Home Support for People with Dementia : Developing a Fidelity Index

This study aimed to develop an evidence based (‘what works’), service template, specifying the appropriate approaches for home support teams, and a measuring tool (a 'fidelity index') that service managers can use to self assess critical components of service delivery.

Fidelity denotes how accurate a copy is to its source; how closely a set of procedures are implemented - have they been implemented as they were supposed to have been.

Index denotes a detailed listing of topics, that directs attention to some fact, condition, or guiding principle.

A Fidelity Index measures how closely a service matches the conditions and guiding principles that might be expected from such a service.

The primary study objectives were to:

1. review the literature and professional guidance in order to establish a consensus agreed evidence base on the critical components of effective, efficient and successful integrated support at home by a service team for people with dementia and their carers.
2. develop a Service Template for this support at home by such teams for people with dementia and their carers.
3. devise a Fidelity Index (FI) for services to self-assess how faithfully the critical components are delivered.
4. field test the FI.
5. disseminate this work and make the FI available for service self-assessment, and audit and benchmarking.

We wanted to find out the answers to the following:

• What works? What does the evidence and expert consensus show are the components and service characteristics necessary in order to provide effective, efficient and successful integrated support at home by a service team for people with dementia (PWD) and their carers?
• Can managers use it? Do managers find the FI acceptable and usable as a service self audit assessment and service improvement tool?
• Does the Fidelity Index have validity, acceptability and utility?
• Can evidence be useful? Can evidence from the perspectives of: (a) examining service documentation, (b) the views of care workers, (c) the views of client carers and (d) the views of professionals, who know the service, be usefully added to the manager’s assessment?
• Are managers’ assessments and any such evidence in agreement? Do they seem concordant?

The following organisations took part in the research:

• Calverton Supreme Home Care Ltd
• Direct Health
• Extra Care Charitable Trust
• Home Instead Senior Care
• Nottingham City Council
• Nottingham Community Housing Association
• Mears Care
• Percurra
• Saga Homecare
• Westminster Home Care

There were four phases:

1. Completing / filling in the Fidelity Index (FI) tool
2. Showing the researcher some of the non-confidential ‘evidence’ used in order to fill in the FI tool
3. Distributing a short questionnaire to some of the other stakeholders of the service
4. Participating in a short interview to determine your experience of using the FI tool