‘Ageing in place’ (AiP) is generally understood as the preference for older people to remain in their own homes and communities as they age. While this aligns with policy narratives of independence in later life, this can also serve as a cost-cutting strategy that obscures the structural inequalities shaping later life, including unequal access to support networks and the stability of ‘place’ itself. This paper provides a critique of these limitations and argues that the undervaluing of day centres reflects the narrow ways AiP is currently understood and implemented.Drawing on the authors’ secondary reflective analyses of research with day centres across three disciplines, this paper explores how older people navigate health and spatial inequalities in their everyday lives, and how day centres can mediate these challenges. Findings suggest that day centres play a critical role in offsetting the limitations of individualised care models by offering collective spaces of support through relational and reciprocal place-making. These spaces enable older people to engage in meaningful activities, extending the notion of ‘home’ beyond the private sphere to include community settings that sustain identity and agency. By highlighting the contribution of day centres, this paper builds on critiques of the individualised and home-centric model of AiP to call for reinvestment in (and therefore reimagining of) these infrastructures as inclusive spaces that can support layered forms of relationality.

Background Housebound patients are an under-researched group who face challenges accessing primary health care and have complex needs. There is no consensus definition of ‘housebound’, hindering research. Aim To develop a definition of housebound. Design & setting A mixed-methods study using consensus methodology was conducted in the UK. Method The study had the following parts: (i) a systematic review to examine how housebound was defined within UK literature; (ii) interviews to explore views of housebound people and carers ( n = 12); (iii) a consensus exercise with health and social care professionals ( n = 14) to agree a definition. An evidence summary was developed for each definition, combining review and interview data. A two-stage RAND/UCLA Appropriateness Method was used, with consensus defined as a median score ≥7/9 for clarity and appropriateness. Results In total, 847 titles and abstracts were screened, and 413 articles underwent full-text review. Fifty-two definitions were identified, grouped under the following five themes: unable to attend the surgery; unable to leave the house; unable to leave the house without assistance; self-report of being housebound; and recorded as housebound on healthcare records. Subcategories of housebound included fully or semi, temporarily or permanently, and blockbound, housebound, chairbound, or bedbound. Six definitions met the top-scoring criteria, and a final definition was agreed: ‘Someone who is unable to leave their home or who requires significant assistance to do so. This may be due to illness, frailty, disability, surgery, mental ill health, or nearing the end of life.’ Conclusion Our consensus definition can be used in UK research and may help policymakers and providers — within and outside the UK — evaluate and develop healthcare services for housebound patients.

For adult social care organizations faced with growing challenges, an increasingly important issue is how best to make use of relevant research. This article reports on a survey that sought to assess the views, experiences, and use of research among adult social care staff in three neighboring local authorities in England. Findings In total, 250 staff (30% response rate) across all grades and areas of practice responded to the survey. Staff expressed positive views about the role of research in practice and 36% of respondents could think of changes to their practice that were informed by research findings. Staff with personal experience of doing research, on more senior grades, and in receipt of relevant training reported more positive views, knowledge, skills, and application of research. Elements of research engagement were reported more frequently by occupational therapist staff compared to those in social work. There were no significant differences based upon duration of service or recency of professional qualification. Staff trained in literature searching and critical appraisal were generally not confident to apply their learning. Inadequate time was a leading barrier to research engagement. Applications This study highlights the need for an organization-wide perspective on promoting greater use of research evidence in adult social care decision-making. From this stance, our research indicates the importance of attending to the interests and capacities of diverse staff groups alongside a focus on specific staff-informed opportunities and leverage points through which to disseminate the use of research evidence in complex organizations.

Context: There is a view in England that collective forms of day care for older adults are ‘out-dated’. However, recent studies in the UK and internationally suggest that these services have the potential to address contemporary policy aspirations. Objective(s): This paper reports findings from a study that explored the role of collective day care in England in order to consider a reimagining of services. Method(s): The paper draws on qualitative data collected from 8 case-studies in which 120 interviews were held with older people, their carers, staff and managers of services and local stakeholders. Interviews with managers included questions about the costs and resources used in running services. The reimagined models of care were refined in workshops with research partners. Findings: Analysis of the data revealed three themes underpinning day care provision: the importance of space, place and transport; inclusive and person-centred practice; and the need for purposeful activities. Three models of reimagined day care were developed: 1) small scale collective care for low to moderate needs, 2) larger scale preventative and social provision and, 3) collective care for people with complex and personal care needs. Limitations: Recruitment of sites began after Covid-19 restrictions were lifted in 2021, some sites had not reopened or declined to take part, consequently the study may not reflect the full range of day care services that exist. Implications: The findings illustrate the potential of different models of collective day care services to work together as part of an ecosystem that addresses contemporary policy aspirations.

The nature of professional identity in the roles of practitioners in social care is not clearly defined. This article uses baseline data from a study seeking to increase the use of research in decision-making within adult social care to discuss the role of research in the professional identity of social care practitioners. Semistructured interviews were completed with 25 members of staff working in adult social care in the UK, employing purposive sampling to ensure representation across various professional roles and seniority levels. The interviews explored participants' perspectives on research, its role in their practice, and factors influencing engagement with research. Following thematic analysis of the interview transcripts, results revealed diverse views among social care professionals regarding the use of research in their daily work. Occupational therapists characterised their practice as 'evidence-based' and discussed differences between the use of research in social care compared to in health settings. Social workers voiced a range of opinions, with some considering research integral to social work practice, while others viewing it as a separate, academic task. Experience was valued over research by some participants, suggesting a shift in views among professionals over the course of their careers. Research was not considered a core component of the role of nonprofessionally qualified staff. Senior leaders were expected to engage more with research, yet practical demands often limited their involvement. The role of principal social workers and principal occupational therapists emerged as critical in championing research across the workforce, but concerns were raised about fostering a culture of dependency on these leaders for research dissemination. The article concludes by highlighting the need for a comprehensive development program promoting research engagement at all levels within social care organizations to bridge the gap between research and evidence-based decision-making.

Purpose This paper examined the significance of the built environment for shaping inclusion and social connections in housing with care (HwC) schemes for older people (50+ years) in England and Wales. The purpose of this study was to develop a better understanding of how the availability, absence and use of communal spaces impacts social connections with other residents within HwC schemes. Design/methodology/approach Longitudinal and cross-sectional qualitative interviews were conducted with 72 residents across three HwC providers in England and Wales. Data were analysed using a thematic framework approach to examine how residents experienced their living environments. Findings Whilst the presence of communal shared spaces helps facilitate social connections and the development of friendships, full and equal access to these spaces remains challenging for residents with minority characteristics, and/or physical impairments. Building designers need to ensure they are complying with building regulations and the Equalities Act. The presence of on-site staff may also help to manage the impact of discriminatory attitudes. Research limitations/implications A key strength of this study is its design, both in using longitudinal and cross-sectional interviews and in recruiting respondents with marginalised characteristics, whose voices have often been excluded in gerontological research. Another strength, albeit unexpected, is that this study was able to capture perspectives across the onset of the COVID-19 pandemic. The pandemic, however, may also have generated some limitations in this study. COVID-19 restrictions limited the ability to engage face-to-face within housing schemes whose residents were predominantly from different ethnic minoritised groups, and it therefore limits the inclusion of the voices and experiences of these groups. Responses in later interviews may also have been influenced by the changes in social engagement stimulated by lockdowns and may only be specific to the context of the pandemic. However, the findings reported here focus on the role and use of the built environment, and much of the interview content would feasibly apply regardless of the pandemic. Practical implications This research offers some key insights and implications for housing providers and policy. Housing providers and architects must ensure that the design of HwC schemes affords all residents access to every area of the built environment to maintain independence, autonomy and to adopt the ethos of the ageing in place agenda. If communal areas are to function as “third” or social spaces – if they are to remain equally accessible to all members of the community – then building providers must ensure that all areas are accessible to all residents in line with building regulations and the Equality Act (2010). Social implications Housing staff need to balance the natural development of friendship groups with the potential of the formation of exclusionary “cliques” within HwC schemes. Such cliques threaten the accomplishment of communal areas as “third” or social spaces and, as such, impact the quality of life for residents. Originality/value This study offers insights into how built environments support the development of social connections and friendships in HwC schemes. It also identifies ways that housing managers can ensure that all residents feel equally valued and included.

This paper considers the role of collective forms of day care for older people and their carers during the enforced closure of services in 2020 due to COVID-19. The study provides a unique opportunity to examine how the sector adapted to these unprecedented times. The paper draws on qualitative data collected from 8 case studies conducted in England, during which 120 interviews were held with older people, their carers, staff, and managers of services and local stakeholders. The findings demonstrate how day centres reimagined their services to meet the needs of older people and their carers in new and imaginative ways. They offer insights into the potential role day care centres could play in the new place-based partnerships envisaged in recent legislation. The study provides an opportunity to consider the importance of day care services in the light of their enforced closure, providing a more nuanced understanding of day care provision. The impact of COVID-19 on the social care sector meant that many day care centres were not fully operational and consequently the samples may not reflect the experiences of all centres.

Resource-use measurement is integral for assessing cost-effectiveness within trial-based economic evaluations. Methods for gathering resource-use data from participants are not well developed, with questionnaires typically produced for each trial and rarely validated. The healthcare module of a generic, modular resource-use measure, designed for collecting self-report resource-utilisation data, has recently been developed in the UK. The objective of this research is to identify and prioritise items for new, bolt-on modules, covering informal care, social care and personal expenses incurred due to health and care needs. Identification and prioritisation, conducted between April and December 2021, involved a rapid review of questionnaires included in the Database of Instruments for Resource Use Measurement and economic evaluations published from 2011 to 2021 to identify candidate items, an online survey of UK-based social care professionals to identify omitted social care items and focus groups with UK-based health economists and UK-based people who access social care services either for themselves or as carers to prioritise items. The review identified 203 items. Over half of the 24 survey respondents reported no missing items. Five academic health economists and four people who access social care services participated in focus groups. Feedback shaped the social and informal care modules and indicated that no specific personal expenses were essential to collect in all trials. Aids/adaptations were highlighted as costly personal expenses when relevant; therefore, the personal expenses module was narrowed to aids/adaptations only. Draft informal care, social care and aids/adaptations modules were developed, ready for further testing.

Abstract Aims This study aimed to explore the perceptions of Meals on Wheels (MoWs) service users (SUs), and people who refer them to MoWs (‘referrers’), with accessing and commencing the service in England, the barriers that might hinder service uptake, and what information would be valued when considering accessing the service. Methods Semistructured interviews were conducted in May–July 2022 with seven SUs and 21 referrers, recruited from four MoWs providers across England. Data were analysed using inductive thematic analysis. Results Participants indicated various pathways into the service, but referrers (family members) were more likely to be the ones enquiring about, and commencing, MoWs for SUs. Once an enquiry about MoWs had been made, the service was perceived as straightforward to set up. However, existing preconceptions and stereotypes were perceived to act as barriers to accessing MoWs. Information that participants deemed important to have available when deciding on whether to access MoWs related to the meals, the specific services provided, the reliability and flexibility of delivery and the cost of services. Conclusion These findings could inform MoWs service providers' public awareness strategies about MoWs, to facilitate referrals to the service for adults with care and support needs. Patient or Public Contribution An advisory group of people with lived experience of MoWs (users of the service and their family referrers) extensively discussed the findings of the research and advised on the implications and future dissemination steps.

BACKGROUND:Meals on Wheels (MoWs) could help adults with care and support needs continue living independently. However, many people are not aware that the service still exists in England, or that it could provide benefits beyond nutrition. OBJECTIVE:Working with an existing advisory group of six people with lived experience of MoWs (an adult who uses MoWs and people who have referred a family member to MoWs), this work aimed to co-produce knowledge translation resources (two infographics and a film) to raise awareness of MoWs and their benefits. METHODS:Four participatory online workshops were held in May-July 2023, to establish perceived high-priority themes from recent qualitative research that should be included in the resources, and preferences about message content, language, design, and how the resources should be disseminated. FINDINGS:The most important perceived MoWs benefits that the group agreed should be included in the resources were: the importance of a nutritious meal that requires no preparation; the service's reliability/consistency; the importance of interactions in reducing social isolation, and; the ease to commence the service. The group highlighted the need for language to be nontechnical and invitational, and for images to relate to respective messages, and be inclusive of anyone who could benefit from MoWs. Several routes for dissemination were proposed, highlighting the need to disseminate to the NHS, social care organisations and community groups. CONCLUSION:These co-produced resources could enhance adult social care delivery in England, as raising awareness of MoWs and their benefits could increase referral rates, so that more adults with care and support needs can benefit from the service. PATIENT OR PUBLIC CONTRIBUTION:An advisory group of people with lived experience of MoWs (users of the service and family referrers) participated in the workshops, extensively discussed the findings of earlier research, co-produced the knowledge translation resources, and advised on the implications and future dissemination steps. The group also provided informal feedback on a draft of this manuscript.

Despite a recognition that research evidence plays a critical role in informing decisions in adult social care, there has been little investment in developing the sector's own capacity to engage with it. This article reports on a qualitative study of the adult social care workforce (social workers, occupational therapists, managers and commissioners) in three local authorities in England. Data were collected through twenty-five semi-structured interviews with key stakeholders and analysed iteratively using thematic analysis. The interviews explored participants' understanding and use of research in adult social care. Four key influences on research use were identified: time; accessibility; skills and confidence; and organisational support. Finding time was the most frequently cited barrier. This was exacerbated by the difficulties participants described in finding research that was trusted and relevant. Protected time was regarded as essential, and both organisations and individuals had a role in ensuring that time was available to engage with research. Participants identified skills gaps, including how to read, critically appraise and apply evidence from research. The findings confirm an appetite within the workforce for developing the skills and confidence to make more use of research but suggest that achieving this requires organisational support and access to resources. Although research is known to be important for all those who make decisions in adult social care, there has been little investment in strengthening its use. Researchers working with three local authorities explored what social care staff understand about research and how they used it. They found four main influences: (1) time, (2) ease of access, (3) skills and confidence and (4) support from their organisation. Not having enough time to use research was mentioned most often, but being able to find relevant research that they can trust is also difficult. Those interviewed said they would like to use research more but needed to learn new skills to use it well. These skills include how to read and judge research. They also identified a need for protected time and strategies to use that time more effectively.

Background:Despite calls for greater use of research and an appetite to do so within adult social care, a gap persists between research and practice. Aims and objectives:To explore views of adult social care staff about research and its application to everyday practice. To understand how these might impact upon research use capacity-building initiatives within adult social care organisations. Methods:Thematic analysis of semi-structured qualitative interviews with 25 staff members working within the adult social care departments of three English local authorities. Findings:Participants characterised research as feeling separate from practice. They reflected on their use of it in relation to pressures affecting adult social care and identified a lack of relevant research. Research benefiting service users, supporting individual practice or informing organisational decision-making was considered useful. However, research could also be viewed as a luxury where its findings were felt to represent an 'ideal' rather than real world of practice or did not accord with practice knowledge or local experience. Discussion and conclusions:While participants feel positively towards research, there remains a gap between these perceptions and its use in practice. There remains a need to improve research relevance and accessibility and to clarify its role in decision-making in social care, including where there is no evidence, where evidence challenges existing practice, or where the evidence base is growing. Collaborative partnerships between adult social care organisations, researchers and service users could help to narrow the research-practice gap and support the routine translation of research to practice.

Emerging research suggests autistic people are disproportionately represented in homeless populations. Less is known about how autistic people experience homelessness and what prevents them from exiting homelessness. This article presents findings from a narrative enquiry investigating the link between autism and homelessness. Ten autistic adults consented to participate in narrative interviews which explored their life histories and pathways through homelessness. This article considers how participants experienced rough sleeping and sofa surfing before attempting to access hostels. It then examines how participants navigated support systems, arguing that barriers to accessing services perpetuated homelessness. Because of these barriers, some participants disengaged with services, preferring to sleep rough. The extent to which participants could be said to have ‘chosen’ homelessness is balanced with consideration of the lack of autonomy autistic adults are able to exercise over their lives. This article concludes with discussion of practical implications for services and policy in England. Lay Abstract Recent research suggests many autistic people experience homelessness. However, little is known about the types of homelessness autistic people experience and what barriers autistic people face when trying to exit homelessness. This study involved gathering life stories of autistic people who had experienced homelessness. Ten autistic participants talked about their pathways through homelessness and the difficulties they had in accessing support. After first becoming homeless, participants tended to experience rough sleeping and sofa surfing. When participants approached housing and homelessness services, they were often told they were not eligible for support. This could happen when support workers were not aware of autism, or when autism was not considered ‘severe’ enough. Overcrowding, confrontation and lack of control over routine and environment were particular issues for participants when they entered homelessness hostels. Some participants chose to sleep on the streets rather than stay in environments which increased social anxiety and sensory difficulties. This study discusses ways in which homelessness and housing services can increase accessibility and improve engagement for autistic people. It is important to increase awareness of autism while understanding that autistic people who experience homelessness may have complex needs. In addition, services need to listen to autistic people with lived experience of homelessness to decide what changes will have the most impact.

The COVID-19 pandemic and the lockdown measures imposed as a result affected the lives of people in all parts of society across the world. In 2020, during the first UK national lockdown, older adults (aged 70 years and over) were told to 'shield' within their homes, as they were regarded as being at higher risk of serious COVID-19 infection compared to other age groups. This paper explores older adults' experiences of COVID-19 lockdown measures whilst living in housing with care schemes for older people. The purpose is to examine the impact of the lockdown measures on scheme life including social connections amongst residents and their general everyday wellbeing during this time. We present qualitative findings based on interviews with 72 residents who took part in longitudinal and cross-sectional interviews across 26 housing with care schemes. Data were analysed using a thematic framework approach to examine specifically their experiences of living in housing with care schemes during the 2020 UK lockdown. The paper highlights that COVID-19 restrictions had a detrimental impact on the social connections and interactions of older residents living in housing with care schemes, as well as on their feelings of autonomy and independence. Despite this, residents adapted and coped with self-isolation restrictions and sought out positive ways to maintain social contact with others inside and outside to the scheme. We further highlight the tensions that providers of housing for older adults faced in promoting residents' autonomy and connectedness whilst also trying to provide a safe living environment and protect residents from risk of COVID-19 infection. Our findings apply not only to a pandemic situation but to the broader understanding of how housing with care for older adults must navigate between autonomy and support.

COVID-19 lockdown and social distancing measures have restricted funerals and memorial events and have limited the face-to-face social networks that grieving people might normally be able to draw upon for emotional support. However, while there is considerable expert informed speculation about the impacts of grief and "COVID bereavement", detailed accounts of experiences of bereavement and bereavement support during the pandemic have the potential to enrich and provide nuance and subtlety to the evidence base. This paper draws on diary accounts of bereavement support volunteers in the UK, who have been providing support for the bereaved through these challenging times. These reveal layers of complexity to the experiences of loss, grief and bereavement during these extraordinary times. However, they also point to a number of additional themes that lend a more positive valence to the suspension of normal social expectations and memorial practices associated with the pandemic, which, we argue should be reflected upon for their potential to address the discontents of contemporary governance of end of life and bereavement.

There is a widespread view amongst policy makers, as well as some senior managers and commissioners in local authorities, that collective forms of day care for older people are outdated and not aligned with wider policy ambitions. However, there is also growing recognition, amongst advocacy organisations such as Carers UK and Age UK, that many older people and their caregivers would welcome the opportunity to attend collective day care services, as well as growing interest amongst providers of services and older people themselves about the need to transform provision. As health and social care commissioners in England develop Integrated Care Systems, there is potential for reimagined day care for older people to play an important role in delivering person-centred, preventative and place-based care for older people and their caregivers, including enabling older people to live at home for longer as well as addressing wellbeing, loneliness and social isolation. The presentation will outline findings from case studies visited as part of a National Institute for Health Research, School for Social Care Research study exploring the experiences of and aspirations for collective day care in England, from the perspectives of older people, their carers, those who work in or manage services, as well as local stakeholders from the health and care system. For this research, day care is defined as community building-based services that provide care and/or health related services and/or clubs and activities specifically for older people (65+) with care and support needs. Case studies visited included a range of models of day care for older people including day centres for people living with dementia, small-scale day care based in a hosts home, to large-scale preventative provision for older people. The study explored: peoples experiences of attending; impact on wellbeing and health of older people and their caregivers; what an ideal model of day care would look like; experiences of day care through the COVID-19 pandemic; and relationships with local health and community partners. Our findings highlight the role day care can play in providing opportunities for connection and friendship for older people who attend, supporting caregivers to sustain their caring role, and supporting physical and mental wellbeing and health of older people and their caregivers. Highlighting the importance of personal connections, joy and purposeful activity, design of the physical space and connections with local place, the presentation will discuss innovations in practice that may support a ‘reimagining of day care’, ensuring it meets the aspirations of older people and their caregivers, as well as supporting wider policy ambitions including how social care services can contribute to the wider preventative health agenda.

The adult social care sector in England has been encouraged to increase the role of volunteers in service delivery. To understand the volunteer role in care delivery and its impact upon paid care work, we undertook 94 qualitative interviews in seven care settings for older people in England. While the boundaries between care worker and volunteer were clearly established in some organisations, they were more indistinguishable in others. We discuss how both clear and murky boundary making, especially regarding ‘emotional’ and ‘bodily’ aspects of care, can contribute towards paid care work’s invisibility, lack of recognition and poor remuneration.

Faced with unprecedented challenges, the adult social care sector in England has seen increasing attention given to the potential of volunteers to contribute to service provision. This article reports the findings of a qualitative study that explored the contribution made by volunteers to social care services for older people. The article draws attention to the difficulties associated with recruiting and training volunteers to work in the sector, particularly during a period of reduced public expenditure, which is putting the sector under strain. Given the challenges faced, the article considers whether it is appropriate to involve volunteers in care work.