades and is already putting pressure on health and care systems, both formal and informal, and on costs, both public and private. One response could be to make greater use of digital and other technologies to try to improve outcomes and contain costs. We were commissioned to examine the economic case for accelerated investment in technology that could, over time, deliver savings on the overall cost of care for people with dementia. Our short study included a rapid review of international evidence on effectiveness and cost-effectiveness of technology, consideration of the conditions for its successful adoption, and liaison with people from industry, government, academic, third sector and other sectors, and people with dementia and carers. We used modelling analyses to examine the economic case, using the UK as context. We then discussed the roles that state investment or action could play, perhaps to accelerate use of technology so as to deliver both wellbeing and economic benefits

The impact of personal budgets on unpaid carers of older people

This paper focuses on the impact of a personal budget (PB) – either in the form of a direct payment (DP) or managed personal budget (MPB) – on the role of unpaid carers of older budget holders. Data were collected via postal survey of 1500 unpaid carers and semi-structured interviews with 31 carers. Findings: Unpaid carers played a central role in supporting older budget holders irrespective of the type of budget received. The allocation of a PB may have decreased the amount of ‘hands-on’ care they provided, enabling them to do different things for and with the person cared for, but most did not relinquish direct involvement in care provision. Both kinds of PB provided greater flexibility to juggle caring tasks with other roles, such as childcare or paid employment. However, carers supporting DP users did experience higher levels of stress. This seemed linked to the additional responsibilities involved in administering the DP. Carers seemed relatively unsupported by their local Adult Social Care Department: the survey found that only 1 in 5 said they had ever received a carer assessment. Application: The findings offer a detailed exploration of the impact of PBs on carers, suggesting that even in countries with relatively well-developed systems of support for carers such as England their impact remains overlooked. The paper may be of interest to social work practitioners, managers, academics and social work policy specialists working in countries that have, or are about to introduce, personal budgets or other forms of cash-for-care scheme. <br/

Using GPS Safer walking technology to promote identity and well-being through engagement in meaningful outdoor occupations

More now, than ever before, we are aware that spending time in outdoor natural environments and maintaining connections to nature are important to our health and well-being. Yet, access to the outdoors is sometimes limited for people living with dementia because of concerns about the risks of them becoming lost, particularly in natural outdoor environments such as woodland and green open spaces. This can prevent people with dementia engaging in meaningful activities outdoors and lead to a reduced quality of life. In the UK, safer walking technology is increasingly being used by people with dementia to access the outdoor environment, (Wood, Woolham and Ward 2015). This new research from Coventry University explores the use of this technology, through the lived experience of both people living with dementia and family carers

Placing assistive technology and telecare in everyday practices of people with dementia and their caregivers: findings from an embedded ethnography of a national dementia trial

Background: Policy makers and care providers see assistive technology and telecare as potential products to support people with dementia to live independently in their homes and communities. Previous research rarely examined how people with dementia and their caregivers actually use such technology. The study examined how and why people living with dementia and their caregivers used assistive technology and telecare in their own homes. Methods: This study used an ethnographic design embedded within the NIHR-funded Assistive Technology and Telecare to maintain Independent Living At home for people with dementia (ATTILA) randomised controlled trial. We collected 208 h of observational data on situated practices of ten people with dementia and their ten caregivers. We used this data to construct extended cases to explain how technologies supported people with dementia in home and community settings. Results: We identified three themes: placing technology in care, which illustrates how people with dementia and caregivers ‘fit’ technology into their homes and routines; replacing care with technology, which shows how caregivers replaced normal care practices with ones mediated through technologies; and technology displacing care and everyday life, which highlights how technologies disrupted the everyday lives of people with dementia. Discussion: This study exemplifies unintended and unanticipated consequences for assistive technology and telecare uptake in ‘real world’ community-based dementia care. It underlines the need to identify and map the context of technological provision over time within the changing lives of people with dementia and their caregivers

Adult safeguarding managers' understandings of self-neglect and hoarding

Self-neglect and hoarding are behaviours that are hard to define, measure and address. They are more prevalent among older people because of bio-psycho-social factors, which may be exacerbated by advancing age. This paper aims to further understandings of self-neglect and hoarding in England's Care Act 2014 context, drawing on a study involving qualitative interviews with local authority adult safeguarding managers who play an important role in determining interventions with individuals who self-neglect and/or hoard. Online interviews were conducted with adult safeguarding leads and managers from 31 English local authorities in 2021. Interview data were subject to thematic analysis. This paper explores the commonalities and differences in adult safeguarding managers' understandings of the causes and consequences of self-neglect and/or hoarding among older people, which are likely to have tangible impacts on service provision in their local authority, and influencing of wider changes to policies and procedures. Most participants understood these phenomena as caused by a range of bio-psycho-social factors, including chronic physical conditions, bereavement, isolation. A minority took a more clinical or psycho-medical perspective, focusing on mental ill-health, or referred to the social construction of norms of cleanliness and tidiness. Whatever their understanding, by the time such behaviours are brought to the attention of safeguarding professionals a crisis response may be all that is offered. The implications of the findings are that other agencies should be encouraged to provide more early help to older people at risk of self-neglect and/or of developing harmful hoarding behaviours, and that sustained engagement with those affected may help to understand some of the causes of these behaviours to enable effective support or practice interventions