Cost-benefit analysis in social care for elderly people

Social care at home for elderly people is now growing rapidly in France. A new question is, What are better forms of care for the different partners concerned? The research presented here, and made for the Comity of Lille Employment Area with cooperation of the Caisse Primaire d'Assurance Maladiede Lille (the local board of the national social security system), offers some answers to that question. Ceteris paribus, cultural activities-in a group or at home-versus others appear to produce more interest for elderly, professional caregivers, and the rest of society.     

The politics of care for elderly people in Scandinavia

Most of the European countries struggle with a lack of public resources for the care of elderly people. Several comparative studies have shown that the ‘social democratic’ welfare regime of Scandinavia offers more public services to older people than any other regime. This is true both for institutional care and home care. The national averages, however, hide some serious problems. The responsibility for the care of elderly people has been transferred to the municipalities. This is threatening one of the cornerstones of the Scandinavian welfare state, equality. Access to care is increasingly becoming a question of which municipality you happen to grow old in. While inequality seems to be the problem when comparing elderly living in different municipalities, too egalitarian a policy seems to be a problem within the municipalities. In a situation where every old person is entitled to get help, the number of old people is growing and the economic resources are restricted, the cheapest form of care, ‘thinly spread’, often seems to be the only solution. It is argued that this leads to unnecessary institutionalisation. Whether there are other solutions, and what consequences they have, is also discussed. Empirical findings from a study of the care of older people in five municipalities in Denmark, Finland, Iceland, Norway and Sweden from 1991 to 1995, will be used as examples.     

Policy networks and the implementation of community care policy for people with mental handicaps

Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, 'in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great'. This paper examines the extent and causes of this 'implementation gap' in respect of services for people with mental handicaps--a consistent priority group for national policymakers. We examine centre-periphery relations in the health and personal social services in the light of Rhodes' power-dependence framework and his concepts of policy networks and policy communities. The NHS has been described as the archetypal professionalised policy network but we conclude that it is possible to account for implementation failures in community care only partly in terms of the dominance of the medical professions' values and interests and the deficiencies of accountability and control due to clinical autonomy. Such failures are due also to the inherently limited power of the centre. Sub-central units are not merely its meek agents. Moreover, the centre must explicitly structure local environments by itself providing a coherent framework of service and resource policies compatible with the national objectives it is seeking to achieve.     

Enhancing participatory research with the community oriented primary care model: A case study in community mobilization

Refining Participatory Research with the methodology of Community Oriented Primary Care (COPC), sociologists, medical providers and other “professionals” were able to assist the people of a small, rural county in western Appalachian North Carolina create a “community health consortium.” The consortium grew out of a research process funded by the W.K. Kellogg Foundation, which included some 40 interviews with community groups that articulated health problems and barriers to health care. The consortium then undertook action projects, which in turn enhanced networking between community groups and agencies while reducing mistrust between them. The consortium empowered people to articulate their realities, needs and became a force for change able to make demands on political office holders and decision makers. Despite its democratic origins and ideology, the consortium needs to do more to extend its outreach to include the marginal and disenfranchised.     

National policy approaches to social care for elderly people in the United Kingdom and Singapore 1945-2002

The authors compare policy approaches in the United Kingdom and Singapore on social care for older persons. The context of these approaches is discussed showing the development of policies, in each country from the aftermath of the Second World War to the present. Given that Singapore is a former British colony, it is of interest to scholars of social policy to examine its welfare approach as compared to the welfare state approach espoused by the United Kingdom. Both nations are faced with the challenges of an aging population, which necessitates handling similar problems with strategies that are in harmony with their respective economic, social, and cultural contexts. This paper considers their divergence of philosophies and policies, concluding with the recognition that the major difference lies in national and governmental expectations regarding the extent of the financial and regulatory responsibility for care for older people carried by the individual, the family, and the state.     

Procedures when young people leave care — Views of 111 Swedish social services managers

In western societies, there is a general tendency towards a protracted transition to adulthood for young people, who thereby may become increasingly dependent on support from family. Young people leaving a placement in out-of-home care often lack such support, and will thus have a disadvantageous position compared to their peers. With the purpose of looking into the procedures when young people leave a placement in out-of-home care, telephone interviews were performed with 111 managers of social service units in two Swedish regions (West Sweden, and Stockholm Region), using a structured interview schedule. Answering rate was 99.1%.Only 6% of the managers had information of the young people's whereabouts once they had left care. 86-88% had general support programmes for all young people concerning housing, employment etc. but only 2-4% had specific programmes for young people leaving care. A majority of the managers were attentive of the difficulties the young people leaving care may encounter, but displayed little awareness of the consequences of a prolonged transition to adulthood, and the need for continued support after leaving care. Several managers referred to the general support of the Swedish welfare state, meaning that young people leaving care had the same access to support as all other young people in Sweden. Consequently, young people leaving care are at risk of being invisible in the welfare system and facing a compressed transition to adulthood.     

Caring for people with disabilities in the Haredi community: adjustment mechanism in action

This study aims at examining the change in caring for individuals with developmental disability in the Haredi (Jewish ultra-Orthodox) community in Israel. Using qualitative methods, we examined the setting up and operating of educational, residential, and recreational facilities for this population. Of the 31 such facilities in two Israeli cities, 16 were randomly selected. The findings revealed three central issues expressing the process of a gradual change in the attitudes and in the forms of caring for persons with disabilities in this sector: (a) social crisis as a catalyst for change; (b) the Social model and rehabilitation principles; and (c) the role of the rabbis in the change process. These issues were explained based on the concept of 'adjustment mechanism'.     

Developing practice in caring for confused elderly people

The problem focused style of training we describe offers a means of helping Managers to be purposeful and successful in establishing developments in caring for residents. The training programme is concerned with the management and organisational context of resident care, as well as the skills of caring. Officers in Homes are actively engaged in the planning, training and development associated with the training programme, in consultation with a Training Co-ordinator, and a Client Group Specialist. We outline the outcomes, structure, content and methods of the programme, paying particular attention to responses to the different circumstances of each Residential Home.     

The struggle for citizenship: the case of disabled people

The notion of 'citizenship' has become a popular slogan of governments who espouse a commitment to democratic ideals. Such discourse tends to emphasise responsibilities with little serious significance being given to the question of rights. In this paper we explore the continual discrimination which disabled people experience and which militates against the realisation of meaningful citizenship. The struggle for citizenship is viewed as an affirmation of the value of choice, independent and control which disabled people conceive in terms of human rights.     

International migrations and care provisions for elderly people left behind. The cases of the Republic of Moldova and Romania

International migrations are posing numerous challenges to care systems in both sending and receiving countries. Based on a multi-method research conducted between 2011 and 2013, this article looks at how the care provisions for elderly people are rearranged in two Eastern European countries affected by the care drain phenomenon (the Republic of Moldova and Romania). The author charts and compares how transnational families, but also the other facets of the care diamond, such as the public sector, the market and the not-for-profit sector, provide care to elderly people left to cope at home alone because their close relatives have migrated. The main findings of the article are that transnational families are the principal welfare provider for elderly people left behind, while there is a serious delay in the adoption of specific policies for the elderly.     

The supportive community: a new concept for enhancing the quality of life of elderly living in the community

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a "neighborhood facilitator," and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

Interprofessional education for community mental health: Attitudes to community care and professional stereotypes

Social workers are considered key members of community mental health teams, yet difficulties in interprofessional collaboration between social workers and health care professionals, particularly psychiatrists and nurses, have been reported. This paper examines some sources of these difficulties in terms of perceived differences in models of mental illness, attitudes and values, including stereotyping, professional identification and role clarity. Interprofessional education (IPE) may diminish negative stereotypes and promote multidisciplinary teamwork. A theoretical framework is described and findings from the evaluation of a 1-year programme of interprofessional education for community mental health are presented. These findings suggest that attitudes and values concerning community care for people with mental health problems are largely shared by different professions, but they do confirm the existence of interprofessional stereotypes and of perceived status differences. In contrast to previous research, there was no evidence of changes in stereotypes. These findings are discussed in terms of the theoretical framework and the design of the programme.     

Residential care for children and young people: priority areas for change

Abuse in residential childcare has been of concern to the public and the profession for a number of years. This article highlights a Scottish Institute for Residential Child Care's (SIRCC) response to the Scottish Government which was requested following allegations of abuse in Glasgow City Council's Kerelaw residential school and secure unit. It offers priority actions to address the challenges of residential childcare and ensure the safety of children and young people as far as is practicably possible. It contextualises the residential childcare task, and explores four interrelated areas in which change is strongly recommended: (1) organisations' cultures; (2) workforce challenges including the status of the sector, staff selection standards, the role of residential childcare workers in relation to their level of autonomy and their education levels; (3) abuse allegations, in particular the sector's growing fearfulness of false allegations, support for practitioners' anonymity when accused of abuse and a reconsideration of criminal record certificate information; and (4) service delivery related to behaviour management and advocacy support. The intersection between the SIRCC and the subsequent Kerelaw Inquiry reports is outlined. Finally, it concludes with a scan of the immediate strategic policy horizon which indicates an unprecedented momentum for change. While based in the Scottish context, it reflects lessons which are applicable internationally. Copyright © 2010 John Wiley & Sons, Ltd.     

Mobile phones and elderly people: a noisy communication

Knowing the users is capital for building user-friendly digital interfaces. One way to think about the users is considering their familiarity with this technology. This article presents the results of twelve interviews with elderly people residing in the so-called South Zone of Rio de Janeiro (Brazil) who have used mobile phones over at least one year. It is part of the Doctor's Thesis "Mobile phones for elderly people - usability for social integration" ("Celulares para idosos - usabilidade a servi?o da integra??o social"), which is targeted at ascertaining if the current mobile phones are user-friendly for elderly people. Through the technique of Guided Interviews, we found usage time, criteria for choice of phones, reasons for changes, preferences, and manners of use. Preliminarily, we have noticed differences in the behavior of the participating users and performed a qualitative analysis according to groups of age and gender.     

Communes of elderly people: Between independence and colonization

While it is generally assumed that elderly people want to live alone, at least as long as they are physically able, this is not always the case. Not only has the rapid growth of communes of elderly people in the Netherlands attracted international attention, it has also become a social policy issue. The government and institutional care providers tend to see them as informal homes for the aged, whereas the elderly who are involved in this see the communes as positive alternatives to traditional ideas on aging. In a theoretical interpretation it is shown that both the communes and the different reactions to them represent in a nutshell important developments concerning aging and the position of the aged in Western society, as well as major trends in the modernization process.     

Intentions and strategies among elderly people: Coping in everyday life

Many studies of the elderly adopt a provider perspective, focusing on social policy, organizations, and professional groups. Less is known about how the elderly manage when they eventually need help in everyday living. This study examined the everyday behavior and strategies of the elderly through conducting semi-structured, in-depth interviews with 22 people over age 65. The intentions and strategies found revealed that the elderly managed or coped in active, adaptive, and passive ways, ranged along a continuum from actively maintaining their independence to passively depending on others.     

Paying for the health and social care of the elderly

The aging population of Japan is causing serious concern among social policymakers. The most urgent issue is to find a way to pay for the health and social care of the frail elderly. After universal coverage of pension and health insurance was achieved, but just before the economic growth rate was considerably slowed, in part, because of the oil crisis, the Japanese government more than doubled pension benefits and made medical care for the elderly free. Since the early 1980s, the government has tried hard to cut and control these benefits, only with moderate success. With a consumption tax rate of only 5%, rather than the proposed 7%, the government is now considering establishing a new health and social care insurance scheme for the elderly to finance the increasing cost of their care.