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Prioritising care services: do the oldest users lose out?
- Authors:
- GAUTUN Heidi, GRODEM Anne Skevik
- Journal article citation:
- International Journal of Social Welfare, 24(1), 2015, pp.73-80.
- Publisher:
- Wiley
Population ageing is a major concern in most European countries. Demands for health- and care services will increase, as older people typically have a higher need for such services. Older users increasingly compete with younger users for the same limited care resources. By interviewing decision-makers in Norwegian municipalities, this study examines how staff in the Norwegian care sector make decisions regarding the allocation of services to younger and older users. Despite providing for equal rights to services, laws allow for an interpretation of needs and this can result in the unequal distribution of services. The study indicates that needs are defined differently for younger and older users, which affects the amount, type and content of the services allocated to younger and older people. (Edited publisher abstract)
Moving beyond patient and client approaches: mobilizing ‘authentic partnerships’ in dementia care, support and services
- Authors:
- DUPUIS Sherry L., et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 11(4), July 2012, pp.427-452.
- Publisher:
- Sage
The notion of a client-centred or person-centred approach was first introduces in the 1940s. Over the past several decades, however, the true intent behind its original relational approach has been lost, settling instead on well-intended but often paternalistic approaches that place patients or clients at the centre of care, but rarely, if ever, actively involve them in decision-making. This is no more apparent than in the case of people living with Alzheimer's disease who, due to the stigma and misunderstanding surrounding dementia, are often assumed to lack the capacity to be involved in their own care and the care of others. Drawing on the experience of the authors, working directly with persons with dementia, family members and professionals, and systematic research on a number of mutual partnership initiatives, this paper present an alternative approach, one that views persons with dementia as equal partners in the context of dementia care, support and formal services.
Improving decision-making in the care of older people: exploring the decision ecology: report
- Author:
- JOSEPH ROWNTREE FOUNDATION
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2012
- Pagination:
- 71p.
- Place of publication:
- York
The proportion of the population in retirement is estimated to rise significantly. This major demographic change makes it imperative to review the position of older people both as receivers and as givers of care and support. This report reviews the evidence relating to how to improve decisions made by and for older people about their care and support. It investigates how formal, semi-formal and informal relationships can work together to best effect, and the relationship between risk, trust, and good decision-making. The report: examines the nature of decision-making; explores the 'decision ecology' - the multi-factored contextual backdrop to decisions about risk and trust in an ageing society; discusses factors that influence, improve and impede caring decisions taken by a range of actors; considers the role of narratives in improving decisions for, by and about older people and their care; appraises risk management and trust development strategies; and investigates responsibility in decision-making. It argues that effective decision-making requires constructive partnerships between older people (carers and cared-for), and informal and formal carers that understand their value, potential shortcomings and strengths. However, risk elimination is not possible and the wellbeing of older people requires positive risk-taking.
Improving decision-making in the care and support of older people: summary
- Author:
- JOSEPH ROWNTREE FOUNDATION
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2012
- Pagination:
- 4p.
- Place of publication:
- York
The proportion of the population in retirement is estimated to rise significantly. This major demographic change makes it imperative to review the position of older people both as receivers and as givers of care and support. This report summary outlines the findings of a review of the evidence relating to how to improve decisions made by and for older people about their care and support. It investigates how formal, semi-formal and informal relationships can work together to best effect, and the relationship between risk, trust, and good decision-making. This summary lists the key points identified by the review and also briefly discusses the findings in relation to: how decisions are made; the decision-making ecology; influences on caring decisions; the role of narrative; risk and trust; and responsibility. It argues that effective decision-making requires constructive partnerships between older people (carers and cared-for), and informal and formal carers that understand their value, potential shortcomings and strengths. However, risk elimination is not possible and the wellbeing of older people requires positive risk-taking.
Hybrid inclusion - the new consumerism of Danish welfare services
- Author:
- HOJLUND Holger
- Journal article citation:
- Journal of European Social Policy, 19(5), December 2009, pp.421-431.
- Publisher:
- Sage
This article focuses on the provision of care for older people in Denmark where recent fundamental changes to welfare structures has meant decision making has become more consumer orientated and both private enterprises and non-profit organisations have been invited to tender for the delivery of welfare services. This author uses a systems approach in which the three decision making systems of organisations, as autopoietic systems of decision making, persons, who individually wear roles in the realm of communication and the concepts of inclusion and exclusion, where persons are approached inside some communicative systems while at the same time being outside others are equally considered. Rather than a simple transition from traditional welfare models to markets models, the author sees the inclusion of citizens in decision making has resulted in hybridisation, with different rationalities brought together with purpose, rather than unhappily as a forced marriage. Network approaches to welfare in general and care of older people specifically, systems for needs assessments, home visits and choosing providers are discussed
The same old process?: older people, participation and deliberation
- Author:
- BARNES Marian
- Journal article citation:
- Ageing and Society, 25(2), March 2005, pp.245-259.
- Publisher:
- Cambridge University Press
Opportunities for older people to take part in decision making about public policies and services are expanding in the United Kingdom and elsewhere. This paper considers the potential of older people's participation in policy processes for both transforming the policy process and for achieving socially just outcomes. It argues that the way in which such participation takes place, in particular the nature of the deliberative processes, affects both who will feel able to take part and the capacity to develop new policy discourses which can challenge official perspectives and assumptions. It draws from critical perspectives on deliberative democracy to provide a theoretical framework. This work emphasises the importance of story telling and forms of exchange designed to offer recognition to others, as well as the rational argument more usually associated with deliberation on matters of public policy. The argument is illustrated with examples of participation initiatives that have involved ‘active’ older people and those who are users of social care services. Different styles and processes of exchange are distinguished in the three case studies. In one, active facilitation enables individual stories of ageing and of service use to be woven into collective narratives that offer an alternative vision of care services. In another, a strong emphasis on ‘greeting’ enables conflicting views to be expressed without participants falling out. In the third, styles of exchange familiar in formal debate limit the development of an alternative discourse. The conclusion suggests that attention needs to be given to the process of participation as well as to outcomes.
Partnership boards and generic care workers at centre of services reform
- Author:
- SALARI Natasha
- Journal article citation:
- Community Care, 16.10.03, 2003, pp.20-21.
- Publisher:
- Reed Business Information
Older people are often marginal to decisions that affect the services they use. Discusses a new report, 'All our tomorrows' commissioned by the ADSS and the LGA, which aims to put them at the heart of planning their wants with the development of older people's partnership boards.
Exploring ways for staff to consult people with dementia about services
- Author:
- JOSEPH ROWNTREE FOUNDATION
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2001
- Pagination:
- 4p.
- Place of publication:
- York
Previous research has demonstrated that, given the right support, individuals with dementia can express opinions about services. However, staff need help with identifying and using opportunities for meaningful consultation. This study by Kate Allan explored how staff can encourage people with dementia to express their views and preferences in the course of day-to-day practice. The focus was on the process of undertaking service user consultation with people with dementia.
Are there differences in standard of care for the elderly? A comparative study of assistance decisions in Stockholm
- Authors:
- LAGERGREN M., JOHANSSON P-A.
- Journal article citation:
- Scandinavian Journal of Social Welfare, 7(4), October 1998, pp.340-349.
- Publisher:
- Munksgaard/ Blackwell
Discusses how according to Swedish law, an elderly dependent person is entitled to public services in the form of home help in ordinary housing or a place in special housing - i.e. sheltered housing, a residential home or a nursing home. Describes a study of ten districts in Stockholm in order to determine whether there were systematic differences between districts with regard to provision of services to the elderly.
Keeping together
- Author:
- BOND Henrietta
- Journal article citation:
- Community Care, 20.6.96, 1996, p.23.
- Publisher:
- Reed Business Information
The idea of splitting up elderly couples who need different levels of care is abhorrent. The author asks why the suggestion ever came to be considered.