A Role for Anyone? A Description of Social Work with the Elderly in Two Area Offices

Summary This article analyses information from Case Review Forms completedby social workers on 199 allocated elderly clients. These peoplewere very frail, most were considered to be ‘at risk’and to require regular, reliable and frequent care. The questionof the client moving to a tafer setting arose in two-thirdsof the cases, concerning which there was often some dispute.It is argued that social workers require a high level of professionalskill in dealing with clients, and others involved, faced withsuch questions and that this requirement will remain with thedevelopment of ‘community social work’.     

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.     

Short Term Care for the Elderly in Residential Homes: A Research Note

Please address requests for reprints to Dr. D. Boldy, Division of Health Sciences, Centre for Advanced Studies, Western Australian Institute of Technology, Kent Street, Bentley WA 6102, Australia. Summary Short term care for the elderly has expanded rapidly in thelast five years. The study evaluates short stay care in fourresidential homes using interviews with 42 clients, their main‘carers’, officers-in-charge of the homes and socialworkers. Whilst the service worked reasonably smoothly and provideda break for family carers there remains further potential forimproving the quality of service in the context of a full rangeof services for elderly people.     

Barriers to Implementation of a Cooperative Model of Respite Care

This paper describes the conceptualization and field experience with a cooperative model of respite care for the frail elderly. Planning and program development were successfully completed yet implementation did not come to fruition. A survey of family caregivers, conducted to analyze obstacles to implementation, is instructive in identifying attitudinal barriers to use of a cooperative model for providing respite care for the frail elderly. The reasons for the program's failure and the lessons learned from it are examined and discussed. Implications are drawn for the planning and development of new intervention programs.     

Community-Based Long Term Care

Through the Living at Home Program (LAHP) 20 communities across the United States have developed cooperative networks involving multiple health and social services providers. The LAHP networks have sought to increase access to care, reduce duplication of services, and identify and fill service gaps. The LAHP national evaluation is examining the inter-organizational linkages that have been implemented by the networks and the characteristics of 1500 clients enrolled for care. Preliminary findings at the midpoint of the evaluation indicate that the networks have moved from a reliance on informal communication and coordination mechanisms at baseline to the use of more formal structural mechanisms over time. Despite the lack of formal targeting criteria, the networks have enrolled a quite frail elderly population. Future analyses will examine variability across the networks in client targeting and service utilization, In order to shed light on the need for utilization review of community based long term care.     

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.     

A Comparative Case Study of Care Systems for Frail Elderly People: Germany, Spain, France, Italy, United Kingdom and Sweden

Comparative studies of European social policies towards frail elderly people typically focus on the systems and their implementation. The study presented in this article, conducted in 2001 in six European countries (Germany, Spain, Italy, France, the United Kingdom and Sweden) aims at comparing the rights of the individuals within the different care systems. The methodology used is a case study approach, which draws on a series of situations of dependent elderly people. Therefore, the analysis focuses on the public authorities’ responses – the care packages, which determine the type of care required and the financial contribution of the user – in each of the six countries, in relation to the concrete situations of frail elderly people. As local variations are important, in all the countries studied, local authorities have been chosen in each of the countries. This approach gives us interesting concrete elements on the services and financial help which can be given to frail elderly people, but it also enables us to understand precisely the national care systems organized in the different countries and the main difficulties encountered by public authorities in facing this problem of frail elderly people.     

Controlling for Care: Private and Voluntary Homes Registration and Inspection--A Forgotten Area of Social Work

Summary The size and growth of private and voluntary residential careprovision for the elderly make it, despite past neglect, a subjectof great importance to social workers. Drawing on exploratoryresearch data, the origins and role of registration and inspectionare discussed and some of the shortcomings of the present systemhighlighted. The paper discusses necessary requirements to preventfinancial exploitation of the elderly and makes two modest suggestionsfor improving and maintaining the quality of care-designatedliaison officers and a complaints procedure. In conclusion,however, it is pointed out that quality is not the only issuein the regulation of the private and voluntary sectors, thereare also issues of quantity, type and location. None of theseare being addressed by recent legislation and Code of Practice,but their resolution is important in ensuring that elderly peoplereceive the care they want and need, when and where they wantit.     

Community Care for the Elderly -- Rhetoric and Reality

Correspondence to A.C. Bebbington, Assistant Director, Personal Social Services Research Unit, Cornwallis Building, The University, Canterbury, Kent CT2 7NF. Summary This paper investigates the management and delivery of carefor 176 elderly people receiving both community health and socialservices. These people represent a crucial group if the communitycare policy is to become a reality, and they receive high serviceslevels. The study provides both quantitative and qualitativeevidence of inadequate case management and lack of co-ordinationin providing care. Assessment, determining services, and reviewwere all inefficiently managed. Liaison was non-existent forthe majority, and opportunities for substitution were missed.There could be conflict over role, particularly in relationto personal care. Innovations designed to tackle these problemsremain limited in scale. These difficulties are recognized andaddressed by the 1989 White Paper ‘Caring for People’which makes a number of proposals to clarify responsibilitiesand accountability. The different professional assumptions andwork practices among the plurality of agencies providing carewill need to be resolved if community care is ever to offera realistic alternative to care in institutions for increasingnumbers of people with high levels of dependency.     

Intergenerational Care Providers of Non-Institutionalized Frail Elderly

This study reports on the care provided to (41) non-institutionalized frail older persons by their children and/or grandchildren. The study is based on a population of frail elderly persons referred for in-home assessment services to the Iowa Model Gerontology Project in Scott County, Iowa. These referrals were based on the referral sources belief that the older person was at risk for institutional care. The study explores three aspects of intergenerational family caregiving: the characteristics of the off-spring caregivers, their perceptions of both the positive and negative impacts of providing care, and their perceptions of supplementary assistance needed and desired from outside agencies in carrying out the caregiving tasks.     

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.     

Social Work as an Aspect of Primary Health Care: The Social Workers' View

Summary This study is based on an analysis of social workers' viewsof their work with 168 clients referred over a six month periodin 1977 in a health centre setting. A wide range of referralswas made and there was close collaboration with other primaryhealth care professionals as well as outside agencies. Far morepsycho-social problems were encountered by the social workersin the course of their intervention than were apparent on referral,although most of the work was short term. Social work with theindividual predominated and a variety of traditional socialwork skills were employed, although the elderly received relativelylittle help with emotional problems and were offered mainlypractical help. Social workers' perceptions of their clientsare discussed in relation to their choice of methods of interventionand feelings of efficacy. The attachment scheme emerges as generallyfruitful both in terms of social workers' job satisfaction andclients benefitting from a multi-disciplinary approach; howeverthe need for closer inter-professional collaboration in meetingthe needs of the elderly is highlighted.     

Group Living in Homes for the Elderly: A Comparative Study of the Outcomes of Care

Correspondence to Tim Booth, Department of Sociological Studies, Joint Unit for Social Services Research, University of Sheffield, Sheffield S10 2TN. Summary This paper traces the theory and practice of group living inhomes for the elderly in the literature and in the field. Itreviews the current state of research and calls for more workon the comparative evaluation of outcomes. It describes andpresents the results from a longitudinal study of matched samplesof residents in group homes and traditional homes which assessedthe relative changes in their personal functioning over time.The findings suggest that group living arrangements have beenoversold—in so far as they promise more than they deliver.     

Case Management and Care Management in Community Care

Correspondence to Prof. Peter Huxley, Mental Health Social Work Research Unit, Department of Psychiatry, Mathematics Building, Oxford Road, Manchester University M13 9PL. Summary This paper reviews the purpose of case management, its introductioninto the UK, and its central components. While case managementhas empirical referents which have been developed over manyyears (largely in the USA) care management has, until recently,had none. The paper examines different models of case managementin terms of organizational structure, content, and outcome assessment.The importance of the distinction between clinical and administrativecase management is emphasized, especially in work with mentallyill persons. The review of existing evidence suggests that inorder to produce effective intervention services must have clearlyidentified objectives, closely specified target groups, interventionswhich match the objectives, and employ related outcome measurements.Some of the current issues in the implementation of care managementare considered.     

Adopted Children in Care

Correspondence to David Howe, School of Economic and Social Studies, University of East Anglia, Norwich NR4 7TJ. Summary Four local authority social services departments were surveyedto determine the number of adopted children who were currentlyin their care. The biographical characteristics of these childrenand the reasons for them entering care are reported. The adoptivedimension is discussed as a possibly relevant factor in theassessment and treatment of these children and their families.It is concluded that appropriate practice in this field requiresspecialist skills and understanding.     

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.     

Key Issues for Social Workers Placing Children for Family Based Respite Care

Correspondence to Dr. Carol Robinson. Summary This paper seeks to address some of the issues surrounding theplacement of children with handicaps who, at their parent'srequest, go to stay with paid carers working in a family basedrespite care service. The content of the paper derives froma detailed evaluation of the Avon Respite Care Scheme. Thisevaluative study began in April 1984 and was completed in July1986. In order to provide an adequate picture of the contextin which the research was conducted, a brief outline of theliterature and the organization and philosophy of the serviceis provided. Thereafter, the aims of the research and the sourcesof the evidence used are described. In the latter part of thepaper. the results and their implications for social workersinvolved in placing children in family based respite care schemesare discussed.     

Temporary Foster Care

Summary In order to improve outcomes in temporary foster care the authorbelieves there is a need to develop alternative models for practicethat would (a) define the social work task (b) specify in operational terms how that task would be accomplishedand thus would be amenable to empirical testing. (Temporaryfoster care is defined as the provision of substitute familylife for a child received into care, where there is a clearintention to re-unite the natural family at a future date). This article deals with the essential preliminaries to the developmentof a practice model. The first part surveys the relevant literature;part two develops a theoretical framework for practice aroundthree themes which are considered central to a considerationof foster care. These are the separation experience, the placeof the natural family, and role clarification. Other crucialvariables such as the age of the child, the nature of the problem,or the parents' potentiality for change are not dealt with withinthese papers, but are nevertheless seen as important issuesto be considered at the stage of designing a model for practice.     

Entry into Residential Care

Summary This paper examines the interaction between the organizationalstructure of social services departments and procedures foradmission into residential care. By drawing on research experiencea 'placements table' is proposed which contains the key operationaldecisionstaken by the department when the client becomes a resident.It is argued that, in accordance with the structure of the department,it is possible to suggest appropriate staff to make each keydecision in order that departmental criteria for admissionsmay be met.     

Reconciling Cash and Care: Home Care Charges and Benefit Checks in Social Services

Correspondence to Pete Alcock, Health and Community Studies, Sheffield Hallam University, Collegiate Cresent, Sheffield S10 2BP Summary This article contains the report of a small research projecton the development of welfare rights checks for home care clientsin social services departments. Welfare rights take-up activityhas become an important feature of provision by local authoritysocial services departments, frequently targeted on particulargroups of clients known to experience problems in claiming fullbenefit entitlement. Users of home care services are such aclient group. Take-up work with home care clients is also, however,a product of the impact of community care policy changes andof financial pressures on local authority social services. Thesehave resulted in the introduction of charges for home care servicesby many authorities, and the use of rebates from such chargesto protect low income service users. Welfare rights work hasthus become an important feature of the reconciliation of thesenew charging policies with the continued service needs of poorhome care clients. The research examined a successful take-upinitiative, linked to home care charges, in Sheffield and contrastedthis with similar activities in other authorities throughoutthe UK. The conclusion is reached that levels of non-take-upof social security benefits are particularly low amongst homecare clients and that benefit checks can secure significantadditional income for them, which may also have the indirecteffect of increasing the income to social services departmentsfrom the charges for home care services.