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Background and Objectives In many countries, a large proportion of long-term care staff are paid at, or near, minimum wage, leading to concerns of negative effects on care outcomes. This study analysed the effect of staff wages on care home quality ratings in England. Research Design and Methods A national staffing database of long-term care providers was matched with local area information on needs and supply to construct a three-year panel (2016-2018) of English care home observations. Using multiple imputation methods to address missing data provided a dataset of 12,055 observations of 5,556 care facilities (both residential and nursing homes). We analysed the effect of facility-level average hourly wage of care staff on national regulator quality ratings. A measure of impact of exogenous changes in national minimum wage on care facilities was used as an instrument for wage. Results We find that wages positively impact on care home quality ratings. Other things equal, a 10% increase in average hourly wage of direct care workers would lead to a 7.1% increase in the likelihood that a care home will have a high quality rating. The wage effect on quality was significant when controlling for staff skill mix, i.e., share of registered nurses in nursing home staff. Discussion and Implications This study provides important evidence on the positive impact that staff pay can have on the quality of long-term care. Our finding has important implications about appropriate levels of pay and the funding of long-term care.

Purpose We developed preference weights of the Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer) in Japan. Methods We used best–worst scaling (BWS) and composite time trade-off (cTTO) to determine the preference weights for ASCOT-Carer states in the general population. TTO values were applied to convert the BWS scores to utilities. The sample number was approximately 1000 for the BWS survey and 200 for the TTO survey. Whereas face-to-face surveys by computer-assisted interviewing were adopted for the TTO tasks, a web-based survey was used for the BWS tasks. In the BWS tasks, the ASCOT-Carer states were presented, and the “best,” “worst,” “second best,” and “second worst” domains in a profile were selected. A mixed logit model was applied to the BWS data. Results The respondents’ background was similar to that of the general population, although the number of people in the age and sex categories was equal. The preference weights for calculating the utilities of the ASCOT-Carer states were estimated. The estimated utilities of the ASCOT-Carer states were distributed between 1 and 0.02. All preference weights were consistent. The item with the highest preference weight was level 1 in the “space and time to be yourself.” The least preferred item was level 4 in the “space and time to be yourself” and “control over daily life” domains. Conclusion We established Japanese preference weights for ASCOT-Carer states, the first weights of an Asian country. The estimated utilities can contribute to the measurement of caregivers’ social care-related QoL and perform of cost-effectiveness analyses.

This article reports on a study assessing the incentives and deterrents to long-term care (LTC) supply in two local markets in England. The supply of LTC in many countries is facing the issues of rising demand, (lack of) workforce and the interaction of the public and private sectors. Findings from qualitative interviews of local council and provider stakeholders exploring barriers and enablers faced by LTC providers in two local authorities (LAs) are presented and discussed. The interviews provided insight in three main areas: staffing, demand and stakeholder relationships. Staffing, in particular, is crucial and we found that there are many difficulties for providers in maintaining their workforce. Consistent with previous research, we also found that public spending levels on LTC puts pressure on providers striving to maintain a good quality service, including improved remuneration of staff.

Unnecessarily prolonged stays in hospitals can have negative impacts on patients and present avoidable costs to health and social care systems. This paper presents the qualitative findings of a multi-methods study of the social care causes of delayed transfers of care (DTOC) for older people in England. The quantitative strand of this study found that DTOC are significantly affected by homecare supply. In this paper, we explore in depth how and why social care capacity factors lead to delays, from the perspectives of those working within the system. We examined the local transfer arrangements in six English local authority (LA) sites that were purposively sampled to include a range of DTOC performance and LA characteristics. Between March and December 2018, 52 professionals involved in arranging or facilitating discharge from hospitals in these sites provided qualitative data, primarily through semi-structured interviews. Topics included discharge teams and processes, strategic issues and perceived causes of delays. The thematic analysis uncovered the nuances behind the causes of DTOC previously categorised broadly as 'provider capacity' and 'patient choice'. In particular, our analysis highlights the lack of fit between available provision and the needs of people leaving hospital (theme 1); workforce inconsistencies (theme 2) and a myth of patient choice (theme 3). We are now at a turning point in the development of policy to reduce DTOC in the English system, with the full implications of a new national discharge to assess programme yet to be seen. Our research shows the significance of the alignment of service capacity, including the type and location of provision, with the needs and preferences of those leaving hospital. As the new system becomes established, attendance to such nuances behind blockages in the system will be more important than ever.

This paper examines the association between workforce retention and related staffing measures and the quality of English care homes using a national database of social care providers’ staffing. The analysis finds significant correlations between quality and the levels of staffing vacancies and retention of both residential and nursing homes, but no association was found between quality and the use of temporary contract workers nor the resident to staff ratio. Only for staff vacancy rates was there a significant difference in the size of these relationships between types of home. The findings suggest that quality could change for the average care home with a relatively small alteration in staffing circumstance. Long-term care is a labor-intensive industry and many countries face relatively high levels of staff turnover and job vacancy rates. These findings are therefore of interest for policy internationally and for England in particular, where the development of social care recruitment and retention strategies are ongoing.

The increase in the National Minimum Wage rate in October 2015 and the introduction of the National Living Wage in April 2016 led, in a short period of time, to an aggregated increase in the wage floor of over 10 per cent for workers in England aged 25 and over. The long‐term care (LTC) sector is a labour intensive, low pay sector, and as such, can be substantially affected by changes in minimum wage. We assessed the effects of this exogenous wage increase on independent LTC providers by looking at effects on wages, employment, weekly hours, and employment contracts. Using data from the Adult Social Care Workforce Data Set (ASC‐WDS) and applying a ‘before‐after’ analysis, we found that the substantial increase in minimum wage had a strong and positive effect on wages in the LTC sector, but with substantial compression of the wage distribution at the lower end. Although, as in other studies, the employment effect was rather elusive, we found that for care homes this can be partially explained by a negative effect on total weekly hours. We also found positive but short‐term effects on employment without guaranteed working hours (i.e. zero‐hour contracts) for both residential and domiciliary care.

This study presents the first demonstration of the transferability of a convolutional neural network (CNN) trained to detect microseismic events in one fiber-optic distributed acoustic sensing (DAS) data set to other data sets. DAS increasingly is being used for microseismic monitoring in industrial settings, and the dense spatial and temporal sampling provided by these systems produces large data volumes (approximately 650 GB/day for a 2 km long cable sampling at 2000 Hz with a spatial sampling of 1 m), requiring new processing techniques for near-real-time microseismic analysis. We have trained the CNN known as YOLOv3, an object detection algorithm, to detect microseismic events using synthetically generated waveforms with real noise superimposed. The performance of the CNN network is compared to the number of events detected using filtering and amplitude threshold (short-term average/long-term average) detection techniques. In the data set from which the real noise is taken, the network is able to detect >80% of the events identified by manual inspection and 14% more than detected by standard frequency-wavenumber filtering techniques. The false detection rate is approximately 2% or one event every 20 s. In other data sets, with monitoring geometries and conditions previously unseen by the network, >50% of events identified by manual inspection are detected by the CNN.

Fiber-optic distributed acoustic sensing (DAS) cables are now used to monitor microseismicity during hydraulic-fracture stimulations of unconventional gas reservoirs. Unlike geophone arrays, DAS systems are sensitive to uniaxial strain or strain rate along the fiber direction and thus provide a 1C recording, which makes identifying the directionality and polarization of incoming waves difficult. Using synthetic examples, we have shown some fundamental characteristics of microseismic recordings on DAS systems for purposes of hydraulic fracture monitoring in a horizontal well in anisotropic (vertical transverse isotropy [VTI]) shales. We determine that SH arrivals dominate the recorded signals because their polarization is aligned along the horizontal cable at the near offset, although SV will typically dominate for events directly above or below the array. The amplitude of coherent shear-wave (S-wave) arrivals along the cable exhibits a characteristic pattern with bimodal peaks, the width of which relates to the distance of the event from the cable. Furthermore, we find that S-wave splitting recorded on DAS systems can be used to infer the inclination of the incoming waves, overcoming a current limitation of event locations that have constrained events to lie in a horizontal plane. Low-amplitude SV arrivals suggest an event depth similar to that of the DAS cable. Conversely, steep arrivals produce higher amplitude SV-waves, with S-wave splitting increasing with offset along the cable. Finally, we determine how polarity reversals observed in the P and SH phases can be used to provide strong constraints on the source mechanisms.

We present a case study demonstrating the use of an “L”-shaped downhole fibre-optic array to monitor microseismicity. We use a relatively simple method to detect events from continuous waveform data, and develop a workflow for manual event location. Locations are defined with a cylindrical coordinate system, with the horizontal axis of the DAS cable being the axis of symmetry. Events are located using three manual “picks”, constraining (1) the zero-offset “broadside” channel to the event (2) the P-S wave arrival time difference at the broadside channel, and (3) the angle, ? of the event from the array. Because the one-component DAS array is unable to record P-wave energy on the broadside channel, the P-wave pick is made indirectly by ensuring that the modeled P- and S-wave moveout curves match the observed data. The ? angle requires that signal is observed on the vertical part of the array, in our case this is possible because an engineered fiber, rather than standard telecommunications fiber, provided a significant reduction in the noise level. Because only three picks need to be made, our manual approach is significantly more efficient than equivalent manual processing of downhole geophone data, where picks for P- and S-waves must be made for each receiver. We find that the located events define a tight cluster around the injection interval, indicating that this approach provides relatively precise and accurate event locations. A surface microseismic array was also used at this site, which detected significantly fewer events, the locations of which had significantly greater scatter than the DAS array locations. We conclude by examining some other aspects of the DAS microseismic data, including the presence of multiple events within very short time windows, and the presence of converted phases that appear to represent scattering of energy from the hydraulic fractures themselves.

Reforms to social care in response to the COVID-19 pandemic, in the UK and internationally, place data at the heart of proposed innovations and solutions. The principles are not well established of what constitutes core, or minimum, data to support care home residents. Often, what is included privileges data on resident health over day-to-day care priorities and quality of life. This Personal View argues for evidence-based principles on which to base the development of a UK minimum data set (MDS) for care homes. Co-produced work involving care home staff and older people working with stakeholders is required to define and agree the format, content, structure, and operationalisation of the MDS. Implementation decisions will determine the success of the MDS, affecting aspects including data quality, completeness, and usability. Care home staff who collect the data need to benefit from the MDS and see value in their contribution, and residents must derive benefit from data collection and synthesis.

ObjectivesPatients should be discharged from hospital when they are medically fit. However, discharges are often delayed for non-medical reasons including access to social care. One aim of local health and social care partnerships to improve urgent and emergency care in England (known as urgent and emergency care (UEC) vanguards) was to improve integration of health and social care, which could lead to fewer delays. Consequently, we aimed to assess the impact of UEC vanguards on delayed discharges from hospital (delayed transfers of care (DTOC)) in England.DesignUsing a synthetic control estimation method 29 local authorities (LAs) that were UEC vanguards partners were averaged into a single ‘treated’ unit and compared with a unit created using data from LAs that were not UEC vanguards partners to estimate the impact of UEC vanguards on DTOC. Sensitivity analysis included fixed effects panel regressions and various placebo tests.Setting150 LAs in England (excluding city of London and Isles of Scilly); 29 LAs were partners in UEC vanguards between August 2015 and March 2018.Primary outcome measureQuarterly data on days of DTOC at LA level for the period 2010–2017.ResultsSynthetic control estimation showed a large difference in DTOC days between UEC vanguards partner LAs compared with those that were not, with on average 23.7% lower DTOC per quarter (491 DTOC days per quarter). Fixed effect panel regressions found DTOC rates lower by 43.1% (99% CI 13.8% to 72.4%) in UEC partner LAs after the start of the vanguards programme. We found no indication of UEC partner LAs having lower DTOC rates prior to initiation of vanguards.ConclusionsThe evidence indicates a sizeable statistically significant impact of UEC vanguards on DTOC; however, more research is required to explain the underlying reasons for this relationship.

Background: Although multiple sclerosis (MS) confers an elevated risk of acute myocardial infarction (AMI), little is known about how it influences management of AMI. Methods: Using population-based administrative (health) data from two Canadian provinces, we conducted a retrospective matched cohort study. We identified people with MS who had an incident AMI, and up to five AMI controls without MS matched on age, sex, and region. We compared the likelihood of undergoing cardiac catheterization within 30 days of AMI, time to revascularization, use of recommended pharmacotherapy post-AMI, and mortality at 30 and 365 days post-AMI using multivariable regression models adjusting for potential confounders. We pooled findings across provinces using meta-analysis. Results: We identified 559 MS cases and 2523 matched controls. In the matched cohort, the MS cohort was less likely to undergo cardiac catheterization within 30 days of admission (odds ratio (OR) = 0.61; 95% confidence interval (CI) = 0.49–0.77), revascularization (hazard ratio (HR) = 0.78; 95% CI = 0.69–0.88), or to fill a prescription for recommended therapy. Mortality risk was higher in the MS cohort than in the matched cohort at 30 and 365 days post-AMI. Conclusion: Rates of diagnostic and therapeutic care, and survival after AMI were lower in the MS population than in a matched population.

Purpose Research in care homes requires the co-operation of care home managers. Noting the challenges faced by the care home sector, the purpose of this paper is to consider ways in which research studies can encourage care home managers and their homes to participate in research. Design/methodology/approach The discussion is informed by two research projects which are used to explore methods of encouraging managers of care homes to participate in research. One of the studies included interviews with care home managers to understand their reasons for taking part in research. Findings This paper outlines and assesses three strategies for encouraging care home managers to participate in research: working in partnership, providing payment and providing personalised feedback on findings. Whereas all the strategies have the potential to encourage care home managers’ participation in research, partnership working in particular was found to be fraught with difficulties. Research limitations/implications This paper suggests that the research projects could employ any of these strategies to encourage managers of care homes to participate in research. It also suggests that proactive measures could help ameliorate the pitfalls of partnership working. Originality/value This paper shows the advantages and disadvantages of using a combination of strategies for encouraging the participation of care home managers in research.

Objectives: To assess the relationship between Urgent and Emergency Care (UEC) Vanguards, which include as an aim the integration of healthcare and social care sectors, and Delayed Transfers of Care (DTOC) at Local Authority level in England. Methods: Difference-in-difference and fixed effects panel estimations were used to compare DTOC between UEC partner site Local Authorities with non-UEC Local Authorities employing quarterly data on days of DTOC from Local Authorities in England for the period 2010 to 2017. Robustness checks included employing Ordinary Least Squared (OLS) and synthetic control estimations; differences between the UEC and non-UEC sites were checked prior to the start of the Vanguards. Results: A statistically significant negative relationship was found between UEC Vanguards and DTOC rates that is robust to various specification checks with no indication of UEC participant sites having lower DTOC rates prior to the start of the initiative. Conclusions: UEC Vanguards appear to be associated with 40.5% lower DTOC rates at 1% significance level compared with other English Local Authorities. The empirical evidence indicates a statistically significant impact; however, more research is required to explain the reasons for this relationship.

This work quantitatively assesses the potential reasons behind the difference in prices paid by care home residents in England. Evidence suggests that the price paid by private payers is higher than that paid for publicly supported residents, and this is often attributed to the market power wielded by local authorities as the dominant purchaser in local markets. Estimations of private prices at the local authority level are used to assess the difference in price paid between private and public prices, the fees gap, using data from 2008 to 2010. Controlling for local area and average care home characteristics, the results indicate that both care home and local authority market power play a role in the price determination of the market.

Summary Fibre-optic Distributed Acoustic Sensing (DAS) cables are now used to monitor microseismicity during hydraulic fracture stimulations of unconventional gas reservoirs. Unlike geophone arrays, DAS systems are sensitive to uniaxial strain along the fibre direction and thus provide a single-component recording, which makes identifying the directionality of incoming waves difficult to infer. Using synthetic examples, we show some fundamental characteristics of microseismic recordings on DAS systems for purposes of hydraulic fracture monitoring in a horizontal well in anisotropic (VTI) shales. We demonstrate that SH arrivals dominate the recorded signals since their polarization is aligned along the horizontal cable at near offset. The amplitude of the SH phase along the cable exhibits a characteristic pattern with bimodal peaks, the width of which relates to the distance of the event from the cable. Furthermore, we find that shear-wave splitting recorded on DAS systems can be used to infer the inclination of the incoming waves, overcoming a current limitation of event locations which have constrained events to lie in a horizontal plane. Low amplitude qSV arrivals suggest an event depth similar to that of the DAS cable. Conversely, steep arrivals produce higher amplitude qSV waves, with shear-wave splitting increasing with offset along the cable.

Supplemental material, MSJ876038_appendix for Disparities in management and outcomes of myocardial infarction in multiple sclerosis: A matched cohort study by Ruth Ann Marrie, Helen Tremlett, Elaine Kingwell, Stephen Allan Schaffer, Marina Yogendran, Feng Zhu, Randy Fransoo and Allan Garland in Multiple Sclerosis Journal