Using ASCOT to improve care practice

Introduction

Care homes are under increasing pressure to show how the care and support they provide affects people’s quality of life. The Personal Social Services Research Unit (PSSRU), at the University of Kent, developed ASCOT (www.pssru.ac.uk/ascot) to measure the areas of quality of life most affected by social care services.

ASCOT measures eight quality of life domains and tells us what people’s lives are like and how the care and support they receive affects their lives (for better or worse). There are different measures and methods of data collection for different client groups. A version for measuring SCRQoL in care homes was designed so that all residents could be included, even those who find it difficult to tell people about their own lives, such as those living with advanced dementia. Information is collected through observations of life in the home and interviews with residents, staff and relatives. A trained person then uses this to rate the SCRQoL of residents.

Some care home providers have suggested that the care homes toolkit might be helpful for improving care practice in their homes. One service manager used ASCOT to observe care home residents and staff in order to understand what life was like for residents and then gave staff feedback based on these observations.

Objectives

This project sought to systematically explore this approach and examine if staff and management found feedback about residents’ SCRQoL helpful and whether it could be used to inform practice and improve outcomes for residents.

Methods

Four care homes for older adults in one local authority region in England took part in the study, two from a large national chain and two from a small independent provider. All staff were invited and encouraged to take part in the research. All permanent residents were invited to take part in the research, including people with cognitive impairments and communication difficulties.

Data was collected in two phases, the second phase three months after the first. At both these times researchers spent up to five days in each home, conducting interviews with key staff and residents and undertaking observations of residents using ASCOT to rate residents’ SCQoL. Feedback from the first phase was given to care home staff two weeks after it was collected.

Findings

• It was possible to use the Adult Social Care Outcomes Toolkit (ASCOT) to assess the social carerelated quality of life (SCRQoL) of residents in care homes and use this information to sensitively provide feedback to staff and managers in the homes. SCRQoL is a term used to refer to the areas of quality of life most affected by social care and support
• Staff and managers said they were able to use this feedback to make changes to practice that would hopefully improve residents’ lives
• The researchers were not able to directly detect improvements in SCRQoL in the homes when the ASCOT assessments were repeated three months after giving the feedback. However,
  this may be due to other factors, including the natural decline in the health of residents and that three months may not be enough time for changes to have taken effect
• There may be scope for the use of ASCOT as a feedback tool to improve practice if the feedback relates directly to individual residents and can then be used to improve their care
• An alternative to researchers gathering the data would be for care staff to make their own ASCOT ratings of residents’ lives. This may have more impact on care practice but would be less objective from a research perspective.

Related publications

• Using ASCOT to improve care practice
  ( https://www.sscr.nihr.ac.uk/wp-content/uploads/SSCR-research-findings_RF042.pdf )