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Choice, competition and care: developments in English social care and the impacts on providers and older users of home care services
- Authors:
- RODRIGUES Ricardo, GLENDINNING Caroline
- Journal article citation:
- Social Policy and Administration, 49(5), 2015, p.649–664.
- Publisher:
- Wiley
This article critically examines recent changes in markets for home (domiciliary) care services in England. During the 1990s, the introduction of competition between private (for-profit and charitable) organisations and local authority providers of long-term care services aimed to create a ‘mixed economy’ of supply. More recently, care markets have undergone further reforms through the introduction of direct payments and personal budgets. Underpinned by discourses of user choice, these mechanisms aim to offer older people increased control over the public resources for their care, thereby introducing further competitive pressures within local care markets. The article presents early evidence of these changes on: a) The commissioning and contracting of home care services by local authorities and individual older people; b) The experiences and outcomes for individual older people using home care services.. Drawing on evidence from two recent empirical studies, the article describes how the new emphasis on choice and competition is being operationalised within six local care markets. There are suggestions of small increases in user agency and in opportunities for older people to receive more personalised home care, in which the quality of care-giving relationships can also be optimised. However, the article also presents early evidence of increases in risk and costs associated with the expansion of competition and choice, both for organisations providing home care services and for individual older service users. (Edited publisher abstract)
From care in homes to care at home: European experiences with (de)institutionalisation in long-term care
- Authors:
- ILINCA Stefania, LEICHSENRING Kai, RODRIGUES Ricardo
- Publisher:
- European Centre for Social Welfare Policy and Research
- Publication year:
- 2015
- Pagination:
- 15
- Place of publication:
- Vienna
Many countries across Europe have developed strategies to support community-based services in an attempt to replace traditional institutional models of care. Differences in needs, approaches and commitment levels have led to diverse results and pace of progress. However, much can be learned from their experiences and from examples of strategies and models which proved to be effective. This Policy Briefing presents a typology of long-term care regimes and proposes four case studies to illustrate the main barriers and drivers to deinstitutionalisation. Austria (Standard care mix) illustrates the importance of developing strong support systems for informal carers and strengthening home-based care provision. Sweden (UniversalNordic) has made great strides towards deinstitutionalisation by promoting coordination between care providers, but, the coverage and cost of services will soon become unsustainable unless appropriate support for family-based care is provided. Italy (Family-based) and the Czech Republic (Transition) represent situations where the rates of institutionalisation are relatively low and current policy is challenged to contain future growth. Both systems offer significant support to informal and family carers, but this historic over-reliance on household contributions to care is leading to a widening gap between supply and demand, which needs to be addressed through the strengthening of community-based services.The briefing concludes with a discussion of the core principles for reaching a sustainable balance between different long-term care settings. (Edited publisher abstract)