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Policy measures adopted to support unpaid care across Europe
- Authors:
- LE BIHAN Blanche, et al
- Journal article citation:
- Eurohealth, 25(4), 2019, pp.10-14.
- Publisher:
- European Observatory on Health Systems and Policies
- Place of publication:
- Brussels
Providing informal care can have significant negative effects for carers in terms of reducing psychological and physical health outcomes, constraining social participation and limiting ability to remain in formal employment. Developing policies to support informal carers is therefore an important policy objective to enable carers to continue caring for as long as they wish to do so and to ensure that the future availability of unpaid care is sufficient to meet demand. There are different types of policy measures addressed directly to carers that have been implemented across Europe to support provision of informal care. (Edited publisher abstract)
Caps, opt-ins, opt outs: is England making progress in reforming care funding?
- Author:
- LLOYD James
- Publisher:
- Strategic Society Centre
- Publication year:
- 2012
- Pagination:
- 24p.
- Place of publication:
- London
This discussion paper provides a response to the government's recent progress report on care funding. The government’s report ‘Caring for our future: progress report on funding reform’, July 2012, set out the government's response to the recommendations of the Commission on Funding of Care and Support. In this document, the government accepts as the basis for reform the principle put forward by the Commission of financial protection through capped costs and an extended means test, but reveals that it will not make a decision on the capped cost model until the next Spending Review expected in late 2013. This response paper argues that the government's progress report effectively acknowledges that care funding reform could proceed on a cost-neutral basis for the Treasury, and not interfere with the government's deficit reduction strategy. However, the government fails to set out any of the options for paying for care funding reform and does not seek to use its report to inform a wider debate on this issue. This discussion paper suggests that progress toward care funding reform may occur in several ways: public acceptance of the difficult tax and spending decisions required to make the capped cost model cost-neutral for the Treasury; the implementation of a low-cost capped cost model; or the creation of a voluntary capped cost state-sponsored insurance scheme that becomes mandatory over time.
Stepping-stones: a strategy for reforming long-term care funding
- Author:
- LLOYD James
- Publisher:
- Strategic Society Centre
- Publication year:
- 2011
- Pagination:
- 23p.
- Place of publication:
- London
This report looks at how reform of long-term care funding should be framed by policymakers and stakeholders, and what this means for how reform can unfold. Debate on how to fund older people’s long-term care has tended to emphasise a simplistic menu of options, resulting in polarised positions among political parties, and preventing reform from getting under way. This report argues that the outcomes required of long-term care funding reform represent not one reform, but many, which vary in their complexity and the political sensitivities they may incur. The analysis in this report shows how: widely different models of long-term care funding require some of the same policy changes and structural reforms to be made; seemingly large and challenging reforms can be broken down to a series of manageable steps; and, few models of long-term care funding have to represent fixed end-points and can themselves be implemented and developed as stepping-stones in a longer process. Framing reform as a series of ‘stepping stones’ reveals that many of the stumbling blocks to reform can be overcome, for example: the transition to a national assessment and entitlement framework; staged evolution in the shape of the state safety-net; and, a gradual transition from voluntary to compulsory contributions.
Free personal care in Scotland: a narrative review
- Authors:
- DICKINSON Helen, et al
- Journal article citation:
- British Journal of Social Work, 37(3), April 2007, pp.459-474.
- Publisher:
- Oxford University Press
The advent of free personal care for older people was a defining moment in the development of UK political devolution. After all the controversy surrounding the 1999 Royal Commission on Long Term Care, Scotland’s decision to implement the main recommendations of the Sutherland Committee was a decisive break from Whitehall’s approach and seemed to offer a key opportunity to learn from the implications of this policy for an English context. Against this background, this paper summarizes the origins, nature and impact of free personal care, providing a narrative review of the policy to date.
Sea change or quick fix? Policy on long-term conditions in England
- Author:
- HUDSON Bob
- Journal article citation:
- Health and Social Care in the Community, 13(4), July 2005, pp.378-385.
- Publisher:
- Wiley
Long-term conditions is a policy area that has risen rapidly up the political agenda in England, culminating in the development of the National Health Service and Social Care Model in 2005, which is to be implemented over the following 2 years. The Model draws heavily upon US ideas of case management and proposes the creation of 3000 community matrons to undertake this role with the most vulnerable patients. Although welcomed in principle, the specific proposals in the Model have been subject to some criticism, and these issues are explored in the present paper. The problematic areas include patient identification, the transplanting of US models to England (eg the models of Evercare and Kaiser Permanente), the role of case management, workforce and funding issues, and the mix of medical and social models. The author concludes that there is a danger of long-term care policy developing an unduly health-focused approach at a time when the thrust of partnership working is towards an inclusive, whole-system model.
State policy responses to COVID-19 in nursing homes
- Authors:
- VAN HOUTVEN Courtney, et al
- Journal article citation:
- Journal of Long-Term Care, September 2021, pp.264-282. Online only
- Publisher:
- King's College London
- Place of publication:
- London
Context: COVID-19 has a high case fatality rate in high-risk populations and can cause severe morbidity and high healthcare resource use. Nursing home residents are a high-risk population; they live in congregate settings, often with shared rooms, and require hands-on care. Objectives: To assess state responses to the coronavirus pandemic related to nursing homes in the first half of 2020. Methods: An in-depth examination of 12 states’ responses to the COVID-19 pandemic in nursing homes through June 2020, using publicly reported information such as government decrees, health department guidance, and news reports. Findings: No state emerged as a model of care. All states faced difficulty with limited availability of testing and Personal Protective Equipment (PPE). State-level efforts to increase pay and benefits as a strategy to enable infected staff to quickly physically separate from residents were minimal, and other separation strategies depended on the ability to obtain test results rapidly and on state rules regarding accepting discharged COVID-19 patients into nursing homes. Visitor restrictions to reduce risk were ubiquitous, though based on a slim evidence-base. Limitations: The information used was limited to that which was publicly available. Implications: Overall, the results suggest that the states that handle the ongoing pandemic in nursing homes best will be those that find ways to make sure nursing homes have the resources to follow best practices for testing, PPE, separation, and staffing. Evidence is needed on visitor restrictions and transmission, as states and their citizens would benefit from finding safe ways to relax visitor restrictions. (Edited publisher abstract)
Consequences of prioritisation within long-term care in Denmark, England and Norway: towards increasing inequalities and poorer quality of care?
- Authors:
- ERVIK Rune, LINDEN Tord Skogedal
- Journal article citation:
- International Journal of Care and Caring, 5(2), 2021, pp.209-227.
- Publisher:
- Policy Press
Prioritisation concerns choosing something before something else, and in a welfare state context, this is about decisions on distribution, redistribution and rationing. This article investigates consequences of prioritisation within long-term care in Denmark, England and Norway. Analysing interviews with policy actors and policy documents, we find that prioritising home care, combined with increasing targeting of help and restricting institutionalised care towards those with the most severe needs, may reduce both service quality and equality for those not being prioritised. Moreover, monitoring and central control of service provision restrict individual discretion of care workers, with implications for service quality. (Edited publisher abstract)
Long-term care, residential facilities, and COVID-19: an overview of federal and state policy responses
- Authors:
- CHEN Angela T., RYSKINA Kira L., JUNG Hye-Young
- Journal article citation:
- Journal of the American Medical Directors Association, 21(9), 2020, pp.P1186-1190.
- Publisher:
- Elsevier (for the American Medical Directors Association)
The COVID-19 pandemic has disproportionately affected residents and staff at long-term care (LTC) and other residential facilities in the United States. The high morbidity and mortality at these facilities has been attributed to a combination of a particularly vulnerable population and a lack of resources to mitigate the risk. During the first wave of the pandemic, the federal and state governments received urgent calls for help from LTC and residential care facilities; between March and early June of 2020, policymakers responded with dozens of regulatory and policy changes. This article provides an overview of these responses by first summarizing federal regulatory changes and then reviewing state-level executive orders. The policy and regulatory changes implemented at the federal and state levels can be categorized into the following 4 classes: (1) preventing virus transmission, which includes policies relating to visitation restrictions, personal protective equipment guidance, and testing requirements; (2) expanding facilities' capacities, which includes both the expansion of physical space for isolation purposes and the expansion of workforce to combat COVID-19; (3) relaxing administrative requirements, which includes measures enacted to shift the attention of caretakers and administrators from administrative requirements to residents' care; and (4) reporting COVID-19 data, which includes the reporting of cases and deaths to residents, families, and administrative bodies (such as state health departments). These policies represent a snapshot of the initial efforts to mitigate damage inflicted by the pandemic. Looking ahead, empirical evaluation of the consequences of these policies- including potential unintended effects - is urgently needed. The recent availability of publicly reported COVID-19 LTC data can be used to inform the development of evidence-based regulations, though there are concerns of reporting inaccuracies. Importantly, these data should also be used to systematically identify hot spots and help direct resources to struggling facilities. (Edited publisher abstract)
The impact of reforms of national health insurance on solidarity in the Netherlands: comparing health care insurance and long-term care insurance
- Authors:
- AA Maartje J. van der, et al
- Journal article citation:
- Journal of Long-Term Care, November 2019, pp.143-152. Online only
- Publisher:
- King's College London
- Place of publication:
- London
Context: Throughout Europe, the financial risks of health and long-term care are covered to varying degrees through models of national (health) insurance. Such insurance draws upon the principle of solidarity. Much is unknown on the solidarity-effects of reforms in national insurance schemes. Objective: To present an empirical analysis of the effects of recent reforms in national health insurance on solidarity in the Netherlands. Methods: The study conducted a comparative analysis of the 2006 health care insurance reform and the 2015 long-term care insurance reform in the Netherlands. A multidimensional analytical framework of solidarity was developed to study the solidarity-effects of both reforms. Findings: Reforms of health care and long-term care insurance in the Netherlands had some solidarity effects, but they should not be overstated. The study found evidence for increased and decreased solidarity. Health care insurance seems more ‘immune’ to reductions in solidarity than long-term care insurance. Limitations: The present case study involves reforms in the Netherlands. The solidarity framework is specifically designed for the study of solidarity-effects of reforms on national health and long-term care insurance. Effects on informal arrangements for care are beyond the scope of this study. More detailed and quantitative research is required to investigate how the reforms played out for specific groups, for instance the frail elderly, people with a disability and people with rare conditions. Similarly, long-term effects require further investigation. (Edited publisher abstract)
Social care: forthcoming Green Paper on older people and parallel programme (England)
- Author:
- JARRETT Tim
- Publisher:
- Great Britain. Parliament. House of Commons Library
- Publication year:
- 2018
- Pagination:
- 30
- Place of publication:
- London
Briefing paper looking at the forthcoming Green Paper on social care for older people and parallel programme of work on social care for working age adults. It provides a background to the plans for a Green Paper and its confirmed contents, which will include: a lifetime cap on what people pay for social care, integration with health and others services, information on carers, workforce, and technological developments. The briefing also outlines the timetable to date and delays and signposts to a selection of commentaries on the proposed Green Paper. (Edited publisher abstract)