Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-26T18:47:59.409Z Has data issue: false hasContentIssue false
  • English
  • Français

What kind of home is your care home? A typology of personalised care provided in residential and nursing homes

Published online by Cambridge University Press:  30 October 2020

Stefanie Ettelt Open the ORCID record for Stefanie Ettelt [Opens in a new window] ,
Lorraine Williams ,
Jacqueline Damant ,
Margaret Perkins  and
Raphael Wittenberg Open the ORCID record for Raphael Wittenberg [Opens in a new window]
Stefanie Ettelt*
Affiliation:
Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
Lorraine Williams
Affiliation:
Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
Jacqueline Damant
Affiliation:
Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
Margaret Perkins
Affiliation:
Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
Raphael Wittenberg
Affiliation:
Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
*
*Corresponding author. Email: stefanie.ettelt@lshtm.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

This paper examines how care home managers in England conceptualised the approach to delivering personalised care in the homes they managed. We conducted interviews with care home managers and mapped the approaches they described on two distinct characterisations of personalised care prominent in the research and practitioner literature: the importance of close care relationships and the degree of resident choice and decision-making promoted by the care home. We derived three ‘types’ of personalised care in care homes. These conceptualise the care home as an ‘institution’, a ‘family’ and a ‘hotel’. We have added a fourth type, the ‘co-operative’, to propose a type that merges proximate care relationships with an emphasis on resident choice and decision-making. We conclude that each approach involves trade-offs and that the ‘family’ model may be more suitable for people with advanced dementia, given its emphasis on relationships. While the presence of a range of diverse approaches to personalising care in a care home market may be desirable as a matter of choice, access to care homes in England is likely to be constrained by availability and cost.

Keywords

Personalisationperson-centred carechoicecare homesresidential care
Type
Article
Information
Ageing & Society , Volume 42 , Issue 5 , May 2022 , pp. 993 - 1013
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Age, UK (2019) Later Life in the United Kingdom 2019. Factsheet. Available at https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/later_life_uk_factsheet.pdf.Google Scholar
Ågotnes, G and Øye, C (2018) Facilitating resident community in nursing homes: a slippery slope? An analysis on collectivistic and individualistic approaches. Health 22, 469–482.CrossRefGoogle ScholarPubMed
Alzheimer's Society (2019) Facts for the Media. Available at https://www.alzheimers.org.uk/about-us/news-and-media/facts-media.Google Scholar
Bally, K and Jung, C (2015) Caring for older people: is home care always best? Editorial. British Journal of General Practice 65, 565–566.CrossRefGoogle Scholar
Bangerter, LR, Van Haitsma, K, Heid, AR and Abbott, K (2016) ‘Make me feel at ease and at home’: differential care preferences of nursing home residents. The Gerontologist 56, 702–713.CrossRefGoogle Scholar
Bigonnesse, C, Beaulieu, M and Garon, S (2014) Meaning of home in later life as a concept to understand older adults’ housing needs: results from the 7 age-friendly cities pilot project in Quebec. Journal of Housing for the Elderly 28, 357–382.CrossRefGoogle Scholar
Bland, R (1999) Independence, privacy and risk: two contrasting approaches to residential care for older people. Ageing & Society 19, 539–560.CrossRefGoogle Scholar
BMG (2018) Alternative Wohnformen. Pflege-Wohngemeinschaften; Wohngruppenzuschlag; Anschubfinanzierung für neugegründete ambulant betreute Wohngruppen. Available at https://www.bundesgesundheitsministerium.de/themen/pflege/online-ratgeber-pflege/leistungen-der-pflegeversicherung/alternative-wohnformen.html.Google Scholar
Boyle, G (2004) Facilitating choice and control for older people in long-term care. Health & Social Care in the Community 12, 212–220.CrossRefGoogle ScholarPubMed
Brooker, D (2003) What is person-centred care in dementia? Reviews in Clinical Gerontology 13, 215–222.CrossRefGoogle Scholar
Buse, C, Twigg, J and Nettleton, S (2018) Dirty linen, liminal spaces, and later life: meanings of laundry in care home design and practice. Sociological Research Online 23, 711–727.CrossRefGoogle Scholar
Callaghan, L and Towers, AM (2014) Feeling in control: comparing older people's experiences in different care settings. Ageing & Society 34, 1427–1451.CrossRefGoogle ScholarPubMed
Care Quality Commission (CQC) (2018) Regulation 9: Person-centred Care. Available at https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-9-person-centred-care.Google Scholar
Clarke, C and Mantle, R (2016) Using risk management to promote person-centred dementia care. Nursing Standard 30, 41–46.CrossRefGoogle ScholarPubMed
Cooney, A (2012) ‘Finding home’: a grounded theory on how older people ‘find home’ in long-term care settings. International Journal of Older People Nursing 7, 188–199.CrossRefGoogle ScholarPubMed
Cooney, A, Hunter, A, Murphy, K, Casey, D, Devane, D, Smyth, S, Dempsey, L, Murphy, E, Jordan, F and O'Shea, E (2014) ‘Seeing me through my memories’: a grounded theory study on using reminiscence with people with dementia living in long-term care. Journal of Clinical Nursing 23, 3564–3574.CrossRefGoogle Scholar
Davies, S (2003) Creating community: the basis for caring partnerships in nursing homes. In Nolan, M, Lundh, U, Grant, G and Keady, J (eds), Partnerships in Family Care: Understanding the Caregiving Career. Maidenhead, UK: Open University Press, pp. 218–237.Google Scholar
De Rooij, A, Luijkx, KG, Spruytte, N, Emmerink, PMJ, Schols, J and Declercq, AG (2012) Family caregiver perspectives on social relations of elderly residents with dementia in small-scale versus traditional long-term care settings in the Netherlands and Belgium. Journal of Clinical Nursing 21, 3106–3116.CrossRefGoogle ScholarPubMed
De Veer, AJ and Kerkstra, A (2001) Feeling at home in nursing homes. Journal of Advanced Nursing 35, 427–434.CrossRefGoogle ScholarPubMed
Dewar, B, Adamson, E, Smith, S, Surfleet, J and King, L (2014) Clarifying misconceptions about compassionate care. Journal of Advanced Nursing 70, 1738–1747.CrossRefGoogle ScholarPubMed
Dichter, MN, Trutschel, D, Schwab, CGG, Haastert, B, Quasdorf, T and Halek, M (2017) Dementia care mapping in nursing homes: effects on caregiver attitudes, job satisfaction, and burnout. A quasi-experimental trial. International Psychogeriatrics 29, 1–14.CrossRefGoogle ScholarPubMed
Doyle, PJ and Rubinstein, RL (2014) Person-centered dementia care and the cultural matrix of othering. The Gerontologist 54, 952–963.CrossRefGoogle ScholarPubMed
Dyck, I, Kontos, P, Angus, J and McKeever, P (2005) The home as a site for long-term care: meanings and management of bodies and spaces. Health & Place 11, 173–185.CrossRefGoogle ScholarPubMed
Eijkelenboom, A, Verbeek, H, Felix, E and Van Hoof, J (2017) Architectural factors influencing the sense of home in nursing homes: an operationalization for practice. Frontiers of Architectual Research 6, 111–122.CrossRefGoogle Scholar
Ettelt, S, Damant, J, Perkins, M, Williams, L and Wittenberg, R (2020) Personalisation in Care Homes for Older People. Final Report. London: Policy Innovation and Evaluation Research Unit.Google Scholar
Evans, S, Fear, T, Means, R and Vallelly, S (2007) Supporting independence for people with dementia in extra care housing. Dementia 6, 144–145.CrossRefGoogle Scholar
Falk, H, Wijk, H, Persson, L-O and Falk, K (2012) A sense of home in residential care. Scandinavian Journal of Caring Science 27, 999–1009.CrossRefGoogle ScholarPubMed
Fazio, S, Pace, D, Flinner, J and Kallmyer, B (2018) The fundamentals of person-centred care for individuals with dementia. The Gerontologist 58, S10–S19.CrossRefGoogle Scholar
Ferguson, I (2007) Increasing user choice or privatizing risk? The antinomies of personalization. British Journal of Social Work 37, 387–403.CrossRefGoogle Scholar
Fine, M and Glendinning, C (2005) Dependence, independence or inter-dependence? Revisiting the concepts of ‘care’ and ‘dependency’. Ageing & Society 25, 601–621.CrossRefGoogle Scholar
Foucault, M (1977) Discipline and Punish: The Birth of the Prison. New York, NY: Random House.Google Scholar
Giddens, A (1991) Modernity and Self-identity. Cambridge: Polity Press.Google Scholar
Gilleard, C and Higgs, P (2010) Aging without agency: theorizing the fourth age. Aging and Mental Health 14, 121–128.CrossRefGoogle ScholarPubMed
Glasby, J and Littlechild, R (2016) Direct Payments and Personal Budgets: Putting Personalisation into Practice, 3rd Edn. Bristol, UK: Policy Press.CrossRefGoogle Scholar
Goffman, E ([1961] 1991) Asylums. Essays on the Social Situation of Mental Patients and Other Inmates. London: Penguin Books.Google Scholar
Hatcher, D, Chang, E, Schmied, V and Garrido, S (2019) Exploring the perspectives of older people on the concept of home. Journal of Aging Research 2019, 2679680.CrossRefGoogle ScholarPubMed
Hauge, S and Heggen, K (2008) The nursing home as a home: a field study of residents’ daily life in the common living rooms. Journal of Clinical Nursing 17, 460–467.Google ScholarPubMed
Hochschild, AR (1979) Emotion work, feeling rules and social structure. American Journal of Sociology 85, 551–575.CrossRefGoogle Scholar
Hutchinson, A, Rawson, H, O'Connell, B, Walker, H, Bucknall, T, Forbes, H, Ostaszkiewicz, J and Ockerby, C (2017) Tri-focal Model of Care implementation: perspectives of residents and family. Journal of Nursing Scholarship 49, 33–43.CrossRefGoogle ScholarPubMed
Jansson, AH, Karisto, A and Pitkälä, KH (2021) Time- and place-dependent experiences of loneliness in assisted living facilities. Ageing & Society 41, 628–644.CrossRefGoogle Scholar
Johnson, EK (2015) The business of care: the moral labour of care workers. Sociology of Health and Illness 37, 112–126.CrossRefGoogle ScholarPubMed
Johnson, J, Rolph, S and Smith, R (2010) Residential Care Transformed: Revisiting ‘The Last Refuge’. Basingstoke, UK: Palgrave Macmillan.CrossRefGoogle Scholar
Jones, L (2015) What does a hospital mean? Journal of Health Services Research and Policy 20, 254–256.CrossRefGoogle ScholarPubMed
Kendall, S and Cameron, A (2014) Personalisation of adult social care: self-directed support and the choice and control agenda. British Journal of Learning Disabilities 42, 264–271.CrossRefGoogle Scholar
Kitwood, T (1997) Dementia Reconsidered. The Person Comes First. Maidenhead, UK: Open University Press.Google Scholar
Klaasens, M and Meijering, L (2015) Experiences of home and institution in a secured nursing home ward in the Netherlands: a participatory intervention study. Journal of Aging Studies 35, 92–102.CrossRefGoogle Scholar
LaingBuisson (2018) Care Homes for Older People – Market Report. London: LaingBuisson.Google Scholar
Lloyd, L (2010) The individual in social care: the ethics of care and the ‘Personalisation Agenda’ in services for older people in England. Ethics and Social Welfare 4, 188–200.CrossRefGoogle Scholar
Lymbery, M (2010) A new vision for adult social care? Continuities and change in the care of older people. Critical Social Policy 30, 5–26.CrossRefGoogle Scholar
Lynch, BM, McCance, T, McCormack, B and Brown, D (2018) The development of the Person-Centred Situational Leadership Framework: revealing the being of person-centredness in nursing homes. Journal of Clinical Nursing 27, 427–440.CrossRefGoogle ScholarPubMed
Manthorpe, J and Samsi, K (2016) Care homes and the Mental Capacity Act 2005: changes in understanding and practice over time. Dementia 15, 858–871.CrossRefGoogle ScholarPubMed
McCormack, B and McCance, TV (2006) Development of a framework for person-centred nursing. Journal of Advanced Nursing 56, 472–479.CrossRefGoogle ScholarPubMed
Milligan, C (2009) There's No Place Like Home: Place and Care in an Ageing Society. Farnham, UK: Ashgate Publishing.Google Scholar
Molony, SL (2010) The meaning of home: a qualitative metasynthesis. Research in Gerontological Nursing 3, 291–307.CrossRefGoogle Scholar
Nakrem, S, Vinsnes, A, Harkless, G, Paulsen, B and Seim, A (2012) Ambiguities: residents’ experience of ‘nursing home as my home’. International Journal of Older People Nursing 3, 216–225.Google Scholar
National Institute for Health and Care Excellence (2015) Older People in Care Homes (Local Government Briefing No. 25). London: National Institute for Health and Care Excellence.Google Scholar
O'Dwyer, C (2013) Official conceptualizations of person-centered care: which person counts? Journal of Aging Studies 27, 233–242.CrossRefGoogle ScholarPubMed
O'Sullivan, G (2013) Ethical and effective: approaches to residential care for people with dementia. Dementia 12, 111–121.CrossRefGoogle ScholarPubMed
Owen, T and Meyer, J (2012) My Home Life: Promoting Quality of Life in Care Homes. York, UK: Joseph Rowntree Foundation. Available at https://www.jrf.org.uk/report/my-home-life-promoting-quality-life-care-homes.Google Scholar
Peace, S and Holland, C (2001) Homely residential care: a contradiction in terms. Journal of Social Policy 30, 393–410.CrossRefGoogle Scholar
Power, ER (2017) Housing governance and senses of home in older age: the provider scale. Journal for Housing for the Elderly 31, 193–212.CrossRefGoogle Scholar
Reimer, HD and Keller, HH (2009) Mealtimes in nursing homes: striving for person-centered care. Journal of Nutrition for the Elderly 28, 327–347.CrossRefGoogle ScholarPubMed
Rijnaard, MD, Van Hoof, J, Janssen, BM, Verbeek, H, Pocornie, W, Eijkelenboom, A, Beerens, HC, Molony, SL and Wouters, EJM (2016) The factors influencing the sense of home in nursing homes: a systematic review from the perspective of residents. Journal of Aging Research 2016, 6143645.CrossRefGoogle ScholarPubMed
Rockwell, J (2012) From person-centered to relational care: expanding the focus in residential care facilities. Journal of Gerontological Social Work 55, 233–248.CrossRefGoogle ScholarPubMed
Rodrigues, R and Glendinning, C (2014) Choice, competition and care – developments in English social care and the impacts on providers and older users of home care services. Social Policy and Administration 49, 649–664.CrossRefGoogle Scholar
Schwartz-Shea, P and Yanov, D (2012) Interpretive Research Design. Concepts and Processes. New York, NY: Routledge.Google Scholar
Smith, A (2013) Design for People with Dementia: An Overview of Building Design Regulators. Stirling, UK: Dementia Services Development Centre, University of Stirling.Google Scholar
Social Care Institute for Excellence (2019) Improving Personalisation in Care Homes: Care Home Action Plan. London: Social Care Institute for Excellence. Available at https://www.scie.org.uk/person-centred-care/improving-personalisation-in-care-homes.Google Scholar
Spicker, P (2013) Personalisation falls short. British Journal of Social Work 43, 1259–1275.CrossRefGoogle Scholar
Stevens, M, Moriarty, J, Harris, J, Manthorpe, J, Hussein, S and Cornes, M (2019) Social care managers’ and care workers’ understanding of personalisation in older people's services. Working with Older People 23, 37–45.CrossRefGoogle Scholar
Townsend, P (1962) The Last Refuge: A Survey of Residential Institutions and Homes for the Aged in England and Wales. London: Routledge and Kegan Paul.Google Scholar
Trigg, L (2018) Improving the Quality of Residential Care for Older People: A Study of Government Approaches in England and Australia (PhD thesis). London School of Economics and Political Science, London.Google Scholar
Vallelly, S and Manthorpe, J (2009) Choice and control in specialist housing: starting conversations between commissioners and providers. Housing, Care and Support 12, 9–15.CrossRefGoogle Scholar
Wada, M, Canham, SL, Battersby, L, Sixsmith, J, Woolrych, R, Fang, ML and Sixsmith, A (2020) Perceptions of home in long-term care settings: before and after institutional relocation. Ageing & Society 40, 1267–1290.CrossRefGoogle Scholar
Weber, M (1986) Gesammelte Aufsätze zur Wissenschaftslehre, 3rd Edn. Tübingen, Germany: J.C.B. Mohr/Paul Siebeck.Google Scholar
Wilberforce, M, Challis, D, Davies, L, Kelly, MP, Roberts, C and Clarkson, P (2017) Person-centredness in the community care of older people: a literature-based concept synthesis. International Journal of Social Welfare 26, 86–98.CrossRefGoogle Scholar
Woolham, J, Daly, G, Steils, N and Ritters, K (2015) The evolution of person-centred care to personalised care, personal budgets and direct payments in England: some implications for older users of social care services. Sociologia e Politiche Sociali 18, 145–162.Google Scholar