The acceptability and feasibility of using the Adult Social Care Outcomes Toolkit (ASCOT) to inform practice in care homes

Abstract

BackgroundThe Adult Social Care Outcomes Toolkit (ASCOT) measures social care related quality of life (SCRQoL) and can be used to measure outcomes and demonstrate impact across different social care settings. This exploratory study built on previous work by collecting new inter-rater reliability data on the mixed-methods version of the toolkit and exploring how it might be used to inform practice in four case study homes.MethodWe worked with two care home providers to agree an in-depth study collecting SCRQoL data in four case-study homes. Data was collected about residents’ age, ethnicity, cognitive impairment, ability to perform activities of daily living and SCRQoL in the four homes. Feedback sessions with staff and managers were held in the homes two weeks after baseline and follow-up data collected three months later. Interviews with managers explored their views of the feedback and recorded any changes that had been made because of it.ResultsParticipant recruitment was challenging, despite working in partnership with the homes. Resident response rates ranged from 23 to 54 % with 58 residents from four care homes taking part in the research. 53 % lacked capacity to consent. Inter-rater reliability for the ASCOT ratings of SCRQoL were good at time one (IRR = 0.72) and excellent at time two (IRR = 0.76). During the study, residents’ ability to perform activities of daily living declined significantly (z = -2.67, p < .01), as did their expected needs in the absence of services (z = -2.41, p < .05). Despite these rapid declines in functionings, residents’ current SCRQoL declined slightly but not significantly (Z = -1.49, p = .14). Staff responded positively to the feedback given and managers reported implementing changes in practice because of it.ConclusionThis exploratory study faced many challenges in the recruitment of residents, many of whom were cognitively impaired. Nevertheless, without a mixed-methods approach many of the residents living in the care homes would have been excluded from the research altogether or had their views represented only by a representative or proxy. The value of the mixed-methods toolkit and its potential for use by providers is discussed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1763-1) contains supplementary material, which is available to authorized users.

Why are relatives of care home residents reluctant to “rock the boat”? Is there a culture of acceptance?

“…Indeed, the Older People's Commissioner for Wales (2014) found that families often have low expectations about these higher-order aspects of quality of life in care homes. Such findings reflect Maslow's hierarchy of needs (Maslow, 1943) and have been supported by previous research measuring social carerelated quality of life, which found that care homes in England tend to be very good at supporting residents' basic needs but do less to meet their higher-order needs (such as control over daily life and social participation) (Netten et al, 2012;Towers et al, 2016). Reasons for this are multidimensional and might be partly attributed to traditional medical models of long-term care facilities (i.e.…”

“…These focus groups and interviews formed part of a wider feasibility study about the quality of life of residents in care homes for older adults (Towers et al, 2016).…”

Capability instruments in economic evaluations of health-related interventions: a comparative review of the literature

“…Similar studies have also demonstrated the feasibility of use of other ICE-CAP measures [81,90]. Malley et al [70] and Towers et al [67] demonstrated the feasibility of using ASCOT among older people and care home residents; however, the study also highlighted the need for proxy respondents in some situations. This later led to the development of a proxy version of the ASCOT, which demonstrated good feasibility [58].…”

Being occupied: supporting ‘meaningful activity’ in care homes for older people in England

“…Details of the main study can be found in Towers et al . (2016). The study and its pilot included six self-selected homes, of which two provided nursing care.…”

“…ASCOT aims to measure social care-related quality of life (SCRQoL), which is those areas of a person's quality of life that can reasonably be attributed to social care services. The care home version of ASCOT has been used the UK, Austria, Denmark, Finland and Australia (Rostgaard, Brünner and Fridberg 2012; Towers et al 2016; Trukeschitz 2011). In ASCOT, SCRQoL is comprised of eight conceptually distinct domains, including a domain that focuses upon activities and occupation.…”