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Improving the quality of life for older adults living in long term care settings is recognised as an increasingly important issue. Understanding Care Homes draws together a range of research and development initiatives that emphasise the importance of partnership working, and of enabling older people and their families to maintain the highest quality of life. The book is divided into three sections, each investigating how research and development can be undertaken to provide better care for the individual resident and their family, to enhance care at the organisational level and to develop the

This article categorizes and delineates approaches to information sharing and assessment in a demonstration program established by central government in England. Its purpose was to develop and test a set of principles relating to a general assessment framework for adults in demonstrator sites, maximizing the use of information technology where feasible. The method employed comprised the systematic analysis of documents associated with the funding application and a telephone interview with personnel in each site. Data were collected from 17 initiatives, 13 of which provided detailed information on information sharing within the assessment process. A taxonomy of approaches was produced and information sharing in the assessment process reported in terms of setting and personnel; approaches to data collection, storage, and transfer; and changes to the process. A classification of the initiatives within a demonstration program was a useful means of describing them. Measures of intermediate outcomes captured changes in information sharing between agencies. Local initiatives were successful in promoting electronic information sharing between health and social care agencies.

Context: Many people over the age of 65 receive support from home care providers to enable them to continue to live at home. In the UK, local authorities (England, Wales and Scotland) and Health and Social Care Trusts (Northern Ireland) commission these support services. However, little is known about these arrangements. Objectives: To address this knowledge gap through identifying the lessons from research for commissioners of home care for older people. Method: A scoping review was undertaken to extrapolate the lessons from research for future practice. Searches were conducted in 2016/17 and the analysis was completed 2017/18. Electronic and manual searches of UK literature were undertaken using distinct terms to investigate the people, organisations and processes intrinsic to commissioning home care for older people. Findings: From a total of 1,819 papers and government reports, 22 met the inclusion criteria, indicative of a limited body of knowledge. A variety of research methods and designs were included with mixed methods most frequently used. Four lessons were identified relating to: the marketisation of home care; the future of care at home; promoting integration with local partners in commissioning home care; and areas for future research. Limitations: The focus on research evidence may have meant that potentially interesting insights to inform future commissioning strategies from conceptual articles were omitted from the review. Implications: Understanding the complexities of market management in commissioning home care for older people is still at an early stage of development. This review provides evidence to inform its future development of value to policy makers and practitioners.

Comparative performance evaluation has taken different forms depending upon the purposes of performance monitoring and the types of measures available. This paper investigates the different performance measurement systems in place in the social care setting, in particular for older people receiving community care services. In England, earlier systems to assist performance management within organizations have been eclipsed by national systems of regulation with top— down implementation of standards and measures. In Northern Ireland, by contrast, organizations have been compared descriptively without the use of national targets. Internationally, in Japan, organizations arranging similar services have had more local information available collected in a bottom—up fashion with greater employment of service user-level data. These differences in performance evaluation are located within an analytical framework permitting comparisons of system design and the use of measures. Conclusions are drawn concerning the breadth of evidence available for successfully monitoring service provision in this setting.

Abstract
Prior to the COVID pandemic, staffing levels, staff turnover and vacancies in adult social care and social work within the UK were a major concern, with staff experiencing high workloads, burnout, stress and poor morale. The paucity of published evidence in a rapidly evolving contemporary situation indicated the suitability of a scoping review. Systematic searching produced evidence published between 1 December 2019 and 9 May 2023. Out of ninety-seven articles retrieved, the final analysis included thirty nine articles. To report the review findings clearly and accessibly, the analysis used the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework. Abundant evidence emerged on psychological distress and the impact of COVID-19 on the working environment for social care and social workers, but a paucity of psychosocial resilience, supporting social care managers, Personal Assistants and moral injury. Social care needs and the statutory duties of social work are likely to become even more intense. The COVID pandemic magnified a chronic lack of funding, staffing, support and regard for adult social care, with no future planning compared to the NHS. This legacy and backlogs of social care assessment and service delivery are of concern despite the proposed actions of the Adult Social Care Reform Act in England.

Abstract Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in duration. Conclusions Despite evidence about what inhibits and facilitates integrated working there was limited evidence about what the outcomes of different approaches to integrated care between health service and care homes might be. The majority of studies only achieved integrated working at the patient level of care and the focus on health service defined problems and outcome measures did not incorporate the priorities of residents or acknowledge the skills of care home staff. There is a need for more research to understand how integrated working is achieved and to test the effect of different approaches on cost, staff satisfaction and resident outcomes.