Evaluating Health and Social Care delivery

Evaluation seems to be in a major boom phase. Evaluation of social and health care delivery began in the 1990s and has today spread throughout the world. Evaluators in the 21st century mainly deal with evaluation of social programs that are set in such a way as to reduce emergence of social problems that risk the lives of the young and the old (Nugent, Sieppert and Hudson 2001; Bloom, Fischer and Orme 1999). Even though it is believed that collaborative working must be beneficial, little evidence on which to lay the claim on exists.

In the modern era, which is a time when social and health care delivery is increasingly continuing to take the central position in the policy strategies of the government of the United Kingdom, researchers and also scientists are increasingly being required to weigh up a variety of organizational units (Nugent, Sieppert and Hudson 2001). This article will look at a variety of approaches that have been made use to weigh up social and health care delivery. Social and health care professionals are required to understand the evaluation methodologies for social and health care delivery.

Understanding of the evaluation methodologies is essential as it enables social and health care professionals to evaluate their own way of conduct as well as that of others. Even though not all professionals may want to become researchers, they are required to posses the capacity to evaluate the practice of others and themselves. They are required to posses the capacity to appreciate the evaluation methods of others and also comprehend the ways to integrate evaluation findings to their own professional practice (Bloom, Fischer, and Orme 1999).

All social and healthcare professionals are being encouraged to have a critical look at the services they offer to the general public. They are required to question the evidence ground for the services they provide and determine whether these services as well as the mode of delivery is effective for the societies and the people they serve (Nugent, Sieppert and Hudson 2001). Evaluation, according to Bloom, Fischer, and Orme (1999), has to be a central part in the social and healthcare delivery.

Although evaluating practice has been a challenging task for many years and the slit between service delivery and direct practice as well as between research and evaluation continues to exist, professionals should without doubt be engaged in evaluation of their mode of service delivery in addition to that of others. Evaluation helps examine the effectiveness of social and healthcare providers thereby enabling them to improve it.

It also helps them increase their accountability to the elderly generation and also develop an understanding of the ways in which to fill the gaps that exist between knowledge and practice. Evaluation also helps health and social care providers to develop novel models of service delivery and practice (Corcoran and Fischer 2000). The modes of evaluation of social and health care delivery keep on changing. Many governments, including the U. K, are taking on a comprehension of health that comprise of issues regarding equality and disproportion and the importance of social determinants.

Devoid of methodologies to evaluate the impact of various policies and strategies on social and healthcare delivery, it would be hard to determine which strategies are most appropriate for achievement of better outcomes (Bloom, Fischer, and Orme 1999). The United Kingdom has a rich history of inter-professional teamwork in the evaluation of social and healthcare delivery. Health and social care professionals from the United Kingdom are very much aware of the fact that they must work together (Thyer and Kazi 2004).

Nevertheless, due to the fact that they have not gone through any teamwork training and education, realization of the benefits associated with collaborative working is a major challenge. Though they may work collaboratively, the subtleties and the comprehension of inter-professional working in a complex setting never crosses their minds (Thyer and Kazi 2004). Evaluation of social and health care delivery is not limited to determination of the effectiveness of service delivery (Bloom, Fischer, and Orme 1999). It is also a means through which empowerment, social and health care changes are attained.

Through evaluation, social and healthcare practices are challenged to novel understanding and novel methodologies. Social and healthcare evaluation takes into consideration the overall importance of social and healthcare professionals in the delivery of care. Evaluation is not limited to a model of resource accountability; rather, it is conducted in such a way as to take care of process evaluation and practice (Robson 2000). Corcoran and Fischer (2000) states that one of the long standing professional concerns that evaluation of social and healthcare delivery aims to tackle regards the gap that exist between social work and research.

Some of the proposed solution to this challenge is change in curriculum as well as professionals training methodologies in order to equip them with the necessary skills for proper delivery of care. Royse, Thyer, Padgett and Logan (2006), states that the main reason as to why a gap exists between researches and practice in social and healthcare is the disproportion of the criteria of progress between researchers and practitioners. Evaluation of social work has also long been linked to sectional interests in terms of methodologies of practice (Royse, Thyer, Padgett and Logan 2006).

The other issue is that evaluation of social work has long been pursued by different parties that appear ignorant of the interest of one another’s involvement. A very good example is where a potential for common base between social and healthcare delivery evaluation and practice would appear, but practitioners and researchers fail to consult one another (Kazi 2003). The other problems in social and healthcare evaluation emanate from the responses to endeavors to create a theorized stance with reference to evaluation as a core part of direct, local practice.

Evaluation of social care delivery has greatly suffered as a result of failure to perceive it as a professional competence in social work training. There also lacks complete theorization by social and healthcare workers on evaluation of direct practice. This aspect highly contravenes the comparatively rich ground on policy and practice issues regarding social work (Robson 2000). There are situations where the elderly may fail to meet the criteria for social and health care, and this result in a major healthcare crisis.

The government have recognized this problem and pledged to commit its efforts in supporting more effective strategies of delivering social and healthcare to the elderly. A variety of policy initiatives have been introduced in order to streamline the practice of social and healthcare professionals in the delivery of long-term care to the elderly. Older people are the main beneficiaries of a wide range of health and social services implemented by the government (Corcoran and Fischer 2000). This generation is characterized by numerous health needs that call for effective strategies in order to manage them.

These people are prone to chronic diseases, physical impairment, mental incapacity, poverty, in addition to poor housing among many other factors that negatively impact on their lives. They also lack resources that are essential for quick and complete recovery from various devastating conditions. Provision of social and health care to the elderly generation has long been perceived as a low priority task (Kazi 2003). The work of providing social and healthcare services to the elderly generation has long been left in the hands of the less qualified professions.

Due to these facts, the elderly generation is extremely susceptible to adverse life conditions when disparities occur between health and social care professionals. Over the past few decades, citizens of the United Kingdom have experienced numerous changes in social and health care delivery, and especially in long-term care, which have emanated from the progress in technology as well as the novel approaches to the financing of healthcare (Royse, Thyer, Padgett and Logan 2006). Dramatic and equally significant changes have also been experienced in the demographics of the elderly generation.

The statistics, which reveal the increasing percentage of the population, older than 65 years, as well as the increasing diversity of the elderly generation, are now familiar to all citizens of the United Kingdom. People are now living longer as a result of the advances in social and health care delivery. The increasing necessity for biopsychosocial services to take care of the independent functioning of the elderly population in addition to the needs of their care providers implies that a lot of social work assistance is needed to effectively manage their health needs (Thyer and Kazi 2004).

Effective management of functional, social, environmental and psychological necessities of the elderly population calls for the services of social work professionals with outstanding training and knowledge on aging (David and Sutton 2004). A lot of questions crop up from this fact. Some of these questions are whether contemporary social work training will focus on the past healthcare practices or whether instructors of social and healthcare workers will focus on future deigns of practice to create educational programmes.

Modern instructors of social and healthcare providers make it clear that interest in the elderly population and healthcare is going through a remarkable revival. However, thorough evaluation of various revival strategies needs to be carried out in order to close the gaps that exist between, policy, research, training and practice (Thyer and Kazi 2004). Good health and social care delivery to the elderly population comprises of a variety of contentious issues.

It is believed that the core quality of excellent social and healthcare delivery calls for a critical approach; meaning that social and healthcare professionals are required to be doubtless as well as evaluative of their own mode of conduct. Critical approach is also vital in the management of complexity, work load in addition to survival in a constantly changing health and social care environment (David and Sutton 2004). The elderly population is faced by numerous challenges that call for critical attention of social and healthcare providers.

Some of the numerous challenges that face the elderly include: functional limitations, minimal staffing of the elderlys’ health care facilities, adverse medical conditions associated with aging, in addition to procedures aimed at maintaining independence. There are numerous social and healthcare facilities that offer healthcare services to the elderly population in the United Kingdom. These comprise of nursing homes, residential care facilities, life care communities, and assisted living centers among many others (Robson, 2002).

The type of facility available, however, varies according to the location. Old age is a novel phenomenon as the modern society is experiencing it. Many societies not only in the United Kingdom, but throughout the world are enjoying longevity of life. It is predicted that in the subsequent decades, the proportion of the elderly population is going to increase considerably. This increase will come along with an increase in the challenges facing this generation if critical evaluation of social and health care delivery of the elderly is not going to be carried out.

A variety of questions crop up from the issue regarding the evaluation of social and healthcare delivery of the elderly. One major question regards the way social and healthcare professionals, policy makers, and the general public is going to tackle the immense challenges that face this population. Over the last twenty years or so, pressure has been mounting on elderly population service programs, especially long-term care, to demonstrate their efficiency. Social care delivery interventions often occur at the interface of an individual and the society.

The complexities for practice in the delivery of social and healthcare to the elderly population are such that, there exist numerous dimensions in a continuous state of fluctuation. The dimensions of studies that researchers target, in addition to the extent to which the challenges facing the elderly population are managed relies on the paradigmatic perspective of the researcher, and the magnitude to which a specific perspective allows for the management of various challenges by the researchers (Robson 2000). Before the establishment of the National Health Service in the U.

K, development and management of hospitals was in the hands of communities. Charitable in addition to voluntary organizations were the major financiers of the vital services needed by the elderly. In the recent years however, the government has implemented strategies in addition to policies aimed at encouraging diversity of provision and development of an independent sector. Along with government strategies, public organisations have diverted their attention to increased commissioning and services procurement resulting in externalisation of a wide range of services that were in the past delivered in-house (Thyer and Kazi 2004).

Long-term care for the elderly comprises of a wide range of assistance with day to day activities that disabled individuals may be in need of in order to prolong their life and make it as comfortable as possible. The basically low-technology services involved in long-term care are set up in such a way as to reduce, rehabilitate in addition to compensate for loss of physical and mental capacity. Some of the social and healthcare services provided to the elderly include: bathing, dressing, eating, in addition to other personal care.

Long-term care is a consumer directed service aimed at empowering and providing assistance to the elderly. It is based on the strength of this generation and promotes their capacity for independence as well as decision making. It is a cost effective program that helps maintain the old people in the community and also minimizes the administrative costs associated with the provision of a variety of social and healthcare services (St Leger, Schneiden and Walsworth-Bell 1992). Social care entails assisting the elderly in management of a variety of things including money, medication, and transportation (Robson, 2002).

Social services comprise of supervisory human assistance, assistive apparatus such as walking sticks, as well as technology for example computerized medication reminders and alerts settings that notify other family members when assistive devices fail to function. The place where the elderly live can greatly impact on their functional disability, quality of life and independence. Nursing homes comes in handy and provide an environment that positively impacts on the health and capacity of the elderly.

Nursing homes not only provide the elderly with healthcare, but also provide them with social support which is essential for their overall well being. Social and healthcare professionals look into minor details that are often over looked in the provision of care to the elderly in residential settings (Czarniawska, 2004). The major role of long-term care is to provide the frail elderly generation with an environment that makes it easy for them to function independently and for a longer time. Long-term care aims at providing a system that will enhance the performance of the elderly people.

Long-term care, which is an example of social and health care, is provided to both the elderly and the young generation. However, the proportion of those in need of long-term care is higher among the elderly as compared to the young people due to the high rate of disability in this population. Functional incapacity increases with age; people above the age of 65 years are the most affected by functional disability (Czarniawska, 2004). In order to ensure maximum delivery of care to the elderly, critical evaluation of social and healthcare system, during which a variety of questions emerge, needs to be carried out.

Evaluation of health and social care services to the elderly should be designed in such a way as to be in a position to tackle most of the questions that may arise. Theories, methodologies, resources as well as solutions constitute the decision space of the project. All these factors are interdependent and the resolution strategy emanates from their interaction. Social and healthcare delivery evaluation questions are vital to the design process (Daiute and Lightfoot 2004). These questions may be clearly outlined before the evaluation or may arise in the course of evaluation.

Some of the questions that prove hard to get answers for should be discarded in the evaluation process. Rubin and Babbie (2001) make it clear that what is finally learned from an evaluation can be established as a system of answers to the set of questions that were formulated before and during the course of evaluation. The core purpose of evaluation is to determine the rationality of the evaluation questions. The evaluation questions are the main determinants of the methodologies of data collection as well as the evaluation itself.

Some of the evaluation methodologies that exist include: qualitative interviews, instructed interviews, self completion questionnaires, critical surveys, questionnaire surveys, observations, and single-case evaluation among many others (Daiute and Lightfoot 2004). During evaluation, the elderly may be asked concerning their first hand experience with their feelings, as well as perceptions to social and healthcare delivery. Good evaluation methodologies should focus on questions that the evaluating team is able to get answers for at the end of the process.

Hypothetical questions should be avoided; questions concerning perception of causality, and solutions to intricate challenges should also be avoided (Rubin and Babbie 2001). It is important that one question be asked at a time. Questions that call for unnecessary assumptions should also be done away with. The other set of questions that should be avoided are those that comprise of hidden eventualities. The wording of the questions should be designed in such a way that the participants easily understand them.

The time frame that a particular question may refer to should be definite. Multiple questions should be asked in order to simplify difficult evaluation questions (Atkinson, Coffey, Delamont, Lofland and Lofland 2001). Observation, as stated by Yates (2003), as a social and healthcare delivery evaluation methodology greatly assists in comprehending the program as well as the mode of operation of the program. Observation methodology calls for unstructured and exploratory strategies that result in qualitative data.

During observation method, great attention should be paid to the program in order to gain an understanding of its operation and its benefits. Observation method, as Yates (2003) argues, may be combined with informal interviews whereby arising opportunities are taken into account and discussed by the parties involved in evaluation. Participant observations may be carried out in secret, where those who are being evaluated do not know the evaluative role of the researcher. The other style of observation methodology is the structured observation whereby structured observation schedules are involved.

In this modality, a variety of observation categories are established. Observation method mainly involves observing the target population at its natural setting. In social and healthcare context, observation method aims at obtaining the fine details regarding the mode of working of social and healthcare professionals (Yates 2003). A major advantage associated with the use of observation methodology is that it is a flexible modality that does not need to be developed from a certain hypothesis.

Findings from observation methodology are stronger as compared to other techniques due to the fact that a researcher is provided with a base on which to collect a wide range of information concerning a particular topic. Observation methodology can also be used when the subject cannot provide reliable information (Yates 2003). Observational methodology however has a variety of disadvantages associated with it. One of these disadvantages is that a lot of problems are encountered in generalization and reliability.

Reliability is the extent to which results obtained from evaluation can be replicated. Generalizability on the other hand is the extent to which the findings of the evaluation could be true to other people in other contexts. Findings, in observation method, only reflect characters unique to a specific population of people and cannot be extrapolated to others. This results in bias of evaluation (Donaldson and Scriven 2003). Questionnaires can also be used to evaluate social and healthcare delivery to the elderly and frail generation.

Some of the questions that can be included in questionnaires include: where should finances for long-term care of the elderly come from, how should social and healthcare services for the elderly suffering from various disabilities be designed, who is responsible for delivering social and health care services to the elderly, how should the workforce delivering social and health care services to the elderly be recruited and trained, are the current social and health care services delivered to the elderly effective, and what are some of the recommendations of a participant in regard to the issue among many others (Yates 2003).

The issue on financing of social and health care for the elderly has undergone extensive review from the 1970s. Serious debates have been conducted in order to come up with a solution regarding the financing of social and healthcare services to the elderly (Bryman 2001). A major advantage of questionnaires is that it saves a lot of time as well as effort, and is also helpful in making comparisons with other programs. Questionnaires are a very important and inexpensive evaluation tools that can be used to gather data from a large population of respondents.

They are actually the most feasible way through which a large number of reviewers can be reached, to make statistical analysis of results viable. Questions in a questionnaire may be designed in such a way as to gather either quantitative or qualitative data or both (Silverman 2004). Silverman (2004), states that qualitative questions are less precise as compared to quantitative questions. A well structured questionnaire can gather precise information on the overall performance of social and healthcare providers as well as information concerning specific constituents of the system (David and Sutton 2004).

The use of questionnaires is however a challenging task as it requires careful attention. It is also hard to ascertain objectivity while using questionnaires than when data is evaluated in the lab. Due to the fact that evaluation using questionnaires takes place after the event has happened, participants may forget some details that are vital for analysis. Questionnaires do not provide an explanation for the points that the participants may give. Large amounts of data, which is hard to analyze can be generated from open ended questionnaires (DeVaus 2002).

Participants may consider questionnaires as a waste of time and answer most of the questions superficially. Single-case methodology is the other evaluation strategy that can be used to evaluate social and healthcare delivery for the elderly people with disabilities. Single-case methodology comprise of specification of main problems, in addition to selection of an appropriate strategy to take care of these challenges as well as monitor progress (Kazi 1998). Single-case methodology can also be used to determine the natural course of practice of social and healthcare workers.

Therefore, single-case methodology is a flexible and viable way of evaluating social and healthcare delivery to the elderly. The single-case methodology was used in this article as it provides a base for a systematic approach in the definition of challenges, classification of objectives, monitoring of outcomes and selection of intervention strategies. Single-case methodology, according to Kazi (1998), allows for continuous evaluation of outcome by both the patients and the practitioners. It thus provides a base for collaborative working and accountability.

Single-case study is a good source of information concerning social and health care delivery. It is a very important method for challenging theoretical assumptions. However, single-case methodologies have a number of limitations associated with them. One of these limitations is that they are hard to generate precise cause-effect conclusions (Donaldson and Scriven 2003). It is hard to extrapolate information obtained from a single case. Survey method can also be used to evaluate long-term care for the elderly.

Surveys are inexpensive ways of evaluation that can be used to determine the characters as well as the performance of a large population (Punch 2003). This is one of the major advantages associated with the use of surveys. Surveys, as asserted by Punch (2003), can also be carried out from remote locations. Due to the fact that surveys deal with a large proportion of people, the results obtained are statistically viable. Numerous questions concerning a particular topic can be asked in surveys, an aspect that makes evaluation flexible. Standardized questions may be used in surveys.

Standardized questions are important in evaluation as they ensure collection of uniform data. Surveys are highly reliable and can be extrapolated to cover other groups not involved in evaluation (Punch 2003). Surveys however, have some limitations associated with them. To ensure that surveys remain unchanged throughout the course of evaluation, a study design must be created first. The other disadvantage associated with surveys is that participants may experience troubles in recalling some of the controversial events. Surveys do not deal with context as other evaluation methodologies do.

In the process of generating standard questions, the researcher may leave out some issues that are unique to individuals. Surveys require a large number of participants who may, at times, be hard to get (Punch 2003). The findings of the evaluation questions reveal that most of the elderly, who benefit from social and healthcare services, especially long-term care, believe that the current social and healthcare systems satisfy their needs. They also believe that long-term care and other social and healthcare services to the elderly should be provided free of charge.

Social and healthcare services to the elderly should be provided by highly competent people who are aware of and have the capacity to meet the needs of the elderly generation. Answers to a variety of question in the evaluation methodologies also reveal that financing of social and healthcare services for the elderly should be provided by the government. The funds can be allocated in priority bases in order to meet the needs of each and every individual. Though the need for long-term care is common among the elderly generation at all ages, the need sharply rise after one attains the age of 65 years.

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