bluuebunny/crossref_metadata_2025 huggingface dataset:
The Legal Authority to ‘More Than Merely Restrain’ Incapacitated Patients: The Interface Between the Mental Capacity Act and the Revised Mental Health Act in England And Wales
Authors: Shah Ajit , Heginbotham Chris , Kinton Mat
Published: September 2011

The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 within England and Wales as a framework for making decisions about incapacitated persons' care and treatment generally not amounting to a deprivation of their liberty (although such could be authorised under its powers by the new Court of Protection). From a planned date of April 2009, the MCA is to be enlarged by the provisions of the Mental Health Act 2007 (MHA 2007) to encompass deprivation of liberty, with the addition of a new framework of Deprivation of Liberty Safeguards (DOLS). The MHA 2007 also revised significant aspects of the Mental Health Act 1983 (MHA), which were implemented in November 2008. The interface between the MCA, as amended to include DOLS, and the revised MHA is complex and potentially ambiguous. This paper describes in detail some issues that may arise at the interface of the two acts, and seeks to inform professionals involved in the use of these legal frameworks of the resulting complexity.
The Agony and the Inspiration: Professionals' Accounts of Working with People with Learning Disabilities
Authors: Wilson Naomi , Meininger Herman , Charnock David
Published: September 2011

Professionals' accounts of working in challenging service environments bring into relief the tensions they experience in their work. An ethical dilemma where the wellbeing of a severely or profoundly learning disabled (LD) and highly dependent person is at stake is conceptually and emotionally challenging to those responsible for finding some resolution. This report develops the findings of empirical research described in an earlier paper on professionals' experiences of addressing serious ethical issues within their work with people with LD. We attempt to make clear how the ethical and policy frameworks to which they are accountable, their personal desire to improve the lives of people with LD and the relational aspects of their work raises strong feelings that make the work, at times, intolerable and at other times richly rewarding. Regardless, being in relation to the person with LD is prerequisite to making changes in their lives; therefore, the relational as well as procedural aspects of services provided by professionals need to be theorised. We offer a critique of these professionals' perspectives based on a distinction between instrumental and substantial rationalities, the latter being relatively absent in the managerial and scientific discourses within the NHS. This absence risks dehumanising clients and professionals and neglecting what is core to their work: the privilege of being with unique others, bearing witness to their histories and supporting them to live their lives.
Health and Social Needs of People with Low Intelligence
Authors: Schneider Justine , Clegg Jennifer
Published: September 2011

This paper explores the experiences of people with borderline and low intelligence when compared to the general population. The aim was to explore whether people with low intelligence, who are rarely considered apart from the general population, might have particular needs in relation to health or social care. The method was secondary analysis of the ONS survey of psychiatric morbidity, 2000. Variables associated with low intelligence were identified and entered into a logistic regression. We found that a person with low intelligence was significantly more likely to be a smoker, have problems with paperwork and be renting their home, and a significant subgroup was more likely to be friendless. The pursuit of social justice and social inclusion may require greater attention to be paid to the health and well‐being of people with below‐average intelligence.
Aggression in Intellectual Disability — A New Approach
Authors: Turner Katie , Clarke David
Published: September 2011

Aggressive behaviour is a problem for services providing care for people with intellectual disabilities, affecting the quality of life of the individual and the quality of care provided. Current research trends, which focus on risk factors and mental health problems, are discussed. Other factors that could contribute to aggression in people with intellectual disability (PWID), such as lifestyle and environmental issues are examined. A methodology that would allow for the integration of all these factors, Behavioural Sequence Analysis, is a suitable investigative approach to this problem.
Being in Control: Personal Budgets and the New Landscape of Care for People with Learning Disabilities
Authors: Hall Edward
Published: September 2011

A central element in the shift to a ‘personalised’ care system in the UK is the opportunity for disabled people to hold and manage budgets for the purchase of care and support, to replace local authority services. The delivery mechanisms of ‘Direct Payments’ and ‘Individual Budgets’ have allowed many disabled people to control their care and support better, and have promoted their social inclusion. However, the particular contexts and issues for people with learning disabilities in holding personal funding have been little considered. The paper sets out the broad themes of the introduction of personalised care, and examines the limited use by people with learning disabilities of Direct Payments and the subsequent development of Individual Budgets. The paper considers the challenges to the nature, spaces and relations of care commonly used by people with learning disabilities that personal budgets present, in particular for those with more severe disabilities. The paper concludes by suggesting ways in which people with learning disabilities can use personal budgets, whilst maintaining the collective relations and spaces of caring desired by many.
Mental health communication between service users and professionals: disseminating practice‐congruent research
Authors: Crawford Paul , Brown Brian
Published: September 2011

This paper considers the demand for evidence‐based practice in mental health communication and describes how evidence from studies of health communication, as well as recommendations from educational models, professional bodies and policy directives have been incorporated into our ‘Brief, Ordinary and Effective’ model for communication in nursing. A key challenge in putting evidence to work in health care and bridging the theory‐practice gap concerns the social and organisational context that may not always work to sustain new initiatives. Accordingly, we will describe an attempt to support and consolidate awareness of the role of evidence in health care communication via a Managed Innovation Network and the development of the Brief, Ordinary and Effective model of health care communication. This enables us to align the quest for new knowledge and insights that are practice‐congruent with the kinds of applicability criteria that modern health care providers set out. This has yielded important insights about how research can be embedded in informed practice and how evidence‐based communicative practice can be nurtured and made viable in communication in mental health care.
Attachment and psychopathy in forensic patients
Authors: Van den Berg Anne , Oei Karel
Published: September 2011

Effective treatment of patients with severe psychopathy is very difficult to achieve. This conclusion may be drawn from an extensive examination into the usage of the term ‘psychopathy’ in scientific research literature, in theoretical development from various psychological schools of thought, in the practice of therapy and in assessment. The central issue for the authors of this article is the inability of severely psychopathic patients to commit to the patient‐therapist relationship. Attachment theory and mentalisation‐based treatment are used here to define the cause and nature of this inability, which is incurred in very early childhood. These two models can aid in the development of more dynamic definitions of psychopathy, better suited to dynamic therapy formats.The ways in which psychopathy is defined partly account for a number of problems encountered in the practice of therapy. The authors assume that the treatment of psychopathy should be interactional and should match patients' individual levels of psychological development and mentalisation; highly psychopathic patients often perceive others as objects, ie. as part of the context, not as subjects, ie. autonomous personalities.The authors propose to conduct further research in order to verify the validity of their hypothesis. They also put forward a number of suggestions for therapy formats with a view to establishing effective working relationships with psychopathic patients.
New public management
Authors: den Heyer Garth
Published: September 2011

Purpose

The purpose of this paper is to examine the use of new public management (NPM) as a major strategy for democratic police reform in transitioning, developing and post‐conflict nations.

Design/methodology/approach

The paper reviews the literature and history of the use of NPM in the public sector and policing in Western nations and considers its use in programs of police reform.

Findings

The review identifies that NPM can be used as a strategy in police reform and is able to be used in conjunction with policing approaches such as community‐oriented policing. However, the adoption of NPM must be culturally specific and implemented within local capability constraints.

Practical implications

Police reform, transparency and accountability are an important concern for all post‐conflict and transitioning police agencies; therefore, the findings of this research are useful for implementation or planning of police reform and restructuring programs.

Originality/value

With its focus on police management accountability in post‐conflict or transitioning nations, this article expands research on strategies of democratic police reform and capacity development.
Police deviance and community relations in Trinidad and Tobago
Authors: Pino Nathan W. , Johnson Lee Michael
Published: September 2011

Purpose

Corruption and poor relations with citizens are known to be pervasive in the Trinidad and Tobago Police Service (TTPS). Police deviance permeates all levels of the TTPS and threatens the sustainability of reforms. The purpose of this study is to explore the nature and consequences of police deviance in Trinidad and Tobago through the perspectives of community leaders.

Design/methodology/approach

Data were obtained through individual and focus group interviews with members of local community‐based and non‐governmental organizations and the Trinidad and Tobago Police Service in 2009. The data were examined to reveal respondents' perceptions concerning the nature and consequences of police deviance as well as its solutions.

Findings

The types of police deviance that emerged as major themes were inadequate crime control and protection of citizens, maltreatment of citizens, capricious response to criminals and bias toward less serious crimes, and police corruption and collusion with criminals. However, respondents also offered solutions and expressed optimism about police‐community cooperation.

Social implications

Results suggest both the need and potential to improve police‐citizen relations and reduce police deviance. The paper discusses possible solutions, giving special attention to sustainability and democratic policing reform.

Originality/value

Very little research has been conducted on police deviance in the Caribbean. The few studies that can be found focus on brutality and rely more on police survey and official data. Using in‐depth interview data, the current study adds to this small body of research by describing the impact of police deviance on community relations in Trinidad and Tobago.
Police‐based victim services: Australian and international models
Authors: Wilson Dean , Segrave Marie
Published: September 2011

Purpose

The purpose of this paper is to provide an outline of the strengths and weaknesses of selected models of police‐based victim services. It aims to provide an overview of the current predominant models of police‐based victim support in the USA, Canada, UK and Australia. It also aims to advance a typology of police‐based victim services as a useful analytic tool for understanding the varying models.

Design/methodology/approach

The research was based on extensive documentary analysis supplemented by semi‐structured interviews with 17 practitioners in the USA, Canada and Australia. Sites were selected for interview based on documentary research which indicated that they had developed police‐based victim services in their organization that were either particularly representative or innovative.

Findings

Police‐based victim services can be categorized into three broad models: unit services, dedicated liaison officer services, and referral services. Each model has strengths and weaknesses in terms of service delivery and police organization. Unit services may be optimum in delivering services but are also resource‐intensive and may be beyond the financial scope of some police organizations. They also potentially risk sequestering victim services within police organizations and reinforcing a view that dealing with victims of crime is not “real policing”. Dedicated officer services require significant institutional input to achieve their goals, while referral models necessitate workable mechanisms for inter‐agency cooperation. Thus police organizations need a clear perception of their victim services delivery role and how this might best be achieved.

Originality/value

The academic literature on police‐based victim services remains scant. This paper makes a valuable contribution to the literature by providing a useful typology for the analysis of police‐based victim services and the assessment of their strengths and weaknesses. The typology will prove useful for future empirical case‐studies of individual police‐based victim services.
Examining the relationship between police experiences and perceptions of police bias
Authors: Renauer Brian C. , Covelli Emma
Published: September 2011

Purpose

This paper aims to use three theoretical perspectives to understand variation in public opinion regarding the frequency with which police use race/ethnicity unfairly in making stops: procedural and instrumental justice, local government responsiveness, and intra‐racial differences.

Design/methodology/approach

The paper looks at data from a telephone survey of 1,431 Oregon residents: 741 from a stratified state‐wide random sample by county; 164 African‐Americans and 161 Hispanics over samples.

Findings

Perceived negative treatment during recent involuntary police contacts is related to a perception that police are more biased. Instrumental judgments regarding local government responsiveness to constituent needs and personal safety showed a negative relationship to perceptions of police bias. African‐American respondents exhibited the strongest police bias opinions; however, intra‐racial analyses showed that perceptions of government responsiveness weaken bias perceptions across race/ethnicity.

Research limitations/implications

Research needs to explore how the public's relationship to their local government influences perceptions of police. The conclusions of the study are limited by the cross‐sectional design.

Practical implications

The study illustrates that proper police‐citizen communication tactics, stop and investigatory procedures, and ethical decision making should continue to be reinforced along with better promotion of local government and police success in meeting constituent needs through the media.

Originality/value

The paper examines the influence of both procedural and instrumental justice perceptions, and voluntary and involuntary police contacts. The sample contains sufficient numbers of African‐Americans and Hispanics and diverse communities (urban, suburban, and rural) to gain a representative view.
The relationship between stress, strain and social capital
Authors: Gächter Martin , Savage Davd A. , Torgler Benno
Published: September 2011

Purpose

The purpose of this study is to examine the relationship of social capital with the negative externalities associated with stress, or the psychological and physiological strains experienced by police officers.

Design/methodology/approach

Using data collected in 1999 from a survey of Baltimore Police officers designed to examine questions about the relationship between police stress and domestic violence in police families and using multivariate regression analysis, the paper focuses on five different proxies for stress and strain, and two proxies for social capital and conducting several robustness checks.

Findings

Results show that an increase in social capital is significantly correlated to a decrease in the level of strain, in the psychological, physical, burnout and health areas.

Research limitations/implications

While this study examines the social capital/strain relationship with US officers, more research is needed, as these findings may not extrapolate well into other national settings. It may also be interesting to further explore sub‐cultures within departments. Additionally, the data may be dated and, as major changes and events have occurred since the survey, a newer study of officers would be needed to observe whether these changes have had significant impact.

Practical implications

From a policy perspective, the findings suggest that stress reduction programs should actively engage employees to build stronger social networks.

Originality/value

This study comprehensively examines the ability of social capital at negating the impacts of strains, and significantly reduces the impact of major trauma events. This paper adds to the literature as there are few multivariate analyses of the social capital/strain relationship.
Problem behaviors of students pursuing policing careers
Authors: Kevin Gray M.
Published: September 2011

Purpose

The current study aims to examine problematic behaviors of college students who identified policing as their career of choice.

Design/methodology/approach

A self‐report survey was administered and behaviors such as alcohol and drug use, arrest histories, and self‐reported criminality were identified in a sample of 874 undergraduate students, 171 of whom identified policing as their career goal.

Findings

Findings indicate that over 60 percent of students (including those interested in becoming police officers) engage in some level of problematic behavior. While policing students engaged in more excessive recent binge drinking, they had a lower rate of arrests and less other‐than‐marijuana drug use than other students.

Research limitations/implications

This research relies on self‐reported data and therefore under‐ or over‐reporting may occur. While the sample of policing students has similar characteristics to those of current police officers in terms of sex and race, generalizability issues from the entire sample may be present.

Practical implications

Findings suggest the importance of identifying and conveying information to students about problematic behaviors that may prohibit gainful employment. Recruitment implications are discussed for police departments as well as implications for areas of inquiry important for background hiring investigations.

Originality/value

The current research explores problematic behaviors of college students in the context of vocational restrictions that students may face from law enforcement agencies. Findings can better prepare students for such vocations and inform hiring agencies of the range of issues from this population of applicants.
Delivering dignity in care
Authors: Cass Elaine
Published: September 2011

CSCI's market research revealed that people want their ‘dignity, individuality and privacy’ preserved when using public services. WwOP has previously explored the issue of ‘dignity’ (11.3, June 2007) and, given its emergence as a basic human right within the health and social care agenda, we return to the subject as Elaine Cass discusses the progress being made among social care and health workers to instil ‘dignity’ at the heart of services' cultures.
Delayed discharge from hospital: supporting older people to exercise choice
Authors: Cornes Michelle , Manthorpe Jill , Donaghy Eddie , Godfrey Mary , Hubbard Gill , Townsend Jean
Published: September 2011

The government's reimbursement policy, whereby local councils face fines if a patient cannot be discharged from hospital because they are waiting for an assessment etc, introduced new pressures into a system that was already fraught. One of the policy's aims is to allow people to exercise ‘genuine choice’ as regards their ongoing and longer‐term care. Based on their research into the policy however, Michelle Cornes et al investigate whether choice really can be exercised when lying in a hospital bed.
Public attitudes to euthanasia
Authors: McCreadie Claudine
Published: September 2011

Death, as we know, can happen at any age and ordinarily, is not necessarily something that we would choose, if we did indeed have a choice. Or is it? In this article, we move to an unexplored issue for WwOP and possibly an uncomfortable one for some, namely euthanasia. Here, Claudine McCreadie speaks quite frankly about the issue and compares her conclusions with those of the rest of society.
Floating support for older people
Authors: Cousins Tony , Saunders Phil
Published: September 2011

The introduction of ‘floating support’ ‐ a tenure neutral service ‐ in many local authorities is causing much consternation among tenants because the scheme manager they thought would always be there is leaving. Yet, with an ageing population combined with increasingly finite resources, how can services provide support to those who need it most and to what degree should sheltered housing remain untouched? Arguing the case in favour of floating support, Tony Cousins and Phil Saunders outline the reasons why the new service model, while it may not be popular, is necessary.
Explaining about … building to last
Authors: Cann Paul
Published: September 2011

Help the Aged Director of Policy and External Communications Paul Cann discusses how policy‐makers and local government need to listen to the voice of older people when designing the communities we live in. He highlights how simple, joined‐up thinking can make a big difference to older people's lives.
Dignity through change: how continence matters
Authors: Holmes Pamela
Published: September 2011

Many of the great cities of the ancient world had public toilets. It was not until Victorian times that they appeared in any large numbers in this country: the 1848 Public Health Act called for ‘Public Necessaries’ to be provided to improve sanitation. In recent years, public toilet closures have attracted much attention. Here, Pamela Holmes discusses the effects of incontinence on older people and argues that changes in approach can make a real difference to the quality of life for many older people.
Demographics of the ageing rural population
Authors: Atterton Jane
Published: September 2011

There are perhaps a considerable few among us who dream of retiring to the countryside, to spend our autumn years in a rural idyll. According to Dr Jane Atterton et al, more and more people are doing just that. Based on their research and with international comparisons, this article examines the realities of England's ageing rural population and explodes a few myths about this demographic group's contribution to rural life.
The care conundrum
Authors: Redmond Imelda
Published: September 2011

Awareness about the role of carers in society and their contribution to the UK economy has been catapulted to the top of the political agenda in recent months following the launch of the first ever Carers' Strategy. Writing at the time of the document's publication, Imelda Redmond looks in more detail at the make up of this six‐millionstrong group and explains what her organisation is doing to further promote its rights.
Old and inside: older people in prison
Authors: Atkinson Lorraine
Published: September 2011

The number of older people in prison is growing. As more and more people over the age of 60 struggle to cope behind prison walls, the prison service and the wider community are failing to meet their complex needs, according to Lorraine Atkinson of the Howard League for Penal Reform.
My Work
Authors: Emery Wayne
Published: September 2011

In a career that spans four decades, Wayne Emery describes his life spent to date within the housing sector and the changes that he has witnessed to how services are delivered. In a refreshing way, he describes relatively recent policy moves and how the sector ‐ in Wales and elsewhere ‐ must continue to change to meet older people's wishes and needs.
Explaining about … health and social care commissioning
Authors: Klée Deborah
Published: September 2011

While the NHS and local government are developing their understanding of commissioning and are busy with plans for the personalisation of services and ‘world class commissioning’, other partner organisations are left wondering what this all means. In this first article, Deborah Klée explains how national policy is changing the way services are planned and commissioned and what this means for older people and provider services.
Running a care home
Authors: Mackay Ann
Published: September 2011

Services that are commissioned need to balance demands for higher standards, the needs of local communities and person‐centred delivery with ever‐tightening budgets. But, says Ann Mackay, this has yet to be achieved for the care home sector where the cheapest services are chosen at the cost of quality. Recognition of care homes as an investment and the setting of rates based on what it takes to actually run a care home are needed.
Care contradictions: putting people first
Authors: Bernard Caroline , Passingham Anna
Published: September 2011

There is growing evidence that local authorities are providing care only to those people who are deemed to be the most critically in need, while many people are being forced to rely on informal care at home because they cannot afford their local authority charges. Caroline Bernard and Anna Passingham examine the background to the challenges around care charging, but say that the gap between those who need care services but are unable to access them, must be bridged.
Self‐assessment and self‐managed care
Authors: Mills Oliver
Published: September 2011

Since the government published Putting People First, there has been a raft of circulars, pilots, policies, reports and strategies bringing the personalisation agenda ever closer. In this article, Oliver Mills puts a finger on the pulse of local authorities and describes the complex challenges and barriers they face as they piece the jigsaw together that will transform the adult social care system for good.
Dementia ‐ putting people at the centre
Authors: Williamson Toby
Published: September 2011

In the last couple of years, the government has made dementia a policy priority and 2008 has seen the publication of the first ever national dementia strategy for England. Here, Toby Williamson describes the challenge posed by dementia in that context, but also reports on some initiatives that give a voice to people with dementia, partly to challenge some of the ways that dementia is referred to, and to improve their lives in quite practical ways.
The Ransackers project: educational adventures for older learners
Authors: Kathchild June
Published: September 2011

Low self‐esteem and confidence can make someone feel cut off from society and, as Toby Williamson explained, social exclusion can lead to depression and other mental illnesses. Here, June Kathchild explains about the Ransackers project, which has created a growing range of opportunities for older people to study (for the first time), giving the students a renewed zest for life.
My Work
Authors: Morrison Janet
Published: September 2011

Hired to modernise a traditional charity, Janet Morrison has made an impact at Independent Age, introducing changes to its services that aim to reflect what older people want today. Janet admits it has been challenging: communicating what needs to be done to staff and, lately, facing up to the impact of the economic downturn. When times get tough, however, Janet's motivation comes from talking and listening to the very people she wants to help.
Explaining about … individual budgets and self‐directed support
Authors: Close Louise
Published: September 2011

As life expectancy continues to rise and people's expectations of the services they receive also increases, it has become apparent that the current social care system needs a dramatic overhaul. In 2003, In Control recognised this need for fundamental changes to the system and launched its first pilot of individual budgets and the concept of self‐directed support. In our first article, Louise Close explains how these early ideas have developed into a clear and common purpose for the future of social care in this country.
Personalisation within a housing context
Authors: Head Jon
Published: September 2011

And what of social housing's role in the personalisation agenda? Here, Jon Head explains Hanover's approach to personalisation and presents the challenges that the organisation faces in its implementation; and describes its involvement in a pilot project with Housing Associations' Charitable Trust (hact) that offers an exciting and innovative approach to this important agenda for housing providers and residents.
Independent advocacy with older people: what will be the impact of personalisation?
Authors: Miles John
Published: September 2011

Advocacy, while a known phrase, is not fully understood, writes John Miles, a trustee and founder member of the Older People's Advocacy Alliance (OPAAL) UK. In this article, John reviews the position of advocacy with older people as the government pursues its transformation of social care.
Tackling social exclusion through neighbourhood networks
Authors: Klée Deborah
Published: September 2011

It is three years since the publication of A Sure Start to Later Life (Department of Health et al, 2006). In this article, Deborah Klée looks at how this has inspired the development of some innovative projects across the country to improve the health and well‐being of older people and reduce social isolation.
Explaining about…making progress on dementia
Authors: Williamson Toby
Published: September 2011

2009 should be seen as the year for making real progress in the development of services for older people with dementia, as well as services for older people with other mental health problems. It is also likely to herald the beginning of major challenges to ensure that resources are available to support that development. In our first article, Toby Williamson reports on the publication of the national dementia strategy for England, together with other important developments and the challenges. He also describes some initiatives that have important links to dementia care and the future of mental health services for older people.
Understanding the experiences and needs of people with dementia and sight loss
Authors: Lawrence Vanessa , Murray Joanna
Published: September 2011

It would surprise many people to know that sight loss may be more common in people with dementia; the effect of these two conditions on people's lives had never previously been investigated until recently. Here, Vanessa Lawrence and Joanna Murray present the findings of their ground‐breaking research carried out with Professor Sube Banerjee and Dr Dominic Ffytche of King's College, London into how sight loss and dementia affects the lives of older people and their carers.
Rhetoric into reality: the journey towards becoming person‐centred
Authors: Wyllie Sheena , Gains Val
Published: September 2011

Barchester Healthcare's Memory Lane Communities programme is gaining recognition for its standards in specialist care for people with dementia. In this article, Sheena Wyllie and Val Gains explain the company's philosophy, which recognises that every person is an individual. It is practised by staff who undergo training in Barchester's bespoke dementia care programme, which places the family at the heart of the process of understanding the person with dementia.
My work
Authors: Bell Sally
Published: September 2011

Within 10 years, Sally Bell has progressed from being a resident warden to head of a sheltered housing service. She says that her dedication comes from ‘a deep respect’ for older people and, as Sally describes her journey from one role to the other, she reveals a deep appreciation for the places where she has worked and for the many residents whom she has supported along the way.
Care assistants overlooked?: A cross‐national study of care home staff in England and Germany
Authors: Eyers Ingrid
Published: September 2011

Within the context of residential care settings in England and Germany little consideration is given to the role of care assistants. Policies that determine the staffing levels in both countries have resulted in care assistants making a considerable contribution towards the ‘hands‐on’ care of dependent, older people. However, the policies overlook the need to encourage and support care assistants in developing the skills required to provide effective, efficient care to dependent, older people. This paper presents the findings of a small‐scale qualitative study conducted in residential care settings situated in the south east of England and north Germany. The study establishes the connection between the nature of ‘emotional labour’ and the need to provide suitable training to care assistants, thus influencing the quality of care provided to dependent, older people. At present training in both countries is focused on qualified staff. Overlooking care assistants and their contribution towards care could be detrimental to the quality of care provided to older people in both England and Germany.
Modernising attitudes to age?: Using action research to explore the role of the Government in tackling ageism
Authors: Boaz Annette , Hayden Carol
Published: September 2011

Older people feel that ageism underlies many of their more specific concerns. A number of pieces of research carried out on behalf of the Inter‐Ministerial Group on Older People also reveal the importance of the Government addressing the ageist attitudes to older people that affect their ability to participate in society.
Could Better Government for Older People deliver quality in ageing?
Authors: Shreeve Martin
Published: September 2011

This paper examines the experience of the two year action research programme Better Government for Older People within the wider context of an ambition to create ‘quality in ageing’. It argues that within the limits of the originating aims and values of the Better Government for Older People a great deal has been achieved to improve services for older people, and to encourage and recognise the direct contributions of senior citizens within 28 pilot areas and wider Networks of local authorities across the UK. However, the author suggests that such service improvements and experiments in engagement are unlikely to be sustained and developed without a wider commitment by central and local Government to the development of strategies for an ageing population.The paper describes the antecedents of the Better Government for Older People programme, its structure and operational practices. It goes on to examine the programme's achievements against its stated aims and values, seeking to identify what still needs to be achieved. In the final section it seeks to explore the barriers to realising the ambitions of quality in ageing, arguing that ageism coupled with political and professional inertia are major constraints. In conclusion it argues that legislation is likely to be a pre‐requisite for the cultural and organisational shift required in order to move to a system based on older people as citizens rather than service recipients.
Bangladeshi immigration to the United Kingdom: Older people's support networks in the sending and receiving countries
Authors: Burholt Vanessa , Wenger Clare , Scott Anne , Yahya Bashar , Roy Sibani
Published: September 2011

The Bangladeshi Migrants Pilot Study establishes the feasibility of applying the methods used in studying the informal support networks of older people in the majority population of Britain, specifically the Wenger support networks typology, to the elders of an immigrant group, and to elders who have remained in the region of origin. The sample consists of Bangladeshis aged 55+ in Tower Hamlets, London, United Kingdom (N=98), and Sylhet in Bangladesh (N=51) (see Table 1). The paper provides an ethnohistory of Bangladeshi immigration to the United Kingdom, a comparison of the support networks of Bangladeshis living in Sylhet and Tower Hamlets, and a comparison of support networks of Bangladeshis with rural and urban dwellers in the United Kingdom. The Practitioners Assessment of Network Typology (PANT) algorithm produces support network types in 99% of cases and demonstrates that the instrument is applicable in different cultures. Results show little difference between the support networks of Bangladeshis in Sylhet compared with London. There are significant differences between support networks of the Bangladeshi samples and the rural and urban United Kingdom samples.
Breaking the mould: developing a new service for people with dementia and their carers
Authors: Perks Anne , Nolan Mike , Ryan Tony , Enderby Pam , Hemmings Isabel , Robinson Karen
Published: September 2011

Respite care or ‘short breaks’ are currently heavily promoted as services to support older people and their carers. However, uptake of such services can be limited and there is a need to design models which are more flexible and responsive, and also reflect the ethos of personcentred care, which is currently one of the main drivers of health and social care policy in the UK. This paper describes the rationale for, and the philosophy behind, a new service for people with dementia and their carers recently established in Sheffield which provides respite care in the person's own home. The importance of user and carer involvement is highlighted and the need for new approaches to evaluation stressed.
The inappropriate placement of older people in nursing homes in England and Wales: a national audit
Authors: Victor Christina , Hastie Ian , Christodoulou Georgina , Millard Peter
Published: September 2011

Despite the new ‘needs driven’ criteria for public funded admission to nursing homes, there remains concern that older people are entering such care inappropriately. However, neither previous research or policy makers have sub‐divided such inappropriate entries into their constituent groups: those who are inappropriate because they are too independent and those who are inappropriate because they are too dependent. The aims of this study were to determine the extent of inappropriate nursing home admission amongst older people in nursing homes in six areas of England and Wales between 1995‐96. This was done through a retrospective case‐note review using a structured data‐collection pro forma. Although the study found no evidence of extensive inappropriate placement, extrapolation of these data suggests that 6,750 of those admitted to nursing care could have coped in a more independent environment. The inappropriately admitted group were more likely to have lived alone, be female, elderly and not to have seen a geriatrician. It is concluded that the most effective way to prevent such admissions would be to ensure the involvement of specialist geriatricians in the multidisciplinary team involved in admission decisions.
The twilight zone? NHS services for older people in residential and nursing homes
Authors: Jacobs Sally , Glendinning Caroline
Published: September 2011

This paper reviews evidence about the relationships between NHS services and nursing and residential homes in England and Wales. Since the transfer in 1993 of responsibility for funding nursing and residential home care for less affluent older people to local authority social services departments, nursing and residential care has been widely assumed to constitute part of ‘social care’ services. This obscures the fact that residents of nursing and residential care homes frequently have substantial and complex healthcare needs. While some of these healthcare needs may be met through the care provided within homes themselves, most will require substantial contributions from NHS medical, nursing, pharmaceutical and other services. The National Service Framework for Older People (Department of Health, 2001) prioritises reinvestment in intermediate care services, building on the expectation in The NHS Plan (Department of Health, 2000a) that residential and nursing homes will play a major role in the development of these services. This expectation has been further reinforced by the Concordat with the private and voluntary healthcare provider sector (Department of Health, 2000b). However there is little evidence about the NHS services which are currently provided to nursing and residential homes, nor about the capacity of mainstream NHS services to meet the projected development of intermediate care services within the independent institutional sector. This paper reviews the evidence which is available and highlights some of the priorities which primary care groups in England (local health groups in Wales) will need to consider if they are to develop integrated and good quality services for frail older people.
Competencen in home care
Authors: Bell Lesley
Published: September 2011

More and more people are receiving care while living in their own homes, a far greater number than are in residential and nursing home care, and in some cases with more complex needs. Yet there persists an image of home care as a very basic activity needing little or no training and in volving no career pr ogression. This image will have to change radically if registered providers are to meet the new national regulatory standards and if there is to be sufficient staff recruitment to meet the ever increasing demand for home care. This article sets out ways in which provider or ganisations can respond to these changes, particularly by building staff development and training strategies. Such strategies must recognise the growing importance and complexity of home care and take special account of the need for staff to gain vocational qualifications. Home care must be seen as offering professional career opportunities, not just a job. The article concludes that the future will lie in bringing care to the people who need it, rather than bringing people to the care.
Neuroleptic drug use in long‐term care: An inappropriate panacea?
Authors: Hagen Brad , Armstrong‐Esther Christopher
Published: September 2011

Despite the increasing evidence about the inappropriate use of medications by older people, there is very little published evidence about the control and monitoring of neuroleptic drugs used in nursing homes. As others have indicated, this is all the more worrying when set in the context of the paucity of research on nursing home care and the trend to replace registered nurses with untrained care assistants. In the United States, legislation in the form of the Nursing Home Reform Act (OBRA 1987) was introduced, in part, to regulate the prescribing and administration of neuroleptic (antipsychotic) drugs. No such legislation exists in Canada or the United Kingdom. In the case of the latter jurisdiction, the recent Royal Commission on Long‐Term Care for older people (The Stationery Office, 1999) has recommended a national care commission to monitor care, and set assessment and quality benchmarks. In Canada this debate has not even begun, and the purpose of this paper is not to ignite controversy, but to raise questions about the use of these drugs with nursing home residents. Voluntary guidelines and education of physicians, nurses and care attendants would be infinitely better than legislation. In the meantime, we need research to address the following questions: For what reasons should these drugs be given to older people? Are these drugs being used appropriately? Is the risk of side‐effects too great with these drugs? Are the numbers and type of staff employed in nursing homes adequate/qualified to detect and report side‐effects? How well do these drugs manage the behaviours they are given to control? Are they being used as chemical restraints or to make the older person compliant? Are the so‐called ‘atypical’ neuroleptic drugs any better? What we offer in this article is background information that might encourage others to not only review their practice but also to address these questions.
Care of older people from a multi‐professional perspective: Learning on the web
Authors: Bendz Mona , Joakimson Daga , Oinas Eija
Published: September 2011

The European population has undergone important changes during past decades with increased life expectancy and a falling birth rate. The high proportion of older people and the vulnerability related to ageing will in the next century demand more multidisciplinary and innovative approaches towards their care. This was the main rationale for the construction of a web‐based course. Another reason was that many students are not able to leave their homes to study abroad. The aim of the course was to provide an option for students in different programmes and for experienced health professionals to increase their mutual understanding about older people and their need for comprehensive care. The internet offered several health professionals with their different perspectives a place to meet and communicate. Lecturers who had advanced knowledge about specific areas in the countries could present their views, and the course participants could share knowledge about relevant articles, research and personal experiences as well as share their experiences with professionals from more than one culture, which is usually not the case when going abroad. By working together in international groups, the students said that they had learned to analyse shared attitudes and differences between countries, and how cultural and geographical circumstances could affect quality of life for older people. The students and the teachers felt that that a multi‐professional and intercultural approach had increased their knowledge of the various and changing living conditions for older people in different societies.
Insomnia and ageing: Implications for healthcare practice and policy
Authors: Ellis Jason , Cropley Mark , Hampson Sarah
Published: September 2011

Although ageing itself does not lead to insomnia, changes in sleep architecture (the ‘typical’ physiological progression from wakefulness to deep sleep) and health status create a vulnerability to the development of insomnia, which can be precipitated by a trigger event. This review highlights some of the problems associated with insomnia in older people and offers insights into the possible approaches to stop insomnia from becoming a ‘rite of passage’. The main conclusion from this review however, is that sleep research focusing specifically on the ageing population is badly needed, alongside a unified diagnostic system and research structure (Leger, 2000). These findings are also discussed in relation to both healthcare policy and practice.