Title: Models of Support for Moderate needs in Older People (MSMOP)
Funder: Department of Health and Social Care

Abstract: There has been a significant decline in the proportion of older people with moderate care needs receiving publicly-funded care in England and changes in the social care support provided to them. Yet we lack evidence to understand their consequences on care outcomes for this group of older people and their carers. The proposed study aims to provide critical new evidence about how best to support them. The study s objectives are to: Assess the need-related characteristics of older people with moderate care needs and their carers. Develop a typology of local patterns of support for this group. Describe and evaluate the care associated with different support types. Compare the impact of the different support types on outcomes, costs and cost-effectiveness. Identify best practice in provision of support for this group and key barriers and facilitators for its implementation. We propose a mixed-methods study in three phases. Phase I will comprise: development and testing of a typology which groups English LAs into support types; recruitment of 15 local authorities; characterising care models for older people with moderate needs; designing and piloting survey instruments and methodology; assessing in 6 pilot authorities key features of the care system to be explored in later phases. Phase II will comprise: the two-wave survey piloted in phase I; statistical and econometric analyses; exploration of how far implementation of the care model vision leads to change. The survey will involve face-to-face interviews with 1,500 people with moderate care needs and telephone interviews with 850 carers. The analyses will examine links between care needs and receipt of services and associated costs, impact of services on outcomes at 6 months, differences in outcomes and costs at 6 months between support types and relative cost-effectiveness of different support types. Phase III will involve: long-term follow-up of health and social care use by the study participants at 1.5 and 2.5 years following initial contact; and comparison of care use across care models focusing on time to care home admission and hospitalisation and total social care and health care costs. The study involves a collaboration between researchers from leading health and social care research organisations: CPEC at LSE and KCL, as well as Ipsos MORI as subcontractors. We will work closely with care professionals, older people and carers to test our approach and discuss early findings. Public and Patient Involvement and Engagement (PPIE) supporters will help us make our approach to older people and carers meaningful and accessible. A steering group will advise us on strategies for sharing our findings and will provide methodological and practical advice on the implementation of the research. It will help decide the continuation of the study post-piloting phase. We will seek ethics approval from the HRA National Research Ethics Committee and ADASS approval. We will produce easy-read summaries of all written outputs; short videos illustrating key findings; a policy-friendly leaflet outlining recommendations; papers for professional and academic journals. We will hold two workshops for local authorities and the voluntary sector and annual workshops with central government.

Lay abstract: Many councils are changing the way they support older people with moderate care needs, for example, people who face some difficulty getting around inside and outside the home. For example, rather than providing social care services such as home care or help with meals, they may ask voluntary groups to help them to be as independent as they can be. Different councils are developing different support arrangements. This provides an opportunity to learn about what works. This study will provide independent evidence for government and councils about (i) the circumstances of older people with moderate care needs and their carers, (ii) the support they receive (iii) the consequences for their wellbeing of different support and (iv) the implications of different care arrangements for costs and value for money of the care system. We will group English councils by their spending and services. We will identify a few local support types . We will choose 15 councils of different types to work with in greater depth. In each of the 15 councils, we will interview staff, care providers, older people and carers to understand the local system and support is being provided. We will also try to understand what councils are trying to develop and their progress. This information will show what support is available, why councils have arranged support in the way they have, the experiences of older people and their carers, and reasons why councils were able or not able to develop the support they had planned. This will be useful for planning developments for older people with moderate needs. We will also survey older people and their carers when they contact one of the 15 councils and again after six months. We will ask about their support needs, what support they get so that we can understand the short-term effects of support. With their permission, we will track their use of health and social care services for the next 2.5 years to understand the longer-term effects of support. The survey will provide details about older people with moderate needs and their carers. By comparing the costs and impacts of different support types we will assess which care models provide the best combination of benefits and costs. Our Public and Patient Involvement and Engagement (PPIE) supporters will help us with making our approaches to older people and carers meaningful and accessible. We will offer them payment, support and training. We will work closely with staff delivering support, older people and their carers to test out the approach and discuss early findings. An advisory group, including PPIE members and voluntary sector organisations, will help us chose the best approaches and ways to understand and share our findings throughout the study.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE