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COVID-19 has posed serious challenges for informal carers living in the UK. This article examines some of the specific challenges facing carers and the resources they used to manage them throughout the first UK lockdown. We used a framework approach to analyse naturalistic, longitudinal data from 30 carers taking part in 96 of Mobilise’s daily Virtual Cuppas between March and July 2020. We found that lack of information and social restrictions cumulatively impacted carers’ sense of certainty, control and motivation. This took an emotional toll on the carers, leading to exhaustion and burden. However, carers quickly established new routines and used humour and self-care to actively manage their wellbeing. Carers received support but also provided it to those in need, including fellow members of the caregiving community, supporting an ecological approach to carer resilience. Our findings may be used to anticipate challenges and promote protective resilience resources in future lockdowns.

This policy report presents new research evidence on the provision of inclusive housing schemes for older people, which finds that:• HCS schemes work well in counteracting social isolation and preventing loneliness among older residents• Pockets of isolation still exist among some residents, particularly people from social minoritiesThis report also identifies the interpersonal, organisational, physical and environmental factors that help promote social inclusion in HCS for older people, including supportive neighbour relations; on-site staff presence; inclusion with the local area; listening to the views of residents; inclusive and age-friendly design; adequate digital infrastructure; and a supportive policy environment. Using these new insights, we outline the ways in which national government; local councils, commissioners and designers; and housing providers, scheme management and staff can address discrimination and create more inclusive, age-friendly environments to support us as we get older.

BackgroundAssistive technology and telecare have been promoted to manage the risks associated with independent living for people with dementia, but there is limited evidence of their effectiveness.ObjectivesThis trial aimed to establish whether or not assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated.DesignThis was a pragmatic, randomised controlled trial. Blinding was not undertaken as it was not feasible to do so. All consenting participants were included in an intention-to-treat analysis.SettingThis trial was set in 12 councils in England with adult social services responsibilities.ParticipantsParticipants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare.InterventionsParticipants were randomly assigned to receive either assistive technology and telecare recommended by a health or social care professional to meet their assessed needs (a full assistive technology and telecare package) or a pendant alarm, non-monitored smoke and carbon monoxide detectors and a key safe (a basic assistive technology and telecare package).Main outcome measuresThe primary outcomes were time to admission to care and cost-effectiveness. Secondary outcomes assessed caregivers using the 10-item Center for Epidemiological Studies Depression Scale, the State–Trait Anxiety Inventory 6-item scale and the Zarit Burden Interview.ResultsOf 495 participants, 248 were randomised to receive full assistive technology and telecare and 247 received the limited control. Comparing the assistive technology and telecare group with the control group, the hazard ratio for institutionalisation was 0.76 (95% confidence interval 0.58 to 1.01;p = 0.054). After adjusting for an imbalance in the baseline activities of daily living score between trial arms, the hazard ratio was 0.84 (95% confidence interval 0.63 to 1.12;p = 0.20). At 104 weeks, there were no significant differences between groups in health and social care resource use costs (intervention group – control group difference: mean –£909, 95% confidence interval –£5336 to £3345) or in societal costs (intervention group – control group difference: mean –£3545; 95% confidence interval –£13,914 to £6581). At 104 weeks, based on quality-adjusted life-years derived from the participant-rated EuroQol-5 Dimensions questionnaire, the intervention group had 0.105 (95% confidence interval –0.204 to –0.007) fewer quality-adjusted life-years than the control group. The number of quality-adjusted life-years derived from the proxy-rated EuroQol-5 Dimensions questionnaire did not differ between groups. Caregiver outcomes did not differ between groups over 24 weeks.LimitationsCompliance with the assigned trial arm was variable, as was the quality of assistive technology and telecare needs assessments. Attrition from assessments led to data loss additional to that attributable to care home admission and censoring events.ConclusionsA full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare. Use of the full assistive technology and telecare package did not increase participants’ health and social care or societal costs. Quality-adjusted life-years based on participants’ EuroQol-5 Dimensions questionnaire responses were reduced in the intervention group compared with the control group; groups did not differ in the number of quality-adjusted life-years based on the proxy-rated EuroQol-5 Dimensions questionnaire.Future workFuture work could examine whether or not improved assessment that is more personalised to an individual is beneficial.Trial registrationCurrent Controlled Trials ISRCTN86537017.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 25, No. 19. See the NIHR Journals Library website for further project information.

BackgroundPolicy makers and care providers see assistive technology and telecare as potential products to support people with dementia to live independently in their homes and communities. Previous research rarely examined how people with dementia and their caregivers actually use such technology. The study examined how and why people living with dementia and their caregivers used assistive technology and telecare in their own homes.MethodsThis study used an ethnographic design embedded within the NIHR-funded Assistive Technology and Telecare to maintain Independent Living At home for people with dementia (ATTILA) randomised controlled trial. We collected 208 h of observational data on situated practices of ten people with dementia and their ten caregivers. We used this data to construct extended cases to explain how technologies supported people with dementia in home and community settings.ResultsWe identified three themes: placing technology in care, which illustrates how people with dementia and caregivers ‘fit’ technology into their homes and routines; replacing care with technology, which shows how caregivers replaced normal care practices with ones mediated through technologies; and technology displacing care and everyday life, which highlights how technologies disrupted the everyday lives of people with dementia.DiscussionThis study exemplifies unintended and unanticipated consequences for assistive technology and telecare uptake in ‘real world’ community-based dementia care. It underlines the need to identify and map the context of technological provision over time within the changing lives of people with dementia and their caregivers.

Purpose This paper is a conceptual discussion of the ways in which the diverse lives, identities and collective politics of lesbian, gay and bisexual (LGB) people can be made visible, and how they are made visible, in long-term care environments for older people. The purpose of this paper is to problematise strategies of visibility as methods for promoting social inclusion in care environments. Design/methodology/approach This is a conceptual discussion that draws on several social theorists that have previously discussed the politics of visibility, knowledge and sexuality. Findings Promoting increased visibility in itself does not fully grapple with the ways in which older LGB can be represented and known as particular kinds of sexual citizens. This potentially curtails a more holistic recognition of their needs, interests and wishes, inclusive of their sexual lives and histories. Making LGB lives visible in care environments may not always be a productive or affirmative strategy for dismantling homophobic views and beliefs. Practical implications The theoretical implications of a politics of visibility warrant a deeper consideration of strategies for promoting visibility. The paper concludes with a discussion of some of the practical implications for rethinking strategies of visibility in care environments. Originality/value Critical discussions about the application of visibility strategies, and the problematic assumptions contained within such strategies, are lacking in relation to mainstream housing and social care provision for older LGB people. This paper seeks to initiate this important discussion.

Purpose The purpose of this paper is to explore the potential of housing with care schemes to act as community hubs. The analysis highlights a range of benefits, barriers and facilitators. Design/methodology/approach Data are presented from the Adult Social Services Environments and Settings project which used a mixed methods approach including a review of the literature, surveys and in-depth case study interviews. Findings Most housing with care schemes have a restaurant or café, communal lounge, garden, hairdresser, activity room and laundrette, while many also have a library, gym, computer access and a shop. Many of these facilities are open not just to residents but also to the wider community, reflecting a more integrated approach to community health and adult social care, by sharing access to primary health care and social services between people living in the scheme and those living nearby. Potential benefits of this approach include the integration of older people’s housing, reduced isolation and increased cost effectiveness of local services through economies of scale and by maximising preventative approaches to health and wellbeing. Successful implementation of the model depends on a range of criteria including being located within or close to a residential area and having on-site facilities that are accessible to the public. Originality/value This paper is part of a very new literature on community hub models of housing with care in the UK. In the light of new requirements under the Care Act to better coordinate community services, it provides insights into how this approach can work and offers an analysis of the benefits and challenges that will be of interest to commissioners and providers as well as planners. This was a small scale research project based on four case studies. Caution should be taken when considering the findings in different settings.

Affect holds the promise of destabilizing and unsettling us, as organizational subjects, into new states of being. It can shed light on many aspects of work and organization, with implications both within and beyond organization studies. Affect theory holds the potential to generate exciting new insights for the study of organizations, theoretically, methodologically and politically. This Special Issue seeks to explore these potential trajectories. We are pleased to present five contributions that develop such ideas, drawing on a wide variety of approaches, and invoking new perspectives on the organizations we study and inhabit. As this Special Issue demonstrates, the world of work offers an exciting landscape for studying the â pulsing refrains of affectâ that accompany our lived experiences. peer-reviewed

This article critically examines a 21st century online, social movement, the Everyday Sexism Project (referred to as the ESP), to analyse resistance against sexism that is systemic, entrenched and institutionalized in society, including organizations. Our motivating questions are: what new forms of feminist organizing are developing to resist sexism and what are the implications of thinking ethico-politically about feminist resistance that has the goals of social justice, equality and fairness? Reading the ESP in this way leads to a conceptualization of how infrapolitical feminist resistance emerges at grassroots level and between individuals in the form of affective solidarity, which become necessary in challenging neoliberal threats to women’s opportunity and equality. Our contribution conceptualizes affective solidarity as central to this feminist resistance against sexism and involves two modes of feminist organizing: the politics of experience and empathy. By addressing the ethical and political demands of solidarity we can build resurgent, politically vibrant feminist organizing and resistance that mobilizes feminist consciousness and builds momentum for change. Our conclusion is that an ethico-politics of feminist resistance moves away from individualizing experiences of sexism towards collective resistance and organizes solidarity, experience and empathy that may combat ignorance and violence towards women.

Purpose – For the vast majority of cisgendered people who experience alignment between the sex they were assigned at birth, the body they have and their gender identity they are comfortable with (Schilt and Westbrook, 2009), the experience of trans people is a distant one. More of us share an experience of aging and the associated concerns about reduced independence, deterioration of health and increased need for care and support. The paper aims to discuss these issues. Design/methodology/approach – For trans elders, the experience of aging has specific features that have a major impact on their lives if not understood, planned for and responded to appropriately. This paper presents findings from a qualitative study exploring trans peoples experiences, concerns and suggestions for how agencies providing elder care can better meet their expectations (Jones, 2013). Findings – The research revealed low confidence in the ability of current aged care services to meet the needs of trans elders due to a limited understanding of the relationship between health and social care specific to trans people; undervaluing the networks in trans people’s lives; the need to demonstrate culturally competent services and real concerns regarding tackling discrimination and abuse. Despite legislative advancements, there was a sense that activism is central to tackling these issues and trans people are articulating their demands for shaping future provision. The research identifies a number of recommendations for care providers and future areas of research. Originality/value – In response to identifying an absence of trans voices being heard on the subject of trans elder care, this study sought to understand expectations of services, amplify the voices of the participants and share the priorities they articulated to influence future service design and practice.

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Background: Older lesbian, gay, bisexual and trans (LGBT) residents are often invisible in long-term care settings. This article presents findings from a community-based action research project, which attempted to address this invisibility through co-produced research with LGBT community members. Particular Question: What conditions enable co-produced research to emerge in long-term residential care settings for older people? \ud \ud Aims of Project: To analyse outcomes and challenges of action-oriented, co-produced research in the given context. In particular, we explore how co-production as a collaborative approach to action-orientated research can emerge during the research/fieldwork process; and reflect critically on the ethics and effectiveness of this approach in advancing inclusion in context. \ud \ud Methods: The project was implemented across six residential care homes in England. Reflections are based on qualitative evaluation data gathered pre- and postproject, which includes 37 interviews with care home staff, managers and community advisors (two of whom are co-authors). \ud \ud Results and Conclusions: We discuss how the co-production turn emerged during research and evaluate how the politics of this approach helped advance inclusion—itself crucial to well-being. We argue for the value of co-produced research in instigating organizational change in older people’s care environments and of non-didactic storytelling in LGBT awareness raising amongst staff.

There have been substantial achievements in legislative and human rights for lesbian, gay, bisexual and transgender (LGBT) older people and their visibility in health and social care has equally increased. These appear to have surpassed the ability of care services to meet their needs given documented concerns about the accessibility, inclusiveness and safety of care services particularly institutionalised care. This requires systemic change not easy to operationalise. This paper describes an action research initiative where six care homes belonging to a national care provider, collaborated to assess and develop their services with the support of local LGBT “Community Advisors” and academic partners. Framed within Rogers’ (2003) change management framework and combined with a participatory leadership approach, a programme of intervention was implemented comprising structured activities around seven key areas thought to promote LGBT inclusion. A formal evaluation was conducted involving 35 pre- and post-intervention qualitative interviews with 18 people (community advisors; care home managers and senior managers). The findings are presented across three key themes (1) starting points on the journey; (2) challenges encountered along the journey (organisational and interpersonal); and (3) making change happen; opportunities, initiatives and gains. We make recommendations on the value of a programme approach for achieving tangible outcomes that demonstrate increased inclusion for older LGBT people living in long-term care settings.

Purpose The purpose of this paper is to provide an overview of the process of commissioning adult social care services in England. It reflects the literature on commissioning at the strategic level followed by a section on operational or micro-commissioning. The rest of the paper focusses on the emergence of ideas about outcomes-based commissioning (OBC) in the field of adult social care and ends with critical consideration of the effectiveness of OBC in adult social care as applied to support and care provided in extra care housing. Design/methodology/approach The review of strategic and operational commissioning in adult social care in England (and Scotland in brief) is based on both policy documents and a review of the literature, as are the sources addressing OBC in adult social care particularly in extra care housing settings. Findings The core of this paper focusses on the challenges to the implementation of OBC in adult social care in the context of provision for residents in extra care housing. Of central importance are the impact of the squeeze on funding, increasing costs as a result of demographic change and the introduction of a national living wage plus the focus on the needs of service users through the idea of person-centred care and resistance to change on the part of adult social care staff and workers in other relevant settings. Originality/value Addressing the implementation of OBC in adult social care in England in the context of extra care housing.

© 2016, © The Author(s) 2016. This article presents data from a comprehensive study of hyper flexible and precarious work in the service sector. A series of interviews were conducted with self-employed personal trainers along with more than 200 hours of participant observation within fitness centres in the UK. Analysis of the data reveals a new form of hyper flexible and precarious work that is labelled neo-villeiny in this article. Neo-villeiny is characterized by four features: bondage to the organization; payment of rent to the organization; no guarantee of any income; and extensive unpaid and speculative work that is highly beneficial to the organization. The neo-villeiny of the self-employed personal trainer offers the fitness centre all of the benefits associated with hyper flexible work, but also mitigates the detrimental outcomes associated with precarious work. The article considers the potential for adoption of this new form of hyper flexible and precarious work across the broader service sector.

This article discusses findings from a qualitative longitudinal study of dignity in later life, which focused on the perspectives of older people at a time when their need for help and support was increasing as a result of long-term illness. It reflects critically on the methodology for its ability to generate knowledge about this eventful and unstable period of the life-course. It is argued that a longitudinal qualitative approach provides the optimum conditions for researching older people’s perspectives on their health and illness as well as on their experiences of being helped and supported. It sheds light on the changes they faced in their relationships, their home environments and their daily lives as well as how they dealt with these changes while maintaining their dignity.

Purpose – The purpose of this paper is to problematise the notion of woman-as-monster and draws together a conceptual analysis of the monstrous-feminine and its relation to maternal and monstrous bodies including its implications for equality and inclusion in the workplace. Design/methodology/approach – Whilst exploring how female monsters are inextricably tied to their sexual difference, the author draws on social and psychoanalytic perspectives to suggest how such monstrosity is expressed through ambivalence to the maternal. The author analyses two “faces” of the monstrous-feminine in particular: the archaic mother and the monstrous womb (Creed, 1993) and develop this discussion in relation to the potential for a feminist monstrous politics of organisation. Findings – First, the author exposes the basis on which the monstrous-feminine articulates and disarticulates femininity, that is to say, how a feminist analysis of monsters may enable but also foreclose a positive articulation of disruption, disorder and disorganisation central to the conceptualisation of monsters. This is done through a reading of the maternal-feminine and literature on motherhood in organisation studies. Second, the author locates the monstrous-feminine in the body and explores how maternal bodies are constructed and experienced as monstrous as they disrupt the self/other relationship. This analysis suggests that embodying the monster comes with risks and that different configurations of the monstrous maternal are necessary for equality and inclusion in the workplace. Originality/value – The paper identifies and contributes to growing research on the ambivalence of monsters and expands a neglected area of the feminine and maternal aspects of these relationships and what this means for workplace relations.

Purpose– The purpose of this paper is to provide an update to a review of the joint working literature in the field of health and social care for adults, with particular emphasis given to the experiences of users and carers.Design/methodology/approach– The aims of the literature review remained largely the same as those of the original, they were to identify: models of joint working, evidence of effectiveness and cost-effectiveness and the factors promoting or hindering the models. However, to reflect the growing interest in the experiences of users and carers a fourth aim was added to map these experiences. Given their prominence in terms of policy debates about integration, the review focused on jointly organised services for older people and people with mental health problems in the UK only.Findings– The review demonstrates tentative signs that some initiatives designed to join-up or integrate services can deliver outcomes desired by government. Importantly some studies that report the experiences of users of services and carers suggest that they perceive benefits from efforts to join-up or integrate services. However it is our contention that the evidence is less than compelling and does not justify the faith invested in the strategy by current or previous governments.Originality/value– The study updates our knowledge of the impact of joint working in the field of health and social care for adults. Importantly the paper highlights what is known about the experiences of users and carers of joint/integrated services.

Joint working between local authorities and the National Health Service (NHS) has been an integral part of health and social care policy in the United Kingdom for many years. Using evidence from two literature reviews this paper argues that there is little indication that joint working delivers the outcomes envisaged in policy. While recent reforms may be beginning to influence improvements, they are undermined by constant reform and professional scepticism.