This article describes the test of a method for consulting frail older people about the quality of social services and their unmet needs. The method, home interviews by senior social services managers, was prompted by advice from older social services clients about how best to obtain their views. Results of the interview programme are presented, together with benefits arising specifically from using managers as interviewers and discussion of future application of this approach.
Recent years have seen growing interest in service users' views as a source of guidance for service development. This paper reports findings about quality of life from a programme of in-depth interviews with older users of community care, which had been designed to supply guidance for improving local services. One reason for wider interest is that interview methods were tailored to reach very frail older people, who are an increasing proportion of the home care clientele owing to national changes in service targeting (Godfrey, 1999) but hard to reach through conventional 30
Twenty‐three home care providers were interviewed concerning what promotes or impedes quality aspects of service giving, as defined by older customers ‐ like service from familiar staff or flexible help. The influence of Social Services purchasers and of structures for purchasing care proved notably important. Purchasers affected service quality through the amounts of time that they commissioned and through whether they would purchase help for customers' quality of life as well as for their physical survival. Quality was affected through whether care was purchased through fixed quantities of time or through the fulfilment of specified tasks. Some purchasers controlled details of everyday care giving, which other purchasers left to providers' discretion. Also influential was the attitude of providers themselves to giving miscellaneous occasional help like changing light bulbs, finding reliable private tradesmen or taking customers with them on shopping trips. Some providers readily gave such help and found it unproblematic to do so. Others prohibited it, although this seemed to not always be implemented earnestly. The most marked differences in willingness to give flexible help occurred between different independent sector providers, rather than between independent and Social Services in‐house providers. A third type of influence on quality of home care was ‘economic’ factors like the purchasing power of local home care pay rates within the local labour market, local geography and demography. Some questions are itemised which merit inclusion in any evaluation of the quality of a home care provider.
This article presents evidence for important individual differences between older people concerning what they value as high quality service from home care. A case is made for improving service quality through systematically consulting each service user about their own preferences and seeking to fulfil these requests on an individual basis. This contrasts with setting uniform quality standards for all older home care clients, based on their most commonly expressed preferences. Evidence is cited from individual interviews with older home care service users and from an experiment in modifying older people's services through briefing home care staff on the preferences of individual clients. Issues in developing this approach are discussed.
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