Helping older people to engage effectively with community social care (The HOPES study)

SPRU research team

• Mark Wilberforce
• Yvonne Birks

External collaborators

• Sue Tucker, Personal Social Services Research Unit (PSSRU), The University of Manchester 
• Sally Ferris, Together Dementia Support CIC
• Melanie Weatherley, Walnut Care at Home

Project summary

Background to the research

Many older people who need social care support at home (e.g. help with meals or personal care) have dementia, depression, anxiety and/or other mental health difficulties. For some, these problems mean that they cannot easily engage with social care. For example, they may avoid the people who try to give the care, or respond defensively in physical or verbal ways. The causes are complex. In part, it may be because they interpret the care as an intrusion or threat, or because they no longer recognise, or are not motivated to act on, their own support needs. It may also be because social care staff lack the skills and confidence to tailor their care for this group.

Whatever the cause, we know that this can lead to the breakdown of social care and that, without this, older people are at severe risk of self-neglect, growing health problems and admission to hospital.

These difficulties sometimes trigger a referral to community mental health teams (CMHTs). These are specialist teams with mental health expertise, usually spanning both health and social care needs. An earlier study suggested that assistant-grade staff in these teams, known as support workers, are most valuable in helping people to engage with their social care. However, it is not clear what is it about their work this is most helpful, how do these activities work, and what helps or hinders their success?

The purpose of the research

The research aims to find out what makes support workers in CMHTs effective in encouraging older adults to accept social care. It will provide an understanding of how they achieve change and the barriers and facilitators that influence outcomes. The findings will then be used to develop a handbook that can then be disseminated to support workers in CMHTs to create a shared understanding of how best to reduce barriers to the acceptance of social care for older adults with mental health conditions.

What we will do

• Firstly, we will conduct a scoping review, which will synthesise existing literature that offers insight into engagement problems with community care. This will help us gain an initial understanding of how improved engagement can be achieved, and through what steps, and what change is required between each.
• Secondly, we will conduct qualitative interviews and focus groups in four areas of England. We will conduct in-depth interviews with 10-12 informal carers and social care providers to examine how engagement difficulties arise, and their perceptions of how support workers are able to assist.
• Thirdly, a further 22-24 interviews with support workers in mental health teams will be conducted to examine their activities, focusing on key aspects of how change (identified at stage 1) is achieved. Two focus groups with mental health professionals will then examine wider facilitators and barriers to support worker outcomes.
• Finally, we will design and develop a handbook for support workers. This will be a learning resource detailing how support workers can help older people to engage with social care, using illustrative practice examples and prompting for reflection on their own skills and capability. A consultation group with support workers will then consider how practice change could be implemented in the long- term, such as through a training intervention in a future research project. 

Public involvement

Together Dementia Support CIC and Walnut Care at Home helped develop the application and research project and we are being advised by two people with lived experience of dementia:

Wendy Mitchell, Public Involvement Member

David Niman, Public Involvement Member

Additional information