Arrangements for Paying for Care in Independent Homes for Elderly People

Correspondence to Anne Corden, Social Policy Research Unit, University of York, Heslington, York YO1 5DD. Summary A fundamental reorganization of the basis of financial supportfor elderly people in independent sector homes is currentlyin progress. Much of the debate so far has focused on the reasonsbehind the policy changes, and possible implications for furtherdevelopments in provision of care and services. Less attentionhas been paid to practical details of mechanisms for transferringmoney to effect payment to independent proprietors. These havenot yet been finalized. It is important that arrangements eventuallydecided serve the best interests of the elderly people concerned.Such arrangements may not always be the simplest and cheapestto administer, either for those authorities paying the bills,or for proprietors balancing the books and managing homes. Thereis an opportunity now, while mechanisms of payment are stillbeing worked out, to consider the options and raise the levelof discussion on this topic, so that the welfare of elderlypeople is high on the agenda while policy decisions are beingmade. This article describes how elderly people currently paytheir bills for care and accommodation in independent long-stayhomes. Changes in the basis of government financial supportfor long-term care, due to be fully implemented in April 1993,will require different mechanisms for transfer of monies. Theoptions are considered in the light of what we already knowabout the significance of financial exchanges within care homes.     

Residential Care for Elderly People: Characteristics of Patients Admitted To Residential and Nursing Home Care from Hospital

Correspondence to Mr W. Power, Department of Social Work, Kingston General Hospital, Hull HU3 IUR Summary Fifty consecutive admissions to residential and nursing homecare from hospital were examined and the results discussed.Patient profile fitted the general pattern expected of frailelderly people with high dependency needs. There was a noticeableshift towards placements in private establishments but onlyabout half the patients were likely to have satisfied criteriafor local authority placement or require nursing home care.Breakdown in care-giver arrangements was found to be a majorreason for entry to care. Apart from a significant number ofwheelchair users going into nursing homes, there were no sharpdivisions between the residential care and nursing homes groups.     

Factors Predicting Admission of Elderly People to Local Authority Residential Care

Correspondence to Dr Ian Sinclair, Director of Research, National Institute for Social Work. Mary Ward House, 5–7 Tavistock Place, London WCIH 955 Summary Successful community care may partly depend on identifying thoseat risk of entering residential homes and targeting servicesto them. This article is concerned with how this identificationcan be achieved. It considers a sample of old people livingalone. in touch with home helps or social workers and followedup for between two and four years. The research examined thefactors likely to produce admission, and used discriminant analysisto predict it.     

The Approved Social Worker -- Reflections on Origins

Correspondence to Pauline M. Prior, Department of Social Policy and Social Work, University of York, Heslington, York YO1 5DD. Summary The aim of this paper is to examine the role of social workersunder current mental health law, in order to see if the adventof the Approved Social Worker (ASW) represents any more thanthe re-appearance of old concepts in a new guise. It is arguedthat it is impossible for the ASW to be anything more than anupdated version of the Relieving Officer of the last century,in view of the fact that the Mental Health Act 1983 does notprovide a clear mandate for an effective professional advocateon behalf of mentally ill people.     

Residential and Foster Care in the European Community: Current Trends in Policy and Practice

Correspondence to Dr Matthew Colton, Department of Social Policy and Applied Social Studies, University College, Swansea SA2 8PP. Summary This article compares residential care, foster care and theiralternatives in the countries of the European Community. Thefollowing common trends in policy and practice are examined:the decline of residential child care; changes in the populationof separated children; the trend towards small-scale provision;the development of an ecological perspective; increasing differentiationof care provision; professionalization; and alternatives toresidential and foster care. The pace of development is uneven across EC countries. Overall,the trends high-lighted are more apparent in the northern countriesthan in the southern states.     

Visitors' Views on Residental Homes

Correspondence should be addressed to Justine Schneider, Senior Lecturer, Centre for Applied Social Studies, University of Durham, 15 Old Elvet, Durham DH1 3HL, UK. Email: Justine.Schneider{at}durham.ac.uk Summary Relatives and other people who visit residential care homeshave an opportunity to formulate their own views about the qualityof care, often over a considerable period of time. They maybe experienced in providing care themselves, and many have beenthe principal carer before admission of the resident. They canbe decision makers in purchasing care, and their preferenceswill therefore influence the market. Finally, through theirfrequent attendance, they too form part of the environment ofa home. This paper reports the findings of a survey of 228 visitorsto 17 residential care homes throughout England. It shows whothe visitors were, what they did, their likes, dislikes andideas for improvements. It summarizes what aspects were mostimportant to visitors, many of whom were former carers; thishas implications for purchasers and providers of residentialcare. It closes with a methodological discussion about how thevaluable views of visitors may be tapped without encounteringreticence due to guilt or fear of retribution affecting theresident.     

Working in Partnership in Child Protection: The Conflicts

Correspondence to Dr Margaret Bell, Department of Social Policy and Social Work, University of York, York, UK. Summary This article critically examines the work of twenty-two localauthority social workers undertaking child protection investigations.The findings suggest that, while the social workers were committedto being (and believed their practice to be) participative,the dual tasks of making risk assessments for the conferenceand working in partnership with the families concerned producedconflicts of interests and rights. The impact of these on socialworkers' engagement with family members, on their assessments,and on the decision making process is explored. It is concludedthat the difficulties identified limit opportunities for participativepractice, and that these difficulties are endemic to the presentsystem. It is argued that these findings point up the need fora more broadly based child-care service which more appropriatelymeets the families' welfare needs, and that the contradictorynature of the conference task should be addressed by clarifyingthe legal base of the intervention and developing other modelsof decision making. Some ways forward are suggested.     

A Model for the Comprehensive Assessment of Older People and Their Carers

Correspondence to Beverley Hughes, Department of Social Policy and Social Work, University of Manchester, Oxford Road, Manchester M13 9PL. Summary Although local authorities and social service departments arein the process of developing systems of assessment in relationto care management, there has been little debate about the principleswhich ought to underpin assessment processes, nor about thepurpose, scope, and content of comprehensive assessment witholder people. This article discusses these issues and proposesa framework for comprehensive assessment with older people andtheir carers, derived from development work with social workersin a number of local authorities. Of particular importance isthe need for comprehensive assessment to embody meaningful mechanismsfor user and carer participation and empowerment; to acknowledgenot only need and risk but strengths and resources; to regardthe older person as the centre of a network of personal, familial,and social factors which together determine her or his qualityof life and level of risk. The implications for practitionersare examined.     

Working in the Social Services: Job Satisfaction, Stress and Violence

Correspondence to Professor Jan Pahl, Department of Social and Public Policy and Social Work, Darwin College, University of Kent at Canterbury, Canterbury CT2 7NY. Summary A major survey of the social services workforce (Balloch etal., forthcoming), carried out in the Research Unit at the NationalInstitute for Social Work, has produced new data about sourcesof job satisfaction and about the incidence of stress and violence.The survey took place in five different local authorities inEngland, and interviews were carried out with 1276 individuals,selected from four groups of staff: managers, social work staff,home care workers and residential staff. The results suggestedthat those who work in the statutory, social services do experiencemore stress and violence than workers in other parts of thehealth and welfare services. However, different jobs presenteddifferent hazards. In general, home care workers were the mostsatisfied with their jobs, and were also the group least likelyto be stressed or to experience violence in the course of theirwork. By contrast, residential workers, especially those withmanagement responsibilities, were most at risk of both violenceand stress. Men were more likely than women to experience violence,while other groups with a higher than average risk of stressincluded younger members of staff, and managers and social workstaff responsible for elderly people.     

Private Children's Homes

Summary The paper provides survey and intensive research material onthe private children's homes sector. It is shown that this sectoris currently in decline. Private homes are found to be shelteringchildren with long and complex care histories and to adopt adistinctive residential style. Although private homes providevaluable long term continuity, they are less likely to offerthe same range of community services as do residential settingsmanaged by the local authority and voluntary child care agencies.     

Keyworkers Re-examined: Good practice, quality of care and empowerment in residential care of older people

Correspondence to Rosemary Bland, Department of Applied Social Science, University of Stirling, Stirling FK9 4LA, Scotland Summary Social work definitions of ‘good practice’ in residentialcare which were originally developed in work with children andyoung people have also been applied to residential settingsfor other user groups, including older people. However, anylink between such elements of practice and positive outcomesfor users has not always been demonstrated. The introductionof market principles and orientations into social welfare inthe 1980s re-defined the social work ‘client’ asa ‘consumer’ with the associated power to make choicesin the area of social care. The success with which such an approachcan be applied to services for people who are very often, notin a position to exercise much choice, is debatable. Alongsidethe notion of the ‘consumer’ or ‘user’of services has grown the ideology of ‘empowerment’of people who use social work services. Drawing on findingsfrom a recent study, this article explores the contributionof the keyworker role to good practice and the empowerment ofolder people living in residential homes. It concludes that,because their understanding of the concept and practice is largelyundeveloped, the role as currently interpreted is not consonantwith good practice and tends rather to reinforce the power ofstaff.     

Informal Care in Asian and Afro/Caribbean Communities: A Literature Review

Correspondence to Karl Atkin, Social Policy Research Unit, University of York, Heslington, York YO1 5DD. Summary The multi-racial nature of British society can no longer beignored by those responsible for planning and implementing socialcare policy, particularly since community care is presentlyat a crossroads. Informal care provides a useful starting pointfrom which to introduce the notion of race into social caredebates. The paper, by reviewing a mix of empirical studiesand policy debates emerging from the literature on informalcare and black communities, examines the experience of informalcare within black communities. By discussing topics such asthe demography of care, the nature of informal care, and serviceprovision to black carers, it gives coherence to a fragmentedliterature and illustrates gaps in present understanding.     

Child Therapy and Evidence in Court Proceedings: Tensions and Some Solutions

Correspondence to Kate Wilson, Senior Lecturer in Social Work, Department of Social Policy and Social Work, University of York, Heslington, York YO1 5DD. Summary Recent policy developments in the UK, implemented in the wakeof well-publicized child abuse court cases, have highlightedthe tension between offering the abused child adequate supportand providing sound evidence in any statutory proceedings. Therapeuticwork can give the court clear indications of the child's wishes,feelings and developmental needs, with or without explicit verbalstatements, and non-directive play therapy, because it is non-coerciveand largely free from therapist suggestion, is particularlyeffective in this respect. Particular features of non-directiveplay therapy which enhance the validity of such evidence areconsidered and a range of factors involved in presenting therapeuticwork to the courts are explored.     

The Right Kind of Telling? Locating the Teaching of Interviewing Skills within a Systems Framework

to Juliet Koprowska, Department of Social Policy and Social Work, University of York, Heslington, York, YO10 5DD, UK. E-mail: jk11{at}york.ac.uk Summary There is a gradually expanding literature addressing the teachingand learning of interviewing skills in social work education.The process of professional learning in the wider field is notfully understood; empirical studies are rare and methodologicaldifferences make comparison difficult. Few papers offer a theoreticalbasis for methods of teaching. The article starts with a shortaccount of the literature, with more explication of papers whosethemes are closely related to those of this article; a considerationof skills training on social work qualifying programmes follows.Next, Agazarian's (1997) theoretical framework is presentedand then the theory and methods of practice are employed tomake sense of obstacles to learning and to demonstrate how toovercome them. Finally, potential areas for further researchare suggested.     

Consistency: a pre-requisite for inspecting old people's homes?

Correspondence to Dr Ian Gibbs, Centre for Housing Policy, University of York, Heslington, York YO1 5DD. Summary Inspection of old people's homes, in both local authority andindependent sectors, forms a major component in the work ofthe new ‘arm's length‘ inspection units. The successof these units will depend in part on inspectors' ability tomake consistent judgements based on agreed standards. This articlereports on a study which examined the extent to which inspectorswere able to reach reliable conclusions about the quality ofcare in old people's homes and the possible contribution ofchecklists in this task.     

Quality Indicators: Disabled Children's and Parents' Prioritizations and Experiences of Quality Criteria when Using Different Types of Support Services

Correspondence to Dr Wendy Mitchell, Social Policy Research Unit, University of York, York YO10 5DD, UK. E-mail: wam1{at}york.ac.uk Summary Current health and social care policy seeks to develop and refinestandards of service quality. However, policies have so farlargely focused upon statistically based service output indicators.Recognizing the importance and yet limitations of this, especiallyin services for disabled children and their families, this paperdraws upon qualitative and quantitative data to explore indicatorsthat are meaningful and relevant to disabled children and theirfamilies. Results demonstrate the need to look beyond a genericfamily-based perception of service quality, as children andparents value different aspects of service quality and prioritizedifferent indicators when using different types of services.Although some indicators are regarded as ‘core’quality indicators, irrespective of service type, others areonly prioritized for specific types of services.     

Which Children are Registered at Case Conferences?

Correspondence to Terry Fisher, Department of Social Policy and Social Work, University of York, Heslington, York YO1 5DD. Summary A postal questionnaire to social workers was used to describethe characteristics of situations where children were the subjectsof child protection case conferences, to identify factors distinguishingthose registered from those not registered and to describe theaccounts given by social workers of the reasons for registration.The paper reports and analyses this information and raises somebasic issues about the relative importance in registration decisionsof evidence of physical or sexual abuse, characteristics ofthe adults involved, and a child's feelings and emotional state.     

Parental Contact with Children Fostered and in Residential Care after the Children Act 1989

Correspondence to Andy Bilson, Department of Social Work and Social Policy, University of Northumbria, Newcastle NE7 7XA. E-mail Andy_Bilson{at}Unn.AC.UK Summary Research carried out since the implementation of the ChildrenAct 1989 based on a sample of 848 children looked after by localauthorities indicates that previous estimates of the numberswho have no contact with parents may have underestimated theextent of the problem, and that despite the emphasis placedon contact by the Children Act there is still much work to bedone to improve practice. The research not only confirms earlierfindings about the instability of placements in care but alsoshows differences in face to face contact which depend on thelength of time in care or accommodation and the reason for entry,as well as differences between children placed in residentialand foster care. Finally it was found that where children havespent long periods in care they tend to have little contactwith fieldworkers, and it is suggested that there is a needto redefine the social work agenda for this vulnerable groupof children.     

Foster and Residential Care Practices Compared

Correspondence to Dr Matthew Colton, Department of Social and Administrative Studies, Barnett House, Wellington Square, Oxford OX1 2ER Summary This paper reports what is, remarkably, the first systematic,in-depth, comparative study of foster and residential care practices.The overall research objectives were: (1) to delineate and comparecare practice in special foster homes (i.e., homes accommodatingchildren traditionally considered too old or disturbed for fosterplacement) and Children's Homes for older children in localauthority care; and (2) if possible, ascertain whether the responsesmanifested by children in such settings can be related to thecare practices they experience. The approach adopted was essentially sociological. A lengthyperiod of field-work in two local authorities featured the useof a range of research instruments and included the collectionof data on the following: the management of recurrent–mainlydaily–social events; children's community contacts; theprovision of physical amenities; the controls and sanctionsused by caretakers vis-à-vis children; the roles of caretakersand their behaviour and attitudes towards children; and thecharacteristics of children, their behaviour towards caretakers,perceptions of their social environments and progress duringplacement. Quantitative methods were used in data analysis becausethey provide a useful guide to the import of observed differencesbetween foster homes and Children's Homes. Care practice in the foster homes was, overall, significantlymore child-oriented than in the Children's Homes. Moreover,the responses of residential children appeared to fall shortof offering justification for the ways that the lives of suchchildren seemed to differ from those of foster children.     

Determinants of Substitute Child Care Practice

Correspondence to Dr Matthew Colton, Department of Social and Administrative Studies, Barnett House, Wellington Square, Oxford CX1 2ER Summary The first part of this paper attempts to examine the factorswhich help to define foster and residential care practices.The discussion is informed by a comparative study of fosterhomes and Children's Homes, which was reported in the previousissue of this journal (BJSW 18:1). Overall, care practices inthe foster homes compared very favourably with those observedin the Children's Homes. It is argued that this finding owesmuch to the bureaucratization of Children's Homes. The secondsection considers the implications of my work for policy andpractice in the field of substitute child care. Use is madeof the insights provided by the preceding section to suggestways by which the major shortcomings identified by empiricalresearch might be ameliorated. This statement includes an argumentin favour of a significant expansion of family placement forolder children in public care, and a proposal for a child-orientedalternative to the sorts of Children's Homes visited.