OUTCOMES IN SOCIAL CARE

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OUTCOMES IN SOCIAL CARE FOR ADULTS ten years
on. A look backwards and forwards
David Challis Paul Clarkson PSSRU, University of
Manchester
PSSRU Personal Social Services Research Unit at
the University of Manchester
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Types of Outcome for Individuals and Groups (1)
Location destinational Outcomes Community
tenure Nursing home admission Quality of Care
Outcomes Adequacy of services Sufficiency of
services Satisfaction with services Quality of
Life Outcomes Depression Psychological well
being See Challis (1981) The measurement of
outcome in social care of the elderly , Journal
of Social Policy, 10, 179-208

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Types of Outcome for Individuals and Groups (2)

Cost and Resource Outcomes Service receipt Costs
of care (valuation of service receipt) Practice
Level Outcomes Individual problem resolution
assessment information Monitoring Tracking
routinely generated data Performance Measurement
Outcomes Numbers in receipt of intensive home
care Proportion supported in nursing home
care Number of service complaints
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Development of different approaches to Outcome
Measurement
Location Outcomes In local monitoring systems in
part Quality of Care Outcomes Satisfaction
measures special studies Quality of Life
Outcomes Special studies Cost and Resource
Outcomes In local reporting systems Practice
Level Outcomes As part of local record systems
limited development Monitoring As part of
routine descriptive data Performance Measurement
Outcomes Locally limited

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Outcome Measurement ApproachesLocation Outcomes

Comparative Location Outcomes Examples from
research studies include Community tenure
Hospitalisation rates Admissions to care homes
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Outcome Measurement ApproachesQuality of Care
Outcomes

Comparative Quality of Care Outcomes Examples
from service monitoring include Satisfaction
surveys Examples from research studies
include Change in different areas of need
change in perceived service quality
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Care Needs Outcomes (GCCS)

PSSRU Personal Social Services Research Unit at
the University of Manchester
H At home I Institutional Care
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Outcomes for Carers (GCCS)

H At home I Institutional Care
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Outcome Measurement ApproachesQuality of Life
Outcomes

Comparative Quality of Life Outcomes More
general outcomes valued in their own
right Examples from research studies
include Change in different areas of
psychological well being change in valued
activities/events
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Social and Emotional Needs Outcomes (GCCS)

PSSRU Personal Social Services Research Unit at
the University of Manchester
H At home I Institutional Care
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Older Person Well Being Mean change over 6
months

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the University of Manchester
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Outcome Measurement ApproachesService Use and
Cost Outcomes

Comparative Service Use and Cost Outcomes
Patterns of utilisation and financial
consequences Examples from research studies
include Service impact, cost and differences
across sectors (eg health and social care)
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Assessment at the Point of Admission to Care
Homes Service Use and Cost ()
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the University of Manchester
Source Challis et al. Age and Ageing, 33, 25-34.
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Costs for Different Parties (DCCP) ()

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Outcome Measurement ApproachesPractice Level
Outcomes

Practice related Outcomes May include
aggregated or individual service user information
either routine data or special collection Example
s from routine data include Assessment
information Examples from research studies
include Service impact, cost and differences
across sectors (e.g. health and social care)
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Example 1. The MDS/RAI

MDS components 1. Minimum Data Set a
structured assessment tool 2. Resident
Assessment Protocols (RAPs) guide the assessor
through areas of potential need so as to
ascertain if further action is required 3. Can
produce outcome measures (change in depression,
ADL etc) and quality indicators UK Translation
available (Challis et al., 2000)
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MDS Assessment Domains

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MDS Resident Assessment Protocols

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MDS Quality Indicators

• Prevalence of any injury
• Prevalence of falls
• Prevalence of problem behaviour towards others
• Prevalence of symptoms of depression
• Prevalence of depression with no treatment
• Use of 9 scheduled medications
• Incidence of cognitive impairment
• Prevalence of bladder/bowel incontinence

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MDS Quality Indicators (cont.)

• Prevalence of occasional/frequent bladder/bowel
  incontinence with no toileting plan
• Prevalence of indwelling catheters
• Prevalence of faecal impaction
• Prevalence of urinary tract infections
• Prevalence of antibiotic/anti-infective use
• Prevalence of weight loss
• Prevalence of tube feeding
• Prevalence of bedfast residents
• Incidence of late loss ADLs

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Conclusion - MDS - RAI

• Assesses individual need and links to care
  planning
• Costing RUGs and Casemix Standard data to
  link Needs and Outcomes with Resources
• Change in status
• Outcomes -
• Quality indicators
• Workforce Planning Demand profiles Casemix

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Example 2 PSSRU Care Management Record System
1. Assessment document Structured information
about health, disability, family support etc. 2.
Regular review Structured information on
fieldworker activities, type of work undertaken,
other services involved 3. Weekly service use and
costings Agency resources used in total i.e.
(hours of home help number of meals, days at day
centre x price of each resource 4. Feedbacks to
different levels Authority, area, team,
individual fieldworker

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Implementing the Care Plan Outcome by Domain of
Assessed Need
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Goal Achieved by Domain of Assessed Need
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Outcome Measurement ApproachesMonitoring as a
Proxy for Outcomes

Monitoring as a proxy for outcomes Examples
include standard monitoring datasets Australia
n Aged Care Assessment Teams
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Victoria Geriatric Assessment Programme Minimum
Data Set
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Outcome Measurement ApproachesPerformance
Measurement Outcomes

Performance Measurement Outcomes National
Indicators as Outcomes Examples may be found in
PAF items Local Indicators for
Outcomes Examples include PSSRU work on Older
Peoples Services
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Best Value Performance Indicators for Social
Services
National Priorities and Strategic Objectives

• Stability of placements of children looked after
• Educational qualifications of children looked
  after

Cost and Efficiency

• Costs of services for children looked after
• Cost of intensive social care for adults

Effectiveness of Service Delivery and Outcomes

• Intensive homecare
• Older people (aged 65 and over) helped to live at
  home

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Local performance measures

• UK social care developments
• Case review system for social workers 1979 1
• Social Services Research Group (SSRG) local
  performance indicators in 1988 2
• Measurement issues to assess local impact of care
  reforms Bristol University 1992 3

1 Goldberg and Warburton 1979. Ends and Means in
Social Work Allen Unwin London. 2 Barnes and
Miller 1988. Research Policy and Planning 6
1-47. 3 Hoyes et al. 1992. Made to Measure?
Performance Measurement and Community
Care. University of Bristol.
PSSRU Personal Social Services Research Unit at
the University of Manchester
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Developing local performance measures

• PSSRU Local Study Cheshire 1
• A local performance measurement system
• A model to work with staff on the most important
  aspects to monitor
• A suite of local indicators
• Use of comparative analysis across districts

1 Clarkson and Challis 2002. Research Policy and
Planning 20 3-16.
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the University of Manchester
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Outcome Indicators
03 No. of users in long-term nursing home
placements for older people per 1000 pop aged 75
and over Definition The number of users in
nursing homes, financially supported by the SSD,
in relation to the elderly population. PIAF
category OI Policy/Service Objective(s)
Diversion Indicator status Core,
Quarterly Benchmark County average Level of
aggregation Authority, District Comparable
national statistics None

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Outcome Indicators
05 Reasons for admission to long-term nursing
home and residential care home placements Definiti
on During the quarter, the proportion of users
financially supported by the SSD based on the
main reason for admission namely, client
choice, physical ill-health, loneliness, absence
of appropriate community services, care package
in excess of agreed financial limit, loss of main
carer, unacceptable risk. PIAF category
OI Policy/Service Objective(s) Diversion,
Efficient, Choice Indicator status Core,
Quarterly Benchmark County average Level of
aggregation Authority, District, Team Comparable
national statistics None Notes

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Outcome Indicators
08 Proportion of current long-term placements by
dependency bands Definition The distribution of
current placements supported by the SSD at the
end of each month in residential care homes by
type of provider and in nursing homes by
dependency bands. PIAF category
OI Policy/Service Objective(s) Targeted,
Diversion Indicator status Core,
Monthly Benchmark County average Level of
aggregation Authority, District, Team Notes
This measures the prevalence of placements
Comparable national statistics None

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Outcome Indicators
019 of carers satisfied with assessment and
care management processes Definition During the
year, the percentage of carers who express
satisfaction with the way social workers and
community care workers have assessed their needs
and those of the user, and planned services for
them. PIAF category OI Policy/Service
Objective(s) Efficient, Involved Indicator
status Special study annual, but with a view
to routinely asking and recording users and
carers opinions. Benchmark County average Level
of aggregation Authority, District,
Team Comparable national statistics None

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Developing local performance measures

• Requires us to develop an analytical or logic
  model to identify most important elements of
  activity and their relationships.
• The PIAF

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the University of Manchester
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Conclusions

• Social Care Outcomes
• Measure processes often indirectly
• Permit a broad evaluation of effect from the
  point of view of different stakeholders
• May be conceptualised at several levels macro,
  mezzo, micro
• Often service user and professional/administrati
  ve outcomes are valued in similar ways

PSSRU Personal Social Services Research Unit at
the University of Manchester