Long Term Care for the Elderly: the Community Care Scheme

Summary The article describes the full evaluation of the Community CareScheme for the elderly in Kent. The evaluation compared therelative cost-effectiveness of the scheme for clients and carerswith the range of services which would otherwise have been received.It is argued that effective case-management by a key workeris an essential feature of more effective home care for thevery frail elderly and that the case-management role is an appropriatemodel of social work for other long term care groups. The newscheme appeared particularly appropriate for the extremely mentallyand physically frail who were living with others and for theless frail, socially isolated elderly person prone to minorpsychiatric disorder.     

Care for Elderly People in the European Community

All EEC countries are faced with an ageing population, which means an increase of people in some way handicapped in everyday activities. A comparison of the solutions adopted by several EEC countries in the sectors of housing, home care services, residential and nursing homes shows that a real medico-social policy has been worked out only in Denmark and the Netherlands. In France and the United Kingdom, public authorities have certainly defined policies which lay claim to providing overall coverage but they have not provided corresponding resources. In Germany and in Italy there is no clearly defined policy. Here we discuss the various factors which may account for these differences.     

Care Proceedings under the 1989 Children Act: Rhetoric and Reality

Correspondence to Bridget McKeigue and Chris Beckett, School of Community Health and Social Studies, The Old Gym, Anglia Polytechnic University, East Road, Cambridge CB1 1PT, UK. E-mail: b.m.mckeigue{at}apu.ac.uk Summary Among the most important changes that it was hoped would flowfrom the 1989 Children Act were, first, a reduction in delaysin care proceedings, since this was recognized to be harmfulto children and, second, a shift away from the use of compulsiontowards working in partnership. In this article, Bridget McKeigueand Chris Beckett demonstrate that, in both respects, the Acthas not only failed to deliver, but has been followed by rapidchange in the opposite direction to the one hoped for. However,many commentators, both within and outside of government, continueto speak of the Act as if it had been a success. The articleconsiders a series of characteristic rhetorical manoeuvres,which seem to allow the Act’s failings to be passed overin much of this discourse. They conclude that progress is morelikely to be made if the Act’s failure to deliver is franklyconfronted.     

A New Approach to Community Care for the Elderly

Summary Organisations can absorb successfully only a few fundamentalinnovations within a short period of time. It is therefore importantfor the designers of innovations to ensure that they directlyand substantially contribute to solving important problems,and for agencies to concentrate their innovative activity onthose that do so contribute. The first aim of this paper isto analyse the policy context so as to clarify the nature ofthe problems that make innovation in the care of the elderlyimperative and show how features of the Community Care Projectcontribute to their solution. The second aim is to provide somepreliminary evidence of the success of the scheme. The analysisof data for seventy persons in the experimental and controlgroups shows that the experimental group fared better in a numberof important ways; and that the gains appear to have been madeat no extra cost to the social services department. Therefore,it is concluded, the adoption of the scheme may contribute tothe technical progress needed in the provision of social serviceto the elderly with needs at or above the margin for residentialcare.     

Community Integration of the Elderly in Foster Family Care

Currently the care of the elderly is part of a nationwide trend of deinstitutionalization. However, community placement of formerly institutionalized clients, particularly through the mental hygiene system, has in some instances met with negative community response. Extent of resident participation in the community and degree of community acceptance were studied through interviews with caretakers ir) 100 foster homes, housing one to four clients over 60. More than 3/4 of the residents were reported as having met neighbors. One-third of the residents take walks in the neighborhood, with an additional 2/5 visiting in the neighborhood. One-third participate in activities such as senior centers or church groups. Contrary to expectation, those homes associated with the mental hygiene system reported greater participation in community activities than did those sponsored by the social services system. Negative response from the community occurred in only about 10% of homes. Thus, foster family care appears to show promise both for community integration of the elderly and for community acceptance of the deinstitutionalized.     

探讨医务社会工作在社区养老中的作用

社区是老年人生活和活动的主要场所,在提供养老服务方面具有很大优势。由于政府投入社区养老的资源有限和人们观念认识等方面的问题,使得社区养老没有达到预期的效果,即没有满足老年人的有效需求,特别是老年人的医疗需求,使得老年养老问题再次陷入困境。医务社工的介入,是解决当前社区养老中追切需要解决的问题的有效元素,也是使得社区养老资源发挥更大效用的关键因素。     

Charging and Quasi-Markets in Community Care: Implications for Elderly People with Dementia

Social services authorities in the UK are increasingly involved in charging and fee collection activities with clients in receipt of community care services. This article explores the implications of these developments for elderly people with dementia. The starting point of the article is a critique of existing legal and administrative options for handling other people's money, including the difficulties and dilemmas raised for both paid and unpaid carers by the existing arrangements. This is then related to the failure of charging and fee collection systems which have developed as a result of the community care reforms to address the particular needs of elderly people with dementia. A case study of policies in one local authority is outlined and this is followed by the presentation of the view of 37 fieldlevel professionals who were interviewed in focus groups. The concerns of these respondents included the complexity of the assessment task, conflicts between care managers and finance/revenue staff, the difficulty of defining and responding to financial abuse, and dilemmas over the extent to which relatives and carers should be trusted. The final section of the article considers the implications of a move to quasi-markets in social care for elderly people with dementia, particularly in terms of their vulnerability to financial exploitation.     

上海社区居家养老服务的现状、问题与对策

为应对严峻的人口老龄化形势,上海市通过构建以社区居家养老服务为主、机构养老服务为辅的养老服务格局,为老年人提供日常生活照料服务、医疗护理和保健服务、社会帮助与精神慰籍服务。居家养老服务经过十多年的实践,取得了一定的成效,但仍存在许多问题与不足。为此,需从加大资金投入、完善政策连贯性、提高服务队伍素质、健全评估机制等方面入手,进一步促进社区居家养老服务的发展。     

Improving Emergency Care for the Elderly

Much has been written on the developing role for social workers in hospital emergency rooms but little has focused specifically on social work interventions with elderly emergency room patients in an urban teaching hospital. A group of fifty patients over sixty-five years of age, referred to social service for assessment and assistance with home care issues, is described. The emergency room social worker's role with these elderly patients is highlighted and three case examples are discussed. It is argued that social work interventions improve the quality of both emergency and ongoing care for this growing and often at risk population.     

Alcohol Policy and Health Promotion: Rhetoric and Reality

This paper examines the economic and political constraints on the development of Australian policy directed at the prevention of alcohol-related health problems. An analysis is made of recent official statements and enquiries and it is argued that heightened concern about prevention arose in the context of budgetary problems and the need for governments to find ways of containing expenditure in the welfare area. The effectiveness of current efforts is called into question by the real nature of the constraints on health, and of the disparity between prevention rhetoric and policy implementation. It is suggested that government statements of intent to reduce the overall level of alcohol comsumption in the community entail no clear-cut commitment to a particular strategy or set of strategies, and that recent government actions indicate the limited possibilities for the implementation of such a policy. Any policies governments are likely to pursue are unlikely to disrupt major sources of government revenue. Because of the high profile that governments have created for the problem, there is the possibility that the policies that are adopted will be politically expedient in the short-term rather than providing real solutions.     

Service Delivery for the Community Elderly:

Effective service delivery should be based on the interpretation of social research theory into an operational plan. This paper reports on the demonstration and study of an innovative service model which integrates the theories of social roles, life space, and organizational participarion. Through the development of informal support systems on a neighborhood basis, linkages between the elderly person and his environmenr have been effectively strengthened or re-established. It is suggesred that the model be replaced in more rural and urban areas.     

老年人社区服务需求与社区工作专业化

本文以南京市鼓楼区某街道为例,探索了老年人不同层次的社区服务需求及其满足状况。本文认为,当前老年居民低层次的社区服务需求已经基本得到满足,但高层次的社区服务需求难以满足。必需加快社区工作者的职业化和专业化,提升社区服务的质量才能更好地满足老年人的社区服务需求,实现社区和谐发展。     

Foster Family Care for Frail Elderly

For the last 10 years, the development of cost-effective, community alternatives for chronically ill has been a serious concern of many service providers and policy-makers. The expanding of the elderly population has been well documented. In this state, projections show a need for an additional 1602 long-term care beds by the year 2000, almost double the current capacity. The state Medicaid Program is searching for ways to reduce the 50 million spent in 1982 for institutional long-term care. Already experiencing the shortage of long-term beds, hospitals have a chronic loss of revenue potential through the holding of non-acute patients in the hospital while waiting for a nursing home bed vacancy. At the 500 bed acute care hospital, 25-30 beds daily are occupied by nursing home wait-listed clients. The average wait-listed days per patient is 20.4. In September 1979, the hospital's department of social work began foster family care for elderly persons eligible for nursing home care. Foster families are extensively screened and trained for the severely dependent clients. The social worker and registered nurse team are closely involved in placements, developing and implementing an individualized written treatment plan to assure the clients quality of care. Data collected over the past three years clearly indicates that this setting provides cost-effective, quality care. Overall scoring on bathing, dressing, toileting, transfer, and continence, utilizing the KATZ Activity of Daily Living, shows that 71% of the clients improve after 3 months on placement. Although 45% of the clients are incontinent of bowel or urine at the time of placement, 33% make significant improvement to only occasional accidents. With 41% of the clients at placement requiring adaptive device and assistance for walking, 48% of the clients show functional improvements in walking. Most significant for continued survival of this type of care, the total program cost is half the cost of institutional care for these elderly clients. The paper will examine the multiple needs served through the program: the ill elderly person's need of a therapistic, caring environment; the hospital's need to curb loss of potential revenue; and the need of the Medicaid Program to contain costs. The paper also reviews client characteristics, foster family characteristics, quality assurance, and overall cost-effectiveness of the foster family model.     

Hospital-Based Long-Term Care Services for the Frail Elderly

This paper examines acute care hospital diversification into long-term care services for the frail elderly. The discussion focuses on five multifaceted roles played by health care social workers as hospitals develop long-term care initiatives. The need for an advocacy stance in both macro and micro aspects of care is stressed. Ethical dilemmas that arise in hospital-based systems are presented.     

老化与照护:失能老人的长照困境与社会工作服务 ——基于B市Y社区的调查

失能老人养老服务除了面临经济、身体等方面的沉重负担,还面临心理、情绪、观念等方面的负面影响。既有照顾者与被照顾者之间的双向压力,也有政府、社区、机构之间的供给缺位,也存在养老需求与长期照护现实之间的矛盾,还存在社会支持缺失与个体无法增能的双重窘境。基于社会工作助人的专业视角,探索夯实以居家养老为基础的家庭照护、加强社区老年照护服务、转型升级医养结合服务新模式的长照策略,达成失能老人老化态度转变、老年人力资源活化、照护资源有效整合的增能预期,实现"就地老化"和"成功老化"。     

Patients First — Reality or Rhetoric?

This paper will argue that the NHS, despite its aspirations to provide a universal service of excellence, has not been historically very responsive to the consumers it serves. Under the present Government this attitude has ostensibly changed. “Patients First” has become a catch phrase both nationally and at the local level in Brighton Health District. A recent CHC survey of consumers' rections to service revealed however that many elderly patients were not consulted in any meaningful way about their needs on discharge from hospital. Why does the reality of consumerism not match the rhetoric? A number of potentially explanatory factors are identified and their relevance evaluated in the context of Brighton CHC's research. It is suggested that the currently fashionable consumerism represents a different concept from active participation which would necessarily involve a fundamental realignment of the NHS.     

Health Care Utilization Among the Elderly

The present study represents and attempt to develop a conceptual framework which provides a theoretical linkage between predisposing, enabling, and need for care factors and the utilization of physicians' services within an elderly population. Multiple regression and path analytic techniques are used to access the relative importance of these factors in determining health care utilization. The findings indicate, among other things, that the measures of morbidity, or the need-for-care, are the most important variables determining use. The substantive findings and their implications for the development of health care policies and programs for future research are highlighted.     

Towards Integrated Community Care for the Frail Aged

The growing awareness of family support among the frail aged has yet to be incorporated into a clear strategy for developing comprehensive community care. A starting point is to identify the characteristics of target populations, the range of tasks associated with aged care, and the capabilities of various informal and formal providers. Fully appropriate services would take into account the availability of family support as well as the needs of older people themselves. It is suggested that services be designed to (1) supplement support from spouses; (2) periodically substitute for other co-resident carers; (3) complement assistance from nonresident family; and (4) substitute for the unavailability of family support. Community services currently provide modest supplements, principally to nonresident support, but do little to address the other contexts of care. Suggestions are made for program developments that would provide genuine alternatives to institutionalisation without devolving the social costs entirely onto families.     

Elderly Consumers and Social Care Policy

The development of social care policy for elderly Australians is proceeding with little regard for the preferences and perspectives as expressed by the elderly themselves. The likely consequence is a continuation of policies based largely on other people's assumptions about what elderly people actually need and the extension of service categories into which many elderly people do not easily fit. Discussions with 71 elderly consumers during 1983 in Queensland established that they have input to make into policy and service delivery issues such as the provision of information on services, the determination of needs, the extension of choices between alternative services and choice of appropriate service providers. Social care policy should not continue to develop around singular and untested assumptions concerning what elderly people need and prefer.