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Facilitating choice and control for older people in long-term care
- Author:
- BOYLE Geraldine
- Journal article citation:
- Health and Social Care in the Community, 12(3), May 2004, pp.212-220.
- Publisher:
- Wiley
Community care reforms enabled some older people with severe disabilities to remain at home with domiciliary care services as an alternative to institutional admission. This paper explores the extent to which the reforms actually enabled people receiving domiciliary care to have greater choice and control in their daily lives than those in institutions using findings from a comparative study in Greater Belfast, Northern Ireland, that determined the extent to which subjective quality of life, particularly autonomy, varied according to type of setting. Interviews were held with 214 residents in 45 residential and nursing homes and 44 older people receiving domiciliary care in private households using a structured schedule. Subjective autonomy was assessed using a measure of perceived choice consisting of 33 activities relating to aspects of everyday life such as when to get up or see visitors or friends and how much privacy was available. Qualitative data were also recorded which informed on the older people's perspectives on their own lives, particularly the extent to which they exercised choice on a daily basis. The study found that older people living in institutions perceived themselves to have greater decisional autonomy in their everyday lives than those receiving domiciliary care. Indeed, it was clear that living at home did not ensure that one's decisional autonomy would be supported. However, living alone may facilitate exercising a relatively higher degree of autonomy when living at home. While community care reforms have provided some older people with severe disabilities with the option of receiving care at home, this has not necessarily enabled them to have greater choice and control in their everyday lives than older people admitted to institutions.
Going Dutch
- Author:
- COHEN Phil
- Journal article citation:
- Social Work Today, 25.10.90, 1990, pp.15-17.
- Publisher:
- British Association of Social Workers
Concerned by rising demand for and costs of residential care, social work in the Netherlands is moving towards a mixture of residential and domiciliary care to best meet the user's need.
Called to register
- Author:
- MARCHANT Catriona
- Journal article citation:
- Community Care, 15.4.93, 1993, p.11.
- Publisher:
- Reed Business Information
Discusses David Hinchliffe's Bill to register private domiciliary care agencies and explains why it is unlikely to survive a second reading.
Sheffield shows the way
- Authors:
- MacDONALD R., et al
- Journal article citation:
- Community Care, 18.10.84, 1984, pp.28-30.
- Publisher:
- Reed Business Information
Sheffield's, and the country's, first elderly persons support unit (EPSU) offers integrated services to the elderly at one location, from routine domiciliary care to comprehensive care in a residential setting.
Places of living and places of dying: the case for preventing suicide in residential long-term care
- Authors:
- JAIN Briony, et al
- Journal article citation:
- Ageing and Society, 41(9), 2021, pp.1945-1960.
- Publisher:
- Cambridge University Press
This commentary addresses the increasing public health problem of suicide in later life and presents the case for preventing suicide in residential long-term care settings. We do so by examining this issue from the perspective of three levels of stakeholders – societal, organisational and individual – considering the relevant context, barriers and implications of each. We begin by discussing contemporary societal perspectives of ageing; the potential impact of ageism on prevention of late-life suicide; and the roles of gender and masculinity. This is followed by a historical analysis of the origin of residential long-term care; current organisational challenges; and person-centred care as a suicide prevention strategy. Finally, we consider suicide in long-term care from the perspective of individuals, including the experience of older adults living in residential care settings; the impact of suicide on residential care health professionals and other staff; and the impact of suicide bereavement on family, friends and other residents. We conclude with recommendations for policy reform and future research. This commentary aims to confront the often unspoken bias associated with preventing suicide among older adults, particularly those living with complex medical conditions, and invoke an open dialogue about suicide prevention in this population and setting. (Edited publisher abstract)
Free personal care: how to eliminate catastrophic costs
- Authors:
- BUSHNELL Jeremy, MITCHELL Ray, SEYMOUR Catherine
- Publisher:
- Independent Age
- Publication year:
- 2019
- Pagination:
- 16
- Place of publication:
- London
This report argues that providing free personal care would be a fairer, more transparent system that is affordable and would benefit more older people that the current system. It highlights how various proposals to cap the costs of care would leave the majority of older people at risk of catastrophic costs, whether they are receiving domiciliary care or are in residential care, while costing not much less than free personal care. It provides an overview of care costs, looks at the limited impact of caps on costs and outlines the benefits of free personal care for individuals. The report also sets out three steps for the Government to ensure that older people in care do not suffer catastrophic costs. These are: to introduce free personal care for all older people who need it; define catastrophic costs (care costs and hotel costs) as 50 per cent of an individual’s wealth; and introduce a safeguard to protect individuals from catastrophic costs. (Edited publisher abstract)
Organization and supply of long-term care services for the elderly: a bird's-eye view of old and new EU member states
- Authors:
- RIEDEL Monika, KRAUS Markus, MAYER Susanne
- Journal article citation:
- Social Policy and Administration, 50(7), 2016, pp.824-845.
- Publisher:
- Wiley
This article provides an overview of the organization of formal long-term care (LTC) systems for the elderly in ten old and 11 new EU member states (MS). Generally, the authors find that the main responsibility for regulating LTC services is centralized in half of these countries, whereas in the remaining countries, this responsibility is typically shared between authorities at the central level and those at the regional or local levels in both institutional and home-based care. Responsibilities for planning LTC capacities are jointly met by central and non-central authorities in most countries. Access to publicly financed services is rarely means tested, and most countries have implemented legal entitlements conditional on needs. In virtually all countries, access to institutional care is subject to cost sharing, which also applies to home-based care in most countries. The relative importance of institutional LTC relative to home-based LTC services differs significantly across Europe. Although old MS appear to be experiencing some degree of convergence, institutional capacity levels still span a wide range. Considerable diversity may also be observed in the national public–private mix in the provision of LTC services. Lastly, free choice between public and private providers exists in the vast majority of these countries. This overview provides vital insights into the differences and similarities in the organization of LTC systems across Europe, especially between old and new MS, while also contributing valuable insight into previously neglected topics, thus broadening the knowledge base of international experience for mutual learning. (Edited publisher abstract)
Factors associated with the amount of public home care received by elderly and intellectually disabled individuals in a large Norwegian municipality
- Authors:
- DOHL Oystein, et al
- Journal article citation:
- Health and Social Care in the Community, 24(3), 2016, pp.297-308.
- Publisher:
- Wiley
This study reports an analysis of factors associated with home care use in a setting in which long-term care services are provided within a publicly financed welfare system. The study considered two groups of home care recipients: elderly individuals and intellectually disabled individuals. Routinely collected data on users of public home care in the municipality of Trondheim in October 2012, including 2493 people aged 67 years or older and 270 intellectually disabled people, were used. Multivariate regression analysis was used to analyse the relationship between the time spent in direct contact with recipients by public healthcare personnel and perceived individual determinants of home care use (i.e. physical disability, cognitive impairment, diagnoses, age and gender, as well as socioeconomic characteristics). Physical disability and cognitive impairment are routinely registered for long-term care users through a standardised instrument that is used in all Norwegian municipalities. Factor analysis was used to aggregate the individual items into composite variables that were included as need variables. Both physical disability and cognitive impairment were strong predictors of the amount of received care for both elderly and intellectually disabled individuals. The study identified a negative interaction effect between physical disability and cognitive impairment for elderly home care users. For elderly individuals, results also found significant positive associations between weekly hours of home care and having comorbidity, living alone, living in a service flat and having a safety alarm. The reduction in the amount of care for elderly individuals living with a cohabitant was substantially greater for males than for females. For intellectually disabled individuals, receiving services involuntarily due to severe behavioural problems was a strong predictor of the amount of care received. The analysis showed that routinely collected data capture important predictors of home care use and thus facilitate both short-term budgeting and long-term planning of home care services. (Edited publisher abstract)
Linking Disabled Facilities Grants to social care data: a freedom of information survey
- Author:
- FOUNDATIONS
- Publisher:
- Foundations
- Publication year:
- 2015
- Pagination:
- 10
- Place of publication:
- Glossop
Reports on the findings of a Freedom of Information (FOI) request to local authorities in England which asked councils to look at the care needs of people depending on whether they had previously applied for a Disabled Facilities Grant (DFG) to pay for major home adaptations. The request aimed to discover whether local authorities could link the data collected by housing and social care departments; find out how many people who apply for a DFG also receive home care; and what impact a DFG funded adaptation could have on admission and length of stay in residential care. From the 152 local authorities contacted, only 30 were able to provide full or partial returns. A total of 103 authorities could not complete the request, the majority due to their housing and social care data being on separate systems. The results from those local authorities who did respond found that the DFG and subsequent home adaptations enabled people to stay in their homes for longer before being admitted to residential care. It also found that those who needed care at home required fewer hours of home help following adaptations, resulting in cost savings. (Edited publisher abstract)
Extracare: does it promote resident satisfaction compared to residential and home care?
- Authors:
- PHILLIPS Judith E., et al
- Journal article citation:
- British Journal of Social Work, 45(3), 2015, pp.949-967.
- Publisher:
- Oxford University Press
Extracare housing is seen as an innovative solution to meet both accommodation and care needs of increasing numbers of older people. This paper is based on a mixed method study exploring whether extracare is for ‘fit’ and ‘frail’ older people. In particular, the authors compare the satisfaction (financial, personal, social, environmental and access to personal services) of older people in extracare with those in residential care and older people in the community. In relation to the domains of financial satisfaction, residential care respondents reported lower satisfaction, fewer friends and lower social support than those in extracare and in the community, but older people in extracare were less satisfied with their access to personal social services. Additionally, although the care environment did not predict social satisfaction, from our qualitative interviews, the authors found that, whereas more opportunities to socialise existed in extracare, there was little evidence of new developing friendships. These findings are important for social workers and social care professionals when assessing the needs of older people and exploring provision that can meet often complex needs in times of crisis and transition. (Edited publisher abstract)