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Social support at home is key to enabling people with dementia to continue to live independently and in deferring or avoiding their transition to long term care.  Since the launch of the NHS and Community Care Act in 1990, and its promotion of care in the community, home care provision for people with dementia has become an increasingly important source of support.  These developments have been coupled with the emergence of a system of welfare pluralism and a purchaser-provider split with the stated aim of promoting service innovation and customer choice.  In addition, there have been ongoing demands for improvements in the delivery of these services.  Thus, recent policy initiatives suggest that such services should be person centred and personalised.  In view of the service fragmentation arising from welfare pluralism, greater integration of these services is also called for, including collaborative working and coordination between different welfare sectors thus promoting continuity and responsiveness in the care they provide.  In spite of these developments, there are still huge variations in the quality of home care provision and little is known about the effective ingredients of this support for people with dementia. With the aim of answering these questions, research has taken place at the University of Nottingham investigating what these effective ingredients might be and reviewing existing literature on these ingredients.  This research has found that integrated services, continuity of care and care workers who are able to make autonomous decisions and can carry out regular reassessment of their client’s needs are all important components of effective home care provision. While these components may lead to increased direct costs in the short term, this could be offset by reduced hospital admissions and by delayed transitions to more costly forms of institutional care.  Follow these links to find out more:

http://www.emeraldinsight.com/doi/full/10.1108/JICA-09-2016-0032

http://www.sscr.nihr.ac.uk/PDF/Findings/RF7.pdf

In addition to the above findings, my experience as a social worker within a care management team suggests that attention should also be given to the means of gaining access to this support.  For while the rhetoric behind the pluralist system of welfare that characterises the current context of welfare was to reframe service users as active consumers rather than as passive welfare recipients, I have found that many older people are unable or unwilling to engage in this process.  This may be due to a lack of knowledge on what is available and how to access it or due to a preference for the universalistic rather than pluralistic welfare services that tended to characterise their formative years.  Further barriers to access can arise from an innate stoicism and attitudes of ‘coping’ which research has found to be held by many older people.  Thus, to access such services may be perceived by them as an admission of defeat and the start of an unwanted process of decline and dependency.  In order to overcome this resistance, an effective strategy is the adoption by practitioners of a proactive and persuasive approach towards their older clients in the initial introduction of ‘low level’ services such as home care.  If these strategies are adopted, then positive benefits can accrue to the client and the future need for crisis intervention may be avoided.