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8. Community care experiments for frail older people : two care management programmes evaluated

Author

Chesterman, John Francis

Subjects
362.6, H Social Sciences (General)
Abstract

The inadequacy of community-based services for frail older people in the 1970s pointed to the need for providing co-ordinated care responsive to multiple needs. The fully evaluated Kent Community Care Project (KCCP), a care management experiment which pioneered this new approach, successfully maintained users for longer at home with enhanced quality of life at no additional cost. While the KCCP benefited from intensive support from the evaluation team, there was a need to investigate whether schemes set up in other areas could be successful when the promotion of good practice was limited to that provided by the agency. The schemes evaluated in this study were early replications of the KCCP in two contrasting parts of Kent. County-wide mechanisms were set up to encourage good practice, such as regular meetings of field staff and managers on policy and practice issues, a working group to develop procedures, peer review and monitoring and feedback. A full cost-effectiveness analysis was undertaken on each of the two schemes using a quasi-experimental design with before/after evaluation interviews on matched experimental and control groups over a one year period which was costed. Both schemes successfully maintained users at home for significantly longer, and achieved significant improvements in quality of life, quality of care and health status, though less striking than in the KCCP, again at no additional cost. However, they differed from the KCCP in causing a considerable shift in expenditure from health services to social services, with a consequent striking reduction in hospital bed-blocking as well as care home use. Cost-outcomes analyses suggested that budget caps were too generous for resources to be deployed most efficiently. Because this study took place during the early 1980s, it has been treated largely in its historical context. Nevertheless, the investigation also suggests some important ways in which the current practice of post-reform care management might be improved.

Published
2003
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10. Costs and Outcomes of Care

Author

Challis, David, primary, Chesterman, John, additional, Luckett, Rosemary, additional, Stewart, Karen, additional, and Chessum, Rosemary, additional

Published
2018
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14. Outcomes for Older People

Author

Challis, David, primary, Chesterman, John, additional, Luckett, Rosemary, additional, Stewart, Karen, additional, and Chessum, Rosemary, additional

Published
2018
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15. Outcomes for Carers

Author

Challis, David, primary, Chesterman, John, additional, Luckett, Rosemary, additional, Stewart, Karen, additional, and Chessum, Rosemary, additional

Published
2018
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22. Consistency

Author

Bauld, Linda, primary, Chesterman, John, additional, Davies, Bleddyn, additional, Judge, Ken, additional, and Mangalore, Roshni, additional

Published
2018
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23. Outcomes for Users

Author

Bauld, Linda, primary, Chesterman, John, additional, Davies, Bleddyn, additional, Judge, Ken, additional, and Mangalore, Roshni, additional

Published
2018
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24. Care Management

Author

Bauld, Linda, primary, Chesterman, John, additional, Davies, Bleddyn, additional, Judge, Ken, additional, and Mangalore, Roshni, additional

Published
2018
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26. Origins, Design and Context

Author

Bauld, Linda, primary, Chesterman, John, additional, Davies, Bleddyn, additional, Judge, Ken, additional, and Mangalore, Roshni, additional

Published
2018
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29. Informal Carer Inputs

Author

Bauld, Linda, primary, Chesterman, John, additional, Davies, Bleddyn, additional, Judge, Ken, additional, and Mangalore, Roshni, additional

Published
2018
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30. Outcomes for Carers

Author

Bauld, Linda, primary, Chesterman, John, additional, Davies, Bleddyn, additional, Judge, Ken, additional, and Mangalore, Roshni, additional

Published
2018
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31. Caring For Older People

Author

Bauld, Linda, primary, Chesterman, John, additional, Davies, Bleddyn, additional, Judge, Ken, additional, and Mangalore, Roshni, additional

Published
2018
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35. Supporting the Involvement of Adults with Cognitive Disabilities in Research: The Need for Reform.

Author

Shih-Ning Then, Chesterman, John, and Matsuyama, Yuu

Subjects
PATIENT autonomy, HUMAN research subjects, PATIENT-centered care, COGNITION disorders, CONCEPTUAL structures, MEDICAL research, PATIENT decision making, PATIENT participation, ADULTS
Abstract

This article examines current legal and ethical requirements concerning research about adults with cognitive disabilities. These requirements, the article argues, are complex, difficult to navigate, and inevitably act as a disincentive for research to be conducted. These requirements also do little to encourage active involvement by adults with cognitive disabilities in deciding whether to participate in research. The article argues that reforms are needed for State and Territory laws to require, wherever possible, adults to be supported to make their own decisions about research participation. State and Territory law reform is also required to clarify when, and on what basis, others may be appointed to make research participation decisions on behalf of adults with cognitive disabilities. The article concludes by seeking complementary reform of the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research, which would result in it being more human rights compliant and simpler to apply. [ABSTRACT FROM AUTHOR]

Published
2023

46. The Review of Victoria's Guardianship Legislation: State Policy Development in an Age of Human Rights

Author

Chesterman, John

Subjects
Human rights, Disabled persons, Government
Abstract

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-8500.2010.00670.x Byline: John Chesterman (*) Keywords: human rights; guardianship; disabilities Abstract: This article considers the Victorian government's decision to review the state's guardianship legislation and notes the significant place international human rights developments are playing in that review. The article recognises the opportunities these developments present for reworking the guardianship legislation to increase the autonomy and decision-making power of people with disabilities, but also considers the challenge these developments present to ensuring that society continues to protect its most vulnerable citizens. Author Affiliation: (*)Office of the Public Advocate, Victoria

Published
2010

49. National Policy-Making in Indigenous Affairs: Blueprint for an Indigenous Review Council

Author

Chesterman, John

Subjects
Australian aborigines, Government
Abstract

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-8500.2008.00599.x Byline: John Chesterman (1) Keywords: ATSIC; indigenous governance; indigenous review council; national policy-making Abstract: This article examines the dearth of any representative Indigenous role in national Indigenous affairs policy-making and suggests a remedy. After making the case for a specific Indigenous place in national policy-making, the article considers the reasons for the failure of the Aboriginal and Torres Strait Islander Commission (ATSIC), the body that filled this brief for a decade and a half. The article then considers three possible ways of ensuring an Indigenous role in the policy-making process: a replacement for ATSIC with specific policy powers; set seats for Indigenous representatives in federal parliament; and the creation of a new elected body whose role would be to review Indigenous affairs legislation. The article concludes that the latter proposal in particular is worth trialling as it would ensure a significant Indigenous voice in national policy-making while learning from the mistakes that led to ATSIC's demise. Author Affiliation: (*)University of Melbourne

Published
2008

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