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Free personal care: insights from Scotland
- Author:
- INDEPENDENT AGE
- Publisher:
- Independent Age
- Publication year:
- 2020
- Pagination:
- 26
- Place of publication:
- London
This briefing seeks to build on existing information on free personal care – based on the principle of free-at-the-point-of-use social care, like the NHS – by providing an insight into the experiences of some of those involved in, and receiving, social care in Scotland. The paper aims to contribute to the policy debate as the government considers undertaking bold reform in England that similarly includes the principle of free at the point of use. It draws on evidence from interviews with staff involved in the management of social care; a survey of 397 people in Scotland who had had experience of interacting with the care system; and data from 2002 onwards that showed changes to social care delivery since Scotland introduced free personal care. The analysis reveals that many older people in Scotland feel they have benefited from the introduction of free personal care and continue to do so decades later. However, it is equally clear that any government wishing to implement a similar policy in England has much to learn from some of the challenges in Scotland. Of particular importance is the need to be absolutely clear over the definition of personal care and who will benefit, as well as the need to situate any such reform within the context of a long-term stable funding settlement. In addition, the evidence from Scotland shows that while, as an individual policy, free personal care will benefit many older people, it will not provide all that everyone needs, and so must sit within a package of wider reform. Without a combination of these wider reforms, free personal care will be unable to deliver significant benefits for older people and their families. (Edited publisher abstract)
A digital cage is still a cage: how can new and emerging digital technologies advance, rather than put at risk, the human rights of older people who draw on social care?
- Authors:
- CROWTHER Neil, MCGREGOR Lorna
- Publisher:
- University of Essex
- Publication year:
- 2022
- Pagination:
- 98
- Place of publication:
- Essex
This report explores how to choose a future where technology in social care is used to advance human rights, not threaten them. The use of new and emerging technologies as tools for meeting people's need for social care and support has the potential to go one of two ways: it could enable older people to live more autonomous but connected, independent, and dignified lives, or it could facilitate the reduction of human-delivered care and interaction, and at the most extreme, replicate some of the worst features of institutionalisation, through control and coercion. Both futures could also co-exist, whereby some older people enjoy the benefits of new and emerging technologies as part of a rights-based model of social care, and others experience them as a means to deny their rights and to further entrench a 'time and task' approach to care with older people 'maintained' by only meeting their basic needs. The report makes baseline recommendations for approaching the role of new and emerging technologies in social care as a starting point to wider debates and developments in the field, including: overcoming digital divides; identifying red lines in the design, development or deployment of new and emerging technologies for social care; establishing clear safeguards. (Edited publisher abstract)
Social care costs for community-dwelling older people living with frailty
- Authors:
- NIKOLOVA Silviya, et al
- Journal article citation:
- Health and Social Care in the Community, early cite May 2021,
- Publisher:
- Wiley
International evidence indicates that older people with frailty are more likely to access social care services, compared to nonfrail older people. There is, however, no robust evidence on costs of social care provided for community-dwelling older people living with frailty in their own homes. The main objective of this study was to examine the relationship between community-dwelling older people living with frailty, defined using the cumulative deficit model, and annual formal social care costs for the 2012–2018 period. A secondary objective was to estimate formal social care spending for every 1% reduction in the number of older people who develop frailty over 1 year. Secondary analysis of prospective cohort data from two large nationally representative community-based cohort studies in England was performed. Respondents aged ≥75 were used in the main analysis and respondents aged 65–74 in sensitivity testing. This study used regression tree modelling for formal social care cost analysis including frailty, age, gender, age at completing education and living with partner as key covariates. This study employed a minimum node size stopping criteria to limit tree complexity and overfitting and applied ‘bootstrap aggregating’ to improve robustness. This study assessed the impact of an intervention for every 1% decrease in the number of individuals who become frail over 1 year in England. Results show that frailty is the strongest predictor of formal social care costs. Mean social care costs for people who are not frail are £321, compared with £2,895 for individuals with frailty. For every 1% of nonfrail people not transitioning to frailty savings of £4.4 million in annual expenditures on formal social care in England are expected, not including expenditure on care homes. Given considerably higher costs for individuals classed as frail compared to nonfrail, a successful intervention avoiding or postponing the onset of frailty has the potential to considerably reduce social care costs. (Edited publisher abstract)
Public spending on adult social care and delayed transfers of care in England
- Author:
- IPARRAGUIRRE Jose
- Journal article citation:
- Quality in Ageing and Older Adults, early cite 31 August 2020,
- Publisher:
- Emerald
Purpose: This paper aims to whether current public expenditure on adult social care services might be associated with the number of delayed days of care attributable to the social care system in England. Design/methodology/approach: Panel econometric models on data from local authorities with adult social care responsibilities in England between 2013-2014 and 2018-2019. Findings: After controlling for other organisational sources of inefficiency, the level of demand in the area and the income poverty amongst the resident older population, this paper finds that a 4.5% reduction in current spending per head on adult social care per older person in one year is associated with an increase by 0.01 delayed days per head the following year. Social implications: Given the costs of adverse outcomes of delayed transfers of care reported in the literature, this paper suggests that budgetary constraints to adult social care services would represent a false economy of public funds. Originality/value: This is the first paper that models the association between public spending on adult social care and delayed transfers of care due to issues originating in the social care system in England. (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)
Unmet need for social care among older people
- Author:
- VLACHANTONI Athina
- Journal article citation:
- Ageing and Society, 39(4), 2019, pp.657-684.
- Publisher:
- Cambridge University Press
Understanding the nature and extent of unmet need for social care among older people is a critical policy priority in the United Kingdom and beyond, as national governments juggle the provision of adequate social care for a growing older population with competing funding priorities. Several factors can heighten the experience of unmet need among older people, for instance their family environment, and their health and socio-economic status. This paper contributes empirical evidence on the patterns of unmet need for social care among older people in England today, focusing on the individual characteristics associated with experiencing unmet need in relation to mobility tasks, activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The results show that about 55 per cent of older individuals with an ADL difficulty had unmet need, compared to 24 per cent of those with an IADL difficulty and 80 per cent of those with a mobility difficulty. Characteristics reflecting greater vulnerability were more strongly associated with the risk of experiencing unmet need for ADLs, and such vulnerability was greater for particular ADLs (e.g. bathing), and for a higher number of ADLs. The findings reaffirm the complexity of conceptualising and empirically investigating unmet need in later life, and add to our understanding of the challenges of providing adequate and appropriate social care to older people. (Edited publisher abstract)
Satisfaction with adult social care assessment: the development of a measure
- Authors:
- ABENDSTERN Michele, et al
- Journal article citation:
- Research Policy and Planning, 29(2), 2012, pp.95-114.
- Publisher:
- Social Services Research Group
Seeking the opinions of service users is an important aspect of ensuring services are designed and adapted with their views in mind. The evaluation of social care assessment in the UK and elsewhere has to date been limited. This paper describes the development and implementation of The User Satisfaction Assessment Tool (USAT), validated by older people, designed specifically to measure older service users’ views of social care assessment, in particular their satisfaction with it. This was undertaken as part of an evaluation of the Single Assessment Process (SAP), introduced into England in 2004. The challenge was to create a tool that could be used by a broad range of people, be administered in a variety of ways, and be sensitive to variation in response. The paper considers the concept of satisfaction and its measurement, describes the administration of the USAT, and further explores a number of methodological issues arising from this. Following discussion of both its strengths and limitations, the paper concludes that the USAT is an appropriate and reliable satisfaction tool to collect baseline data from which more detailed and in-depth responses could be drawn. (Edited publisher abstract)
A report on the effectiveness of adult protection arrangements across Scotland
- Author:
- CARE INSPECTORATE
- Publisher:
- Care Inspectorate
- Publication year:
- 2014
- Pagination:
- 16
- Place of publication:
- Dundee
A review of the strengths and weaknesses of adult protection arrangements in Scotland. The report draws on previous inspections and the recently introduced joint inspections of health and social work services for older people. Work was also carried out across all 32 local authority areas in Scotland with chief officers and adult protection committees to find out more about the effectiveness of the current arrangements for protecting vulnerable adults. The review found signs that chief officers and adult protection committees have a clear focus on the protection of vulnerable adults although there are some concerns that the capacity for improvement is weak in some areas. In those areas showing signs of effective performance, leaders provide strong direction and collective ownership of shared values for delivering the best possible outcomes for adults in need of protection. Where there was a lack of direction and oversight of the work of the adult protection committee by chief officers, this tended to be associated with an absence of robust self-evaluation and an inability to provide evidence of ongoing improvement. A growing number of chief officers’ groups have reviewed and strengthened structures and governance arrangements for public protection to improve the scrutiny and challenge of performance. This has made the connections across relevant areas such as domestic abuse, violence against women and drug and alcohol partnerships more explicit. It is also leading to improved joint working and successful integrated approaches to protect and support vulnerable and at-risk groups. This report identifies barriers to improvement in protecting vulnerable adults. In the main, barriers are tending to be focused around capacity rather than capability. Given the high level of restructure happening to drive efficiencies and integrate services, the report suggests that it is imperative that roles and responsibilities for adult support and protection are not lost and that a framework of continued improvement is identified and reported to the chief officers’ group. Key processes in assessing and responding to risks and needs are identifies as an area for national improvement. (Edited publisher abstract)
Future of paying for social care in Wales: first report to the Welsh Government
- Author:
- LE WALES
- Publisher:
- LE Wales
- Publication year:
- 2014
- Pagination:
- viii, 84
- Place of publication:
- Cardiff
Sets out the evidence to date on the future of paying for care in Wales. Chapter 1 outlines the scope and approach to the research and analyses the population trends in Wales. Chapter 2 presents a picture of the number of people who received adult social care services from Welsh local authorities; the local authority spend on those services; and the revenue that local authorities receive from charges for those services. Chapter 3 summarises the way in which local authorities charge services users for social care services and also provides information about the levels of those charges. Chapter 4 provides information about the use of deferred payment schemes in Wales and in England, drawing the information from desk research, including Welsh local authority websites, and questionnaire for Welsh local authorities. Chapter 5 provides information about the financial products that are currently available and that maybe useful for service users wishing to pay for care services and also discusses prospects for changes in the availability of such financial products. This draws on desk research supplemented by six telephone interviews with stakeholders in the financial service sector. Discussions were held with product providers, intermediaries and trade associations. Finally, Chapter 6 provides a high level overview of alternative models for paying for care, drawing on the experiences of other countries, including other parts of the UK. (Edited publisher abstract)
Beyond eligibility: universal and open access support and social care
- Author:
- HENWOOD Melanie
- Publisher:
- Melanie Henwood Associates
- Publication year:
- 2012
- Pagination:
- 67p.
- Place of publication:
- London
Age UK commissioned this study in order to better understand councils’ approaches to universal and open access support for older people whose needs do not meet the eligibility threshold for publicly financed adult social care. The study examined: current barriers to universal support; potential levers for improvement; and gaps in knowledge and understanding which impede appropriate development. The research entailed examining councils’ websites, exploring research and wider literature, conducting 9 interviews with key Directors of Adult Social Services (DASSs) and some other leading stakeholders, and participating in numerous email exchanges with other parties. Throughout the fieldwork for this study, interviewees emphasised the fundamental challenge of resource pressures and the impact on eligibility thresholds. Pressure on resources also creates difficulties for councils seeking to innovate or experiment, and the role of elected members is particularly crucial in determining whether or not councils are able to sustain their investment in adult social care. Throughout the study it was apparent that although there were some consistent themes about the need to develop new models and best practice, there is no single blueprint that can be applied to all councils, but it is possible to steer and incentivise the direction of travel.