Contested Housing Landscapes? Social Inclusion,Deinstitutionalisation and Housing Policy in Australia

Deinstitutionalisation is represented as a major step toward social inclusion through the resettlement of disabled people residing in segregated large‐scale institutions into community‐based homes. By promoting the right to live in ordinary community residential settings, deinstitutionalisation fundamentally changes both the support services and housing arrangements of former institutional residents. In Australia, as in many western countries, debates on community care have tended to focus on the location and nature of non‐housing supports for people leaving dependent care. This focus, however, overlooks the fact that deinstitutionalisation involves a radical rehousing of people in care. This paper explores the character and implications of deinstitutionalisation in Australia as a rehousing process. It is based on a recent national research project that has examined the housing futures of people with intellectual disabilities who have been, or will be, deinstitutionalised. The paper considers the increasingly divergent socio‐political perspectives that have emerged in recent discussions about social inclusion, institutional reform and independent living and their implications for housing and community care policies.     

Capacity Building and the Reconception of Political Participation: A Role for Social Care Workers?

This paper explores a citizen-based approach to social workwhich may counter modern negative managerialist pressures onpractice. It links the discourse concerning the growth of userinvolvement in public policy with the discourse about participationin political activity and suggests a role for social workersin supporting service users in initiatives such as self-help,campaigning and community action which offer a new interpretationof community-based social work. By engaging in this activity,health and social care professionals can support people to participatein emerging forms of active and inclusive citizenship. Whileparticipation in traditional political activity such as votingand political party membership is declining in the UK, peoplein marginalized groups are finding ways to have their voicesheard about issues which directly concern them. Increasingly,groups such as disabled people, older people and mental healthservice users/survivors are taking part in activity which marksa shift of focus to include both self-help and campaigning.In contrast to their disillusion with traditional politicalactivity, people across a range of groups have gained strengthand encouragement from campaigning achievements. The paper drawson a national research study which offers fresh insights onthese issues as a basis for exploring participative approachesto social work practice.     

A Brave New World of Personalized Care? Historical Perspectives on Social Care and Older People in England

Social care policy for older people in England continues to generate extensive discussion around the need to break with the past and to deliver a personalized response to need. This article explores the extent to which this represents a complete break with the past by looking at four key reports from the past, namely the Rucker Report (1946 ) on the break up of the Poor Law, the Seebohm Report (1968 ) on the personal social services, the Griffiths Report (1988 ) on community care and The Royal Commission on Long Term Care ( Sutherland Report, 1999 ). Each is interrogated in terms of how social care is defined, how services are to be delivered, how quality is understood and the assumptions made about who will be able to access services. This analysis is used to draw out key continuities in policy assumptions such as the primacy of family and the ongoing debate about ‘What is social care?’ and how it can be distinguished from health care. The article also argues that the voluntary sector has always been seen as a ‘key player’ in social care. Finally, the analysis of the four reports is used to trace the ever changing role of local authorities in the planning, purchase and provision of social care services for older people.     

Integrating Health and Social Care at the Micro Level: Health Care Professionals as Care Managers for Older People

A common problem in the provision of coordinated long‐term care is the separation of health and social care. The present government has been increasingly concerned with promoting convenient, user‐centred services and improving integration of health and social care. One arrangement that could contribute to this for some older service users is for health care staff to act as care managers, coordinating the provision of both health and social care. This paper presents the findings of a survey of arrangements in place in local authorities for health staff to work as care managers for older people. This was designed to provide details about the range and scope of care management activities undertaken by health care professionals. Key areas of enquiry included: which kinds of health care staff undertook care management and in what settings; how long the arrangements had been in place and how widely available they were; whether there was a distinction between the types of cases and care management processes undertaken by health care staff compared with their social service department counterparts; and what management and training arrangements were in place for the health care staff.     

Ageing Populations and Housing Needs: Comparing Strategic Policy Discourses in France and England

Set against a broad European policy agenda which promotes ‘ageing in place’ and representations of older people as active, independent citizens, this article compares recent English and French policy discourses on population ageing and its implications for the housing needs of increasingly large numbers of older citizens. Through analysis of six recent strategic policy statements representing each government's official responses to population ageing and its social policy implications for the 21st century, we demonstrate how differences in the social representation of the ageing process and of older peoples themselves permeate policy discourse, influencing the perceptions of the housing needs of older citizens and the role that housing itself may play in promoting independent living. In England, demographic ageing, housing and its role in facilitating independent living and active ageing are explicitly articulated, whilst in France, the housing environment has until recently, been portrayed as one which must accommodate the illness, incapacity and dependency of later life. Our article offers explanations for these differences in terms of cultural variations in the social representations or ‘constructions’ of later life, divergences in political philosophies and welfare principles.     

Access to Services as a Civil and Social Rights Issue: The Role of Welfare Professionals in Regulating Access to and Commissioning Services for Disabled and Older People under New Labour

This paper draws up a theoretical framework of citizenship, based on Marshall's thesis, that encompasses the idea of access to welfare services (using the example of community care services for disabled and older people) as a civil and social rights issue. The authors critically examine current policy developments in the NHS and local authorities under New Labour that emphasize partnership, particularly the proposals and provisions made in 'The New NHS' and 'Partnership in Action'. Their theoretical framework is used to explore issues concerning access to and the commissioning of health and social care services under New Labour. They conclude that the role of welfare professionals, particularly GPs and social services workers, and their relationships with service users, patients, carers and their families under New Labour presents a continuing challenge to the citizenship status of disabled and older people.     

Will You Still Need Me,Will You Still Feed Me?—Paying for Care in Old Age

A major issue for social policy in the twenty-first century will be providing good-quality support and care for older people. However, recent debate about this has been driven more by ideology than by evidence. This paper examines the socio-economic, demographic and policy changes that are influencing the debate, and outlines findings from current research on attitudes towards financial planning for care in old age. This shows that the majority of people feel that the state should provide or pay for care for older people, either through a means-tested system or one which provides some basic level of protection which people can choose to enhance through their own means. However, only a minority would be willing to pay themselves for this, either directly through increased taxation or indirectly through reduced prospects of inheritance of housing capital. The paper concludes with a discussion of the policy implications of these findings.     

Human Motivation and Professional Practice: of Knights, Knaves and Social Workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self‐interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy‐makers have sought to effect such changes has been through the “new community care” of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide‐ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self‐interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client‐centred ethos.     

Defining responsibility for care: approaches to the care of older people in six European countries

This article examines the social care of older people in six contrasting European countries. Family, institutional and community care are compared, focusing on vulnerability, empowerment and the gatekeeping of resources. The article considers the position of older people in each care system by presenting individual case studies. The six countries include the family-oriented systems of Ireland, Italy and Greece, and the individual-oriented systems of Denmark, Norway and England. To improve the care of older people in any of these welfare cultures, resources need to be developed that work with existing sources of care but extend the rights of older people, at least to assessment and an equitable matching of needs to the care services available. Overall, the different levels of provision of organised social care services are a major aspect of inequality within and between the countries. Whilst there is little prospect for any major policy transfer across national boundaries, there is potential for selective cross-national learning with regard to particular service developments.     

Challenging Professional Roles: Lay Carers' Involvement in Health Care in the Community

The bulk of care in the community is carried out by lay carers. Recent policy initiatives to support them in the United Kingdom are outlined. There remains evidence of significant gaps in support from professional health and social‐care workers including community nurses. This paper reports three studies of lay carers: those caring for older people, carers of technology‐dependent children, and home‐care workers involved in the “direct payments” scheme. Findings are reported in the areas of decisions about appropriate caring roles, the lay–professional boundary, training and respite opportunities and the expertise of lay carers. Recommendations for policy and practices are made.     

The Role of Housing Managers in the Implementation of Community Care

This article will outline the response of housing management to the implementation of community care policy in the North East. It will locate housing's role within the broader development of community care policy, and briefly review the reasons for housing's relatively late arrival as a key partner, alongside social services and health, in the planning and delivery of services. Using information gathered from interviews with housing professionals, part-time housing students, voluntary organizations, and workers within health and social services, it outlines and evaluates five main factors which appear to be affecting the successful integration of housing management into the process of planning and delivering community care services in the North East.     

Effective personalised housing support for people with disabilities – case study analysis

International policy trends favour personalised approaches to housing support for people with disabilities. Previous research is inconclusive about whether these approaches are effective compared to group home support in the way they use government resources and benefit clients, partly because it does not usually consider the experiences of people who use the support. In this research we compared six new, innovative case studies of personalised housing support to previous research about group home support. We included qualitative data about client experiences, in particular regarding social networks, decision making, community service use and participation in domestic tasks. We found that client outcomes were positive in all four categories, while the financial costs to clients and government were similar to group home support. The results offer evidence that current, personalised approaches to housing support can be an effective policy option that allows people with disabilities to make choices about how to live and participate in their communities, without increasing the cost to government.     

A Functional Classification of Services for Older People

A deductively derived classification scheme is proposed which categorizes the health and social services of a community according to the levels of competence (behavioral functioningj and the levels of independence of the older people they address. Five levels of individual behavioral functioning ranging from simple to complex are specified: life-maintenance and health; perception-cognition: self-maintenance; effectance: and sociol role performance. Three levels of independence (of living arrangements) are specified ranging from the independent to the dependent subgroups of older people: the comparatively well elderly; elderly who require alternatives to prevent premature institutionalization; and elderly whose needs may confer institutional care or its equivalents. The services of a sample community are classified within this two dimensional scheme. The applications of the classification scheme to both community planning and individual treatment plan formulation are discussed.     

Lay Assessors and Care Home Inspections: Is There a Future?

This paper reports on research funded by the Nuffield Foundationexploring the role of lay assessors in the care home inspectionprocess in England and Wales. Lay people have been includedin many care home inspections for the past decade. Similar layinvolvement is included in other public service inspectionssuch as the Office for Standards in Education (OFSTED) inspectionsof schools. The Board of the short-lived National Care StandardsCommission (NCSC) controversially decided to dispense with suchlay involvement in the inspection process. The replacement body,the Commission for Social Care Inspection (CSCI), intends toinclude lay people in the inspections of support services inthe community but is hesitating about reintroducing them intocare home inspections. This research project was able to explorethe role taken by lay assessors in thirteen inspections of carehomes for older people and for adults with learning disabilities.The research concluded that lay assessors had a significantrole in communicating with residents and staff and observingcare home life. Their role was particularly important, as inspectorswere often so involved in paperwork and checking policy compliancewith the national minimum standards that they were often ableto spend little, if any, time talking to residents or staff.It is argued that there is considerable potential for a strengthenedrole of lay people in the care home inspection process.     

Bathing and the Politics of Care

Though providing baths in the community for disabled and older people has long been an area of service dispute, it has received little academic or policy attention. This is partly because bathing and washing are assumed to be common-sense activities. This paper suggests instead that washing and bathing are far from straightforward or common-sense and that specific meanings attach to them in ways that affect how people experience the receiving of help in these areas. It explores the history of bathing and washing and the significance of touch and nakedness in service provision. It then turns to the service providers who have traditionally undertaken such work—the community nursing and home care services—exploring the rationales that underlie such patterns and the implications of current changes in community care.     

Helping Older People in Residential Care Remain Full Citizens

New Labour’s project of modernization has involved thepromotion of interlocking ideas about active citizenship andnew modes of democratic engagement combining to produce whathas described as ‘participative governance’. Concernsabout legitimacy, a ‘democratic deficit’ and theneed to shift power and responsibility to the ‘citizen’have led to the emergence of a range of new deliberative foraand democratic processes. This has led to debates about howto ensure that social diversity can be represented in the decision-makingprocess. A challenge has been how to engage with the issuesof an ageing population and represent older people in all theirdiversity. In recent years, there have been growing calls toextend advocacy rights to older people living in residentialcare. Mostly, this has been to ensure that as consumers, theyhave a fuller say in how their service is run. Older care homeresidents are service users but, as persons, should not be reducedto this role only; they are also citizens in the broadest senseand should not be cut adrift from debates at the national, localand community levels on issues that concern them. This paperexamines how the moves to bring older people into deliberativedemocratic processes have tended to focus on those in their‘Third Age’. Those in institutional settings, beingin the ‘Fourth Age’, occupy a much more marginalposition. This effective disenfranchisement is yet another reasonwhy, for many, the move into residential care—a difficulttransition for a variety of reasons—becomes regarded asthe ‘last refuge’. It contributes to the sense ofloss of identity, lowering of self-esteem and a reduced senseof personhood. This article accepts that there should be moreeffective involvement of care home residents in decision makingabout their personal care. However, there are dangers in adoptinga too narrowly consumerist approach. This can reinforce a reductionistview of care home residents simply as ‘service users’—aform of ‘othering’ in itself. As citizens and membersof a wider community, they should be included in consultationsabout any community and wider political debates that affectthem. Such a proposal implies a widening and deepening of advocacyservices available to this group. As most older people in residentialcare are there following the intervention of a social care professional,then ensuring that they have access to advocacy must surelybe a key task. This paper argues that this is frustrated bythe lack of suitable services. Without a significant investmentby the Government in independent advocacy services, not onlyis the social work task with one of social care’s coreclient groups rendered impossible, but the Government cannotdeliver on its own agenda of empowerment, active citizenshipand inclusion.     

Eldercare Service Redesign in Finland: Deinstitutionalization of Long-Term Care

ABSTRACT

Deinstitutionalization is an important trend in the redesign of long-term eldercare in Finland. It refers to a process where traditional institutional care is partly replaced by home care services and the creation of homelike housing units. The first part of this article provides an overview of eldercare service redesign by using national statistics. The second part consists of qualitative analysis of the deinstitutionalization of eldercare. The data consist of 27 interviews conducted among municipal care administrators and is analyzed using thematic and discourse analysis. Main findings show a deep policy change taking place in eldercare deinstitutionalization discourse lying at its center. A distinction between explicit and implicit deinstitutionalization discourse is made. The former clearly states that institutional care needs to be cut back making it possible for all older people to live at home or in homelike housing facilities. Implicit deinstitutionalization discourse is underpinned by comments of a different type, more critical and problem-centered. Within intensive service housing, for instance, fee policy is reformed. The main results include the observation that explicit deinstitutionalization discourse is in line with the national policy aims of putting home first, while implicit discourse deals with hidden or unexpected consequences. The article discusses future research in the conclusion.     

社区照顾在残疾人社会保障中的运用

社区照顾最早产生于英国,自诞生以来,便以其新型的理念与模式日益受到各国学者和政府的重视。社区照顾作为一种专业化的照顾模式,在残疾人社会保障方面具有广阔的发展空间。本文试图将社区照顾的制度安排应用于我国残疾人社会保障事业,并探析我国残疾人社区照顾的模式,以推动我国残疾人社会保障事业向人性化、社会化、专业化方向发展。     

Social Housing Policy Challenges in Tasmania

This paper considers the social policy discourses that senior public housing and Non‐Government Organisation (NGO) housing managers employ to articulate and explain changes in social housing provision in Tasmania. We suggest that the Tasmanian social housing reform agenda is reflective of reforms in other Australian states. The period 2003–10 marked a time of policy change affecting social housing supply and policy discourse, which were influenced by neo‐liberal practices favouring multi‐actor governance models and financing. Interviews reveal that contradictory values and discourses were commonplace. Divergent views centred on the social goals and the efficiency elements of the new social policy focus, the Affordable Housing Strategy (AHS) and its eventual key delivery organisation, Tasmanian Affordable Housing Limited (TAHL). Despite constrained application, neo‐liberal processes remained strong within accounts of new social housing governance practices. We suggest that neo‐liberal practices have extended economic considerations into areas of social housing provision that were previously sheltered from market concerns.     

Alternative Housing

Many types of housing for older people that do not fit into traditional categories have been proposed, and some have been activated. A number of models are discussed, including the boarding/rooming house, cooperatives, house-sharing arrangements, hotels, mobile homes, community housing, the "granny flat," group homes, and foster homes. The ways in which each housing type meets basic residential needs are considered, including needs for a familiar environment, independence, privacy, personal security, social interaction, and social support. Most alternative housing models are of low appeal, solutions that are turned to either when other alternatives are unavailable or when personal needs happen to fit a particular alternative especially well. For both reasons, it is important to understand and foster the development of such alternatives, even if the numbers served will never be really large.