Improving effective integrated home support for people with dementia and their carers; development of a service fidelity index

Introduction

This project aimed to create and test an evidence-based tool designed to allow services to critically self-assess the application of good practice standards in good home care for people living with dementia.

Methods

The first stage of the project was to map from the literature the key ingredients, or enablers, that facilitate good care. The themes arising from this were then used, to develop an evidence-based ‘Service Template’, listing items regarded as central to the delivery of good services.

Findings

• A robust Fidelity Index tool and associated Service Template developed to assess the quality of home care for people with dementia had generally been seen by services as useful as a means of self-assessment, focusing attention on how services might be improved, in a setting where providing good service is evidently most difficult, which in turn makes engagement of services with research very challenging
• While home care is an important Government priority, services appeared to operate within significant ‘structural’ constraints, deriving from partnership issues and commissioning policies and
  practices, that appear to mitigate the application of many of the best practice standards set out in the
  Service Template. This includes disincentives for staff remaining in-post and developing in their role, as the result of a ‘market place’, based upon generally poor pay and conditions, and commissioning practices that can impact on the delivery of person-centred care
• A significant finding of the research, and one that would benefit from further, more detailed work, is the area of partnership working, or collaboration, between home care services and their NHS colleagues. This was a recurrent theme in interviews with service managers,and during conferences designed to explore the Service Template in more detail. While everyone would agree that good communication and cooperation between the different providers of health and social care are important, there would appear to be cultural and structural impediments to its realisation, that suggest the need for further research
• Proper resourcing of services is essential and seeking more evidence, to weigh the relative importance of the key ingredients of good services and how they may best be combined, is crucial.

Resources

Fidelity Index (Manager)

Electronic Fidelity Index (Manager)

Home care for dementia: a systematic search of the literature (PDF)

Related publications

• Improving effective integrated home support for people with dementia and their carers
  ( https://www.sscr.nihr.ac.uk/wp-content/uploads/SSCR-research-findings_RF007.pdf )