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Dividing responsibility for care: tracing the ethics of care in local care strategies dividing responsibility for care: tracing the ethics of care in local care strategies
- Author:
- SIHTO Tiina
- Journal article citation:
- Social Policy and Society, 21(2), 2022, pp.194-209.
- Publisher:
- Cambridge University Press
This article analyses local care policies through the lens of the feminist ethics of care. The focus is on the normative understandings regarding care that emerge in local care strategy documents and how these understandings relate with the concept of 'responsibility'. In this article, strategies published by the municipality of Jyvaskyla, Finland, between the years 2008 and 2016, are analysed using Trace analysis. The research questions are: How is the division of responsibility regarding care among different actors constructed in the strategies? How do the roles assigned to these different actors accord with the principles of ethics of care? The findings show that the documents emphasise individual responsibility in managing risks related to old age, as the norms of local societal institutions are largely detached from the principles of ethics of care. The analysis also reveals the absence of gender and human frailty from the care strategy documents. Rethinking the strategies through the lens of the ethic of care would mean reconceptualising responsibility as relational. (Edited publisher abstract)
What is out there and what can we learn? International evidence on funding and delivery of long-term care
- Authors:
- ROLAND Daniel, FORDER Julien, JONES Karen
- Journal article citation:
- Social Policy and Society, 21(2), 2022, pp.261-274.
- Publisher:
- Cambridge University Press
This article describes the social care funding and delivery arrangements of a varied selection of developed countries, focusing on long-term care of older people. International evidence and latest reforms can inform the debate as countries struggle economically. Some have opted for mandatory social insurance that provides universal coverage. A premium is paid and if the insured individual or relatives require support, they are entitled to it. Others opted for a similar universal system but with earmarked taxation, while others fund their social care entirely from general taxation. Many chose a safety-net system in which benefits are means-tested leaving wealthier individuals to secure private arrangements of care. Within the UK, the level of support varies as Scotland provides personal care free of charge, being more generous than England, Wales and Northern Ireland. There is no "one solution", but understanding different options can help in the discussion of current and future reforms. (Edited publisher abstract)
Incentives and deterrents to the supply of long-term care for the elderly in England: evidence and experience in two local authorities
- Authors:
- ALLAN Stephen, DARTON Robin
- Journal article citation:
- Social Policy and Society, 21(2), 2022, pp.304-315.
- Publisher:
- Cambridge University Press
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. (Edited publisher abstract)
Older carers and carers of people with dementia: improving and developing effective support
- Authors:
- LARKIN Mary, HENWOOD Melanie, MILNE Alisoun
- Journal article citation:
- Social Policy and Society, 21(2), 2022, pp.242-256.
- Publisher:
- Cambridge University Press
The policy drive to support carers is a longstanding national and international priority. Research about the design and delivery of support for carers is critical to the underpinning evidence base. Through a timely exploration of a third sector perspective, the UK-based study discussed in this article provides insights into approaches to, and the commissioning of, support for older carers and carers of people with dementia. The study highlights the importance of: embedding carers' perspectives in service developments; the provision of both generic and targeted support which adopts a nuanced and tailored approach; titrating the delivery of information and advice at a pace to match carers' needs; capturing quantitative and qualitative dimensions in service evaluation; and increased quantity and longevity of funding. Such insights not only complement existing research but are also generalisable to other countries at a similar stage in the development of carer support. (Edited publisher abstract)
Employment inequalities among British minority ethnic workers in health and social care at the time of Covid-19: a rapid review of the literature
- Author:
- HUSSEIN Shereen
- Journal article citation:
- Social Policy and Society, 21(2), 2022, pp.316-330.
- Publisher:
- Cambridge University Press
There are long-standing concerns of inequalities in the workplace among minority ethnic (ME) workers in the UK health and social care (H&SC) sectors. ME workers contribute significantly to H&SC delivery. However, there is considerable evidence of substantial negative experiences among this group across various workplace indicators and outcomes, including (mis)treatment. The COVID-19 pandemic has exacerbated these inequalities with higher infection rates and related deaths among ME health and care workers. A rapid review methodology was employed to examine the work experiences and outcomes of ME workers in H&SC in the UK, focusing on low paid workers. The review identified fifty-one relevant outputs, detailing the nature and extent of inequalities across recruitment, career progression and treatment at work, including bullying and harassment. The findings highlight the impact of the intersectionality of gender, race and migration status concerning the ways inequalities are manifested and operated through individual perceptions and institutional and structural racism. (Edited publisher abstract)
Developing a new conceptual framework of meaningful interaction for understanding social isolation and loneliness
- Authors:
- WIGFIELD Andrea, et al
- Journal article citation:
- Social Policy and Society, 21(2), 2022, pp.172-193.
- Publisher:
- Cambridge University Press
Academic debate about social isolation and loneliness, and their adverse health and well-being implications, has resulted in many policy and programme interventions directed towards reducing both, especially among older people. However, definitions of the two concepts, their measurement, and the relationship between the two are not clearly articulated. This article redresses this and draws on theoretical constructs adapted from symbolic interactionism, together with the Good Relations Measurement Framework, developed for the Equality and Human Rights Commission in the UK, to challenge the way in which social isolation and loneliness are currently understood. It argues for a need to understand experiences of social relationships, particularly those which facilitate meaningful interaction, suggesting that opportunities and barriers to meaningful interaction are determined by wider societal issues. This is set out in a new conceptual framework which can be applied across the life course and facilitates a new discourse for understanding these challenging concepts. (Edited publisher abstract)
Can we talk about it? A qualitative study exploring occupational therapists' decision making in judging when to ask an older person about drinking alcohol
- Authors:
- MacLEAN Fiona, et al
- Journal article citation:
- Ageing and Society, 42(3), 2022, pp.521-538.
- Publisher:
- Cambridge University Press
Older people now currently drink alcohol more frequently than previous generations, indicating a need to understand how this influences health and wellbeing in older adults. However, knowledge and awareness of the changing role alcohol plays in the lives of older people is not necessarily widely understood by allied health professionals in acute hospital contexts. In turn, conversations about drinking alcohol in later life may not be routinely addressed as part of practice, limiting an older person's choice to make informed decisions about their drinking. This paper qualitatively examines when occupational therapists (N = 17) in an acute hospital setting will initiate a conversation with older people (65+ years) about their drinking, guided by a theoretical lens that encompasses both person-centredness and collective occupation. Adopting a qualitative methodology, this study illustrates a typology of reasoning describing how, and in what circumstances, therapists ask older people about their alcohol use. Three themes were generated that provide further insight into the typology, these being 'hesitancy in practice', 'failure to link life transitions to alcohol use' and 'challenges of focusing on healthfulness'. These findings provide a potentially useful tool for therapists, services and organisations to self-assess their approach to asking older people about alcohol use; a necessary element of professional health-care practice as social trends in alcohol use continue to increase. (Edited publisher abstract)
'It gives you a reason to be in this world': the interdependency of communities, environments and social justice for quality of life in older people
- Authors:
- ROBERTSON Jane M., et al
- Journal article citation:
- Ageing and Society, 42(3), 2022, pp.539-563.
- Publisher:
- Cambridge University Press
Research regarding quality of life among older people has predominantly focused on functional elements experienced at individual or dyadic level despite the complex interplay of factors that contribute to quality of life. Perspectives which explore interdependencies within communities and the intersecting environments in which older people exercise agency have seen less study. They do, however, play an important role in influencing quality of life as experienced by older people across community settings. Qualitative data from a co-produced study of dimensions influencing quality of life in older people was subjected to secondary analysis using a critical human ecological approach. Findings demonstrate the importance of community interdependencies in supporting individual quality of life, the expression of active agency to foster quality of life within and across communities, and the importance of state infrastructures and service provision within these interdependencies. This article argues for a movement beyond functional conceptualisations of quality of life towards the inclusion of perspectives regarding communal wellbeing, alongside the role differing types of community play in influencing quality of life. Through developing conceptions of quality of life in social relations and community cohesion, in particular how quality of life is influenced by perceptions of solidarity and social justice including across generations, assessing quality of life at community level will assist in driving cultural change in policy making and practice. (Edited publisher abstract)
Right at home: living with dementia and multi-morbidities
- Authors:
- CUNNINGHAM Nicola A, COWIE Julie, METHVEN Karen
- Journal article citation:
- Ageing and Society, 42(3), 2022, pp.632-656.
- Publisher:
- Cambridge University Press
Dementia is recognised as the biggest health crisis of our time in terms of high personal and social costs and wider impact on health and social care systems. Increases in people living with dementia and multi-morbidities presents critical challenges for home care worldwide. Health-care systems struggle to provide adequate home-care services, delivering limited care restricted to a single-condition focus. This study explored the experiences and expectations of home care from the multiple perspectives of people living with dementia and multi-morbidities and home-care workers providing support. Findings draw from qualitative semi-structured interviews with people with dementia (N = 2), their partners (N = 2), other partners or family carers (N = 6) and home-care workers (N = 26). Three themes are identified: (a) the preference for and value of home; (b) inadequate home-care provision and enhanced care burden; and (c) limited training and education. Despite continued calls for home-care investment, the focus on reduction in costs hides key questions and further dialogue is required exploring how people with dementia can be supported to live independently and flourish at home. This study considers these complex experiences and care requirements through the prism of disability and human rights frameworks. This paper concludes with consideration of more recent human social rights debate and discusses critically what this may mean for people living with dementia and consider the implications for co-requisite policy development to optimise available home-care support. (Edited publisher abstract)
Development of an internationally accepted definition of reablement: a Delphi study
- Authors:
- METZELTHIN Silke F., et al
- Journal article citation:
- Ageing and Society, 42(3), 2022, pp.703-718.
- Publisher:
- Cambridge University Press
With an ageing society, the demand for health and social care is increasing. Traditionally, staff provide care for their clients rather than with them. In contrast, reablement aims to support people to maximise their competences to manage their everyday life as independently as possible. There is considerable variation between and within countries regarding the conceptual understanding of the approach. This variation affects the ability to evaluate reablement approaches systematically, compare and aggregate findings from different studies, and hinders the development of a robust evidence. Therefore, a Delphi study was conducted in 2018/9 with the aim of reaching agreement on the characteristics, components, aims and target groups of reablement, leading towards an internationally accepted definition of reablement. The study consisted of four Web-based survey rounds. In total, 82 reablement experts from 11 countries participated, reaching agreement on five characteristics (e.g. person-centred), seven components (e.g. goal-oriented treatment plan) and five aims (e.g. increase clients' independency). Furthermore, most experts agreed that reablement is an inclusive approach irrespective of the person's age, capacity, diagnosis or setting. Based on these features, a definition of reablement was developed, which was accepted by 79 per cent of participating experts. This study is a significant step towards providing conceptual clarity about reablement. Future research should focus on evaluating the implementation of agreed reablement components to inform practice, education and policy. (Edited publisher abstract)