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Securing good care for older people: taking a long-term view
- Author:
- DAVIES Bleddyn
- Journal article citation:
- Ageing Horizons, 6, 2007, Online only
- Publisher:
- Oxford Institute of Ageing
- Place of publication:
- Oxford
The paper aims to explain and evaluate two key features of Securing Good Care for Older People, the Wanless Report on alternative mechanisms for funding long-term care of older people. The first is the new elements of the methodology for evaluating the alternatives. The paper argues that more successfully than previously and analyses in other countries, these elements focus attention on what are really the core issues: the means and ends which are the unique foci of long-term care, and estimates of the consequences of alternatives for them. By doing so, the report faces the politicians and policy analysis and research communities with a formidable challenge, to master and contribute to the development of the new framework and evidence. Failure to meet the challenge will increases the risk that the policy system will reinforce rather than weaken causes of gross inequity and inefficiency caused by the under-funding of long-term care seemingly unanswerably demonstrated by the report. The second key feature is the type of funding model the Report recommends given expected changes in the balance between demands and public expenditure. It is argued that the report’s analysis as successfully transforms the state of the argument about this as much as about the framework, methodology and evidence for evaluating alternatives, demonstrating the relative weakness of models widely advocated a decade ago. Part 2 discusses how to build on the Report. It discusses the framing of issues and the analysis of evidence for each of the key foci of the report’s main contribution to evaluation methodology. Finally the paper discusses whether the recommended model would be the wisest choice given the environment likely during the next few decades.
Integrated care for older adults: a struggle for sustained implementation in northern Netherlands
- Authors:
- HOLTERMAN Sander, et al
- Journal article citation:
- International Journal of Integrated Care, 20(3), 2020, p.1. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: Integrated care has been suggested as a promising solution to the disparities in access and sustained high quality long-term care emerging in Europe’s ageing population. This study aims to gain a better understanding of context-specific barriers to and facilitators of implementation of integrated care by doing a retrospective assessment of seven years of Embrace. This Dutch integrated person-centred health service for older adults was based on two evidence-based models (the Chronic Care Model and the Kaiser Permanente Triangle). Despite successful deployment the programme ended in 2018. This case study assesses the impact of the programme based on past evaluations, reflect on why it ended, lessons learned and ideas to take forward. Discussion: The majority of health outcomes were positive and the perceived quality of care improved, albeit no clear-cut savings were observed, and the costs were not balanced across stakeholders. The Embrace payment model did not support the integration of health services, despite reforms in long-term care in 2015. Key lessons: Enabling policy and funding are crucial to the sustained implementation of integrated person-centred health services. The payment model should incentivize the integration of care before the necessary changes can be made at organizational and clinical levels towards providing proactive and preventive health services. (Edited publisher abstract)
Household composition and the dynamics of community-based social care in England
- Author:
- IPARRAGUIRRE Jose
- Journal article citation:
- Ageing and Society, 40(8), 2020, pp.1631-1646.
- Publisher:
- Cambridge University Press
Little is known about the dynamic relationship between the different funding sources of community-based social care in England. Using Waves 2–6 (2004–2013) of the English Longitudinal Study of Ageing survey, the author estimated dynamic multi-level cross-classified mixed-effects logistic regression models to investigate whether receiving services by one source is more or less likely if an older person was already receiving services funded by the same source or another in the previous period. Four hypotheses between formal privately and publicly funded help and informal help are tested: substitution, complementarity, compensation and task-specificity. The author also reports evidence that older people on low incomes residing in local authorities that reduce social care spending are especially affected. (Edited publisher abstract)
An international comparison of long-term care funding and outcomes: insights for the social care green paper
- Author:
- INCISIVE HEALTH
- Publisher:
- Incisive Health
- Publication year:
- 2018
- Pagination:
- 49
- Place of publication:
- London
This report, commissioned by Age UK, highlights different approaches to long-term care taken by five countries in the developed world, and looks at how they compare to the system in England. These five countries have very different systems, but face similar demographic and financial challenges to those in England. The countries are France, Germany, Spain, Italy and Japan. The report compares the approaches in relation to: service structures, funding levels, funding models, and outcomes. The findings suggest that creating a sustainable social care system fit for a rapidly ageing population is a challenge in every one of these countries. However, it finds that the financial deal for citizens with care needs is often more generous in other countries in comparison to England, with other nations generally either providing some non-means tested basic level of support, and/or cap the amount of co-payment to be made, and/or use a more gradual means-test. Profiles for each of the five countries are also included. (Edited publisher abstract)
Long-term care funding in England: an analysis of the costs and distributional effects of potential reforms
- Authors:
- HANCOCK Ruth, et al
- Publisher:
- University of Kent. Personal Social Services Research Unit
- Publication year:
- 2013
- Pagination:
- 13
- Place of publication:
- Canterbury
This paper examines projected costs and distributional effects of Government plans to reform the systems that determine how much the state contributes to people's long-term care costs compared with the current system. It also contrasts these costs and distributional effects with the central recommendation of the Commission on the Funding of Care and Support (Dilnot Commission) which was set up by the Government and reported in 2011. Two variants on the Government’s plans which would give additional help to recipients of residential care with capital below the proposed higher capital threshold are also considered. (Edited publisher abstract)
Paying for care in Wales: report of the stakeholder advisory group
- Authors:
- MILSON Steve, (chair)
- Publisher:
- Wales. Welsh Assembly Government. Health and Social Care Department. Paying for Care in Wales Stakeholder Advisory Group
- Publication year:
- 2009
- Pagination:
- 58p., bibliog.
- Place of publication:
- Cardiff
The report of a Stakeholder Advisory Group, set up by the Deputy Minister for Social Services, to consider reform of the system of paying for long-term care in Wales. Membership of the Advisory Group was made up of organisations and individuals representing a range of stakeholder interests, including disabled people, service users and carers, local government and health, care home owners, and older people. This report sets out the conclusions and 28 recommendations for reform. The recommendations are aimed primarily at the Welsh Assembly and UK Governments.
A funding settlement that works for people, not services
- Authors:
- STONE Emma, WOOD Claudia
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2010
- Pagination:
- 9p., bibliog.
- Place of publication:
- York
This paper was written in advance of the Comprehensive Spending Review in October 2010 and the coalition Government's new vision for social care, expected in early November. It is hoped that together these will form the foundations of a permanent settlement for how we all will contribute towards our care in later life and the system that delivers it. The paper considers the question regarding whether the proposed funding settlement and statute will be aligned with each other, and, critically, with a vision for social care that is designed around people’s lives, rather than around services. It argues that only a funding system acceptable in principle and in practice to those who contribute to it will survive over time. It considers four key principles for a future funding settlement, arguing that it should be: fair; transparent; sustainable; and capable of supporting self-defined outcomes. The importance of an outcome-based funding system, which is compatible with how people live their lives, and what they want and value from life, is discussed. The paper considers what a settlement enshrining these principles would look like. It concludes by examining the challenges of an outcome-based model.
Distributional effects of reform in long-term care
- Author:
- KARLSSON Martin
- Journal article citation:
- Ageing Horizons, 6, 2007, Online only
- Publisher:
- Oxford Institute of Ageing
- Place of publication:
- Oxford
Population ageing will intensify the distributional dilemmas related to provision and funding of long-term care (LTC) services. Several OECD countries have recently reformed their LTC systems, but as yet there is a paucity of evidence on how different reform options affect the financial position of different socioeconomic groups. Another neglected issue is how individuals adapt to changes as a result of LTC policy reform. One complication in the analysis of LTC reform is the great uncertainty in projections. This is largely due to the long planning horizon needed, and also the nature of LTC services themselves. The aim of this paper is to review two recent contributions to the literature: Hancock et al. (2006) and Karlsson et al. (2007). Particular emphasis is placed on the policy implications of these findings, but key issues for future research are also identified.
Projections of owner-occupation rates, house values, income and financial assets among older people, UK, 2002-2022
- Authors:
- HANCOCK Ruth, et al
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2006
- Pagination:
- 11p.
- Place of publication:
- Canterbury
This paper contains projections of owner-occupation rates, house values, income and financial assets among people aged 85+ in the UK covering the period 2002 to 2022. The projections have been produced by the microsimulation model CARESIM. CARESIM is a model which simulates the amounts that current and future older people would be required to pay towards residential or home care, should they need that care, under different charging regimes. The projections presented here are produced as an input to those simulations. CARESIM uses a sample of people aged 65 years and over drawn from the Family Resources Survey and projections involve ageing this sample. The sample is not ‘refreshed’ i.e. people under the age of 65 in the base year (2002) are not brought into the sample as they reach 65. By 2022, therefore, CARESIM projections apply only to those aged 85 and over. For this reason results for 2022 are given only for those aged 85 and over. Results for years between 2002 and 2022 are shown only for those age groups for which CARESIM projections apply.
Extra care housing: capital and revenue funding
- Author:
- KING Nigel
- Journal article citation:
- Housing Care and Support, 4(4), November 2001, pp.24-28.
- Publisher:
- Emerald
This is the second in a series of articles introducing ideas about extra care housing for older people. Extra care models and new 'retirement communities' are becoming an alternative to residential care and traditional sheltered housing. This article looks at modelling capital and revenue funding.