Care Provision for Older People

Influencing the Future of Ageing Swansea Researchers: Christian Beech, Prof. Judith Phillips (Lead) Wales is at the forefront of major policy initiatives that acknowledge the importance of person-centred, community-level approaches that promote and maintain the independence of older people. A critical area in achieving these policy imperatives is the development of a portfolio of services, including a quality social work service, which will promote and maintain the independence of older people. Methodology A series of qualitative focus groups were conducted with Social Workers, older people aged 65 and over from across Rhondda Cynon Taff and Powys Council areas covering a range of relevant themes Results Social workers reflected a general understanding of ageing issues but a paucity of knowledge relating to research development within the field of ageing. Older peoples conceptualisation of independence and quality of life is predicated upon maintaining good physical health; self-reliance; financial security and choice and control. Older people also view the role of adult social care services as supplemental to expedite core health care services such as hospital discharge and specialist care in the community. Conclusions Creative and innovative social work practice will need to be conceptualised at a strategic level as older people currently feel stigmatised accessing adult social care services and avoid doing so until at a point of crisis. Future services might have to play a vital but invisible role in supporting other agencies to provide direct services as older peoples expectations of Council services include support through age associated transitions and for robust partnership working between health and social care. Funder: Rhondda Cynon Taff and Powys County Council

Developing Research Mindedness Within Social Work Practice Swansea Researchers: Andrea Murray, Prof. Judith Phillips (Lead) Introduction Current policy acknowledges the significance of evidence based social work practice as a pre-requisite to improving the quality and effectiveness of social work intervention to service user groups. This project seeks to explore and to develop models for promoting increased research use amongst social work practitioners.

College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK

Methodology Participant observation and staff interviews were used to obtain information regarding levels of and attitudes towards research engagement from members of the social work group within one local authority. A grounded analysis of findings was undertaken to evaluate the work of the project as it progressed and to develop the specifics of the research practitioner model. Results Difficulties were encountered in implementing the model, particularly in terms of engaging social workers with capacity related issues being identified by staff as a major barrier to their involvement. Analysis indicates the need to strengthen practitioner understanding concerning the relevance of research to social work. It is important to foster visible commitment to practice based research at a managerial level and within the culture of organisations to ensure that time and space are provided to develop research activity within social settings. Conclusions The findings of this project strengthen understanding of those factors which support and inhibit the development of evidence based social care. This insight is fundamental to the effective generation of models for promoting research mindedness within social work practice. Funder: Wales Office of Research & Development (WORD) - CCA2817

Bereavement Needs Amongst Older People: A Neglected Policy Arena? Swansea Researchers: Jodie Croxall, Dr. Sarah Hillcoat-Nalltamby (Lead) Introduction Bereavement is a universal experience; only those who die young may escape the pain of losing somebody they love through death. It has been estimated that an average of six surviving people, including family members, friends and loved ones are significantly affected by bereavement. Recent socio-demographic trends, particularly due to increased life expectancies and changing patterns of mortality, have made deaths outside the older age ranges relatively rare occurrences; consequently experiences of bereavement have become largely confined to the later stages of the life course. This trend will doubtless continue as populations age. Methodology Qualitative interviews using a semi-structured schedule with two study populations; older bereaved individuals (n=10) and service providers (n=6). The interviews aimed to determine what support was available, who provided support and where there was unmet need. Results Analysis suggests that social isolation and loneliness are particularly dominant concerns amongst older bereaved people. Social change (e.g. increasing divorce, women in work etc.) affects the availability of

College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK

informal support. Older people interviewed felt that they have particular unmet needs for support following bereavement, especially with practical matters (such as paperwork, funeral arrangements); functional support (such as transport, shopping, cleaning); emotional support (companionship, somebody to talk to) and empathetic support (shared bereavement experiences). Conclusions Although increased longevity and population ageing mean that bereavement is increasingly likely to become a commonplace experience in later life, and despite significant research evidence indicating its determining effect upon wellbeing, addressing the needs of older bereaved people has remained largely at the periphery of the welfare agenda. Preliminary analysis points to the need for more formalised support for older people during bereavement.

End of life care for older people in Wales: Policy, practice and the effectiveness of the Integrated Care Pathway for the Last Days of Life. Swansea Researchers: Dr. Christine Dobbs (Lead), Prof. Vanessa Burholt Research Team: Dr. Kate Bullen (Aberystwyth University) Since its roll-out across Wales, the Integrated Care Pathway for the Last Days of Life (ICP) has demonstrated its value. However, the emphasis in the ICP is currently on bio-medical aspects of care. Further, it does not address specifically the needs of dying older people, and spiritual and cultural diversity receive less attention that other issues. We identify here a knowledge gap. It is acknowledged that end-of-life-care (EoLC) patients require psychological, social and spiritual support (WAG, 2003), and evidence suggests that integrating these dimensions of care can improve patients psychological well-being, even in the last stages of life. Further, spirituality is frequently a dimension of cultural diversity, and high-quality EoLC should be delivered with cultural/spiritual competence. The proposed exploratory project focuses on the hospital setting. It seeks to (i) identify older peoples needs and expectations of EoLC, taking cultural/spiritual diversity into account, (ii) investigate together with spiritual mentors if and how they can provide support, and where they see their place in the ICP, (iii) evaluate critically with clinical staff the implementation of the ICP beyond the clinical level and (iv) present stakeholders with these findings and develop a road-map on the first steps to enhancing the ICP. Funder: Wales Office of Research and Development for Health and Social Care scheme: HA09/006.

College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK