Distribution of home help services in an elderly urban population: data from the Kungsholmen Project

Data from the total urban population 75 years and older in Kungsholmen, Stockholm were used to calculate the distribution of home help services. A structured questionnaire was used to collect information about education, occupation, living conditions, Katz Activities of Daily Living Scale, contact with the family, medical treatment and also questions about help needed and functional ability. Home help was considered to be provided when the subjects reported receiving home help service from the municipality. The number of hours of home help and the services received were registered. The results show that 86% of the elderly population in the Municipality of Kungsholmen live in their own homes, even when they are very old. Twenty-seven percent of those over 74 years and 33% of those over 80 years received home help services. The people receiving help were mostly women, single living, older and with disability detected by the Katz Activities of Daily Living Scale. The predicting factors of hours of home help are older age, condition of single living, disability detected by the Katz Activities of Daily Living Scale and less years of education. Our results also show that, among those who receive home help service, those with disability in the activities of daily living get more hours of help. However, a considerable group of elderly people are disabled but do not receive any home help. Our data stress the need for more attention by health care planners of domiciliary and intensive care and residential facilities for the high risk population (very old, living alone and with disability).     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

The Economic and Gender Consequences of South Africa's Home‐based Care Policy

South Africa's approach to care provision in the era of HIV/AIDS is home‐ and community‐based care, but in reality care for ill people in the home is provided on an unpaid basis, predominantly by women. But how much do they spend on this care work, in time and money? And what economic consequences does this policy have, particularly for poorer women? This article is based on findings from a study that focuses on unpaid care provision within the home for those in late‐stage HIV/AIDS in KwaZulu‐Natal, South Africa, and specifically on the costs of such provision. The findings show that female caregivers are bearing the bulk of the costs of care provision for ill people within the home on an unpaid basis. Home‐based care is cost‐effective for the provincial government but not for unpaid caregivers who are subsidizing the provincial economy. While hospital care for people with HIV/AIDS has been capped, home‐based care services have not been increased to a commensurate level. Unpaid caregivers and ill people within the home are largely disconnected from the health system. The analysis clearly shows that the home‐based care policy is not resulting in appropriate or sufficient support for these individuals in need and needs to be revised.     

Is home care a realistic alternative to residential care among institutionalized elderly people in Finland?

The high rate of institutionalization among elderly people in Finland is widely discussed among policy-makers. We studied how realistic the wishes for deinstitutionalization are among the least sick elderly people in residential care, and what patient characteristics predict whether residential care is appropriate. This issue was assessed by the residential home personnel. Personnel assessment of institutional care as appropriate was mainly explained by patients' needing help with medication, limitations in activities of daily living, absence of own home to return to, no living children, incontinence, and poor vision. Discharging elderly people from long-term residential care back to society is limited by factors such as inadequate housing and shortage of domiciliary and rehabilitative services, as well as by attitudes among the institutionalized elderly people themselves. It seems more realistic to prevent the inappropriate institutionalization of elderly people than to discharge the small numbers of fairly independent individuals already in residential homes.     

Do public services influence patterns of informal care? Informal networks and public home care in three Swedish municipalities

Whether an individual receives home care services depends on two factors: the functional disability of the care recipient and the caregiver's gender, when the living arrangements of the care recipient are controlled. Data from this longitudinal study of social networks and home care organization in 3 municipalities in Sweden show that care recipients with a severe disability received more home care services than others. In cases where the main caregiver lives together with the care recipient, the public services are adjusted to the family situation and are independent of the functional disability of the care recipient. Care recipients who live with the primary caregiver receive less formal help than do care recipients who live alone. When the primary caregiver does not live together with the care recipient, the public services are adjusted to the functional disability of the care recipient and are independent of the primary caregiver's gender. Care recipients supported by a male helper received more formal help than care recipients supported by a female helper. Those supported by a female helper received more informal help. Various models of relationships, supplementation and complementation between informal care and public services are discussed. The dependence on public home services is high. Assistance with basic activities of daily living is the first area requiring complementary contributions from the public services. A special type of kin independene was found, related to the function of public services in a modern and gender-equal society. The results provoke a discussion on research design as well as comments on welfare policy and gender equality in the transformation of the welfare state.     

Receipt of Formal and Informal Help with Specific Care Tasks among Older People Living in their Own Home. National Trends over Two Decades

Sweden is seen as a typical example of a social democratic welfare regime, with universal and generous welfare policies. However, in the last decades, there have been substantial reductions in the Swedish provision of care for older people. This study aimed to examine trends in sources of care‐receipt in older people (77+) living in their own home and with a perceived need for help with two specific tasks: house cleaning and/or food shopping. Trends in care‐receipt were examined in relation to gender, living alone, having children and socio‐economic position. Data from the 1992, 2002 and 2011 data collection waves of the national study, Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), were used. Response rates varied between 86 and 95 per cent, and the sample represents the population well. Trends and differences between groups were explored in bivariate and logistic regression analyses. There was a reduction in formal care‐receipt regarding house cleaning and food shopping over the study period. It was more common for women than men to receive formal care, and more common for men than women to receive informal care. Reductions in formal care have affected older women more than older men. Still, living alone was the most influential factor in care‐receipt, associated with a greater likelihood of formal care‐receipt and a lower likelihood of informal care‐receipt. It can be concluded that public responsibility for care is becoming more narrowly defined in Sweden, and that more responsibility for care is placed on persons in need of care and their families.     

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.     

社会资本:破解“空心化”农村养老困境的现实选择——以H村为例

农村"空心化"已成为中国社会经济发展过程中中西部地区的一种普遍现象,年轻人的流失突显了农村的养老问题。在年轻人回乡事亲孝亲和农村社会化养老服务在短时间内都难以做到的情况下,加强农村社区社会资本建设,以协助老年人解决日常生活中的困难,成为破解"空心化"农村养老困境的现实选择和可行之路。     

Harmful care. To what extent is terminology from medicine and clinical psychology applicable to out‐of‐home care?

Research concerning outcomes for children who have been placed in out‐of‐home care has indicated that the care may have unwanted consequences. However, there has been no coherent terminology for differentiating between different types of such unwanted consequences. In this article therefore, we attempt to disentangle different aspects of potentially harmful care for looked after children, as well as to discuss potential pathways to more systematically approach and report adverse events for this group. In this endeavour, we turn to two adjacent disciplines, medicine and psychology, where these issues have received more interest. The applicability of the concepts used in these fields is discussed, and it is concluded that although they provide some help in categorizing different aspects of harmful care, the complexity of out‐of‐home care makes existing models difficult to adopt without adjustments. This has consequences for the possibility of evaluating care in research, as well as for monitoring adverse events in practice. Importantly, the causality will often be unknown. We therefore suggest that it is essential to shed more light on how decisions should be made about when to intervene or not in out‐of‐home care, despite limited information.     

Transparency and ‘uncomfortable knowledge’ in child protection

Australia's child protection systems and the provision of out-of-home care, in particular, have been subject to sustained criticism for decades from dozens of official inquiries and reviews. It is now well established that many children in state care are treated significantly less well than required by relevant legal frameworks and community standards. Much attention and significant resources have been directed toward trying to ameliorate this ‘wicked problem’ and yet it continues. This article focuses on one reason the problems persists, namely the secrecy and closed cultures that characterize relevant organizations which reinforce strategies of denial that avoid acknowledging or dealing with ‘uncomfortable knowledge’. It is a situation many people in child protection systems confront. It is, for example, when we know abuse is taking place, or when they see or are ourselves party to corrupt or negligent practices. It is knowing that important ethical principles are being abrogated. We draw on recent official reports and inquiries noting the repeated calls for greater transparency and independent oversight. An argument is made for a default position of total transparency subject to caveats that protect privacy and any investigation underway. An account of what this can look like is offered.     

Social Support and Government Policy on Services for the Elderly

Government policy on services for the elderly is to increase the provision of care in the community. This paper examines this policy in relation to informal help received from relatives and friends.
Drawing on the results of a pilot study of 92 people over the age of 75, registered in a group general practice, data are presented on the balance between informal and formal help over a group of activities of daily livhg. The main informal helpers are described with the range of activities for which people in the study were receiving assistance.
Community services are, at present, limited in the help they can provide for people in their own homes. If policies of community care are to be successful, then they must take into account the strengths and weaknesses of informal support. Using the data presented, suggestions are made a bout improvements in services including task specific services not currently provided and the definition of groups at risk of their social support breaking down.     

The experience of older people of entering into the phase of asking for public home help – a qualitative study

The aim of this qualitative study was to explore older persons' (n = 28, 75–96 years of age) experience of becoming in need of public home help, their experience of participation and of having influence on the needs assessment procedure and the decisions made about public home help. A content analysis revealed a broad overarching category, labelled: experiencing discontinuity in life as a whole – the countdown has begun . In addition, four principal categories emerged from the data: comparing the past with the present and losing parts of oneself and connectedness; worrying about the losses and what they will bring about; struggling against losing abilities to avoid dependency and home help; and struggling with conflicting feelings about being/becoming in need of help, and from whom. That older people can so perceive their life situation needs to be recognised if they are to be empowered to become involved in and exert influence on the assessment process and its outcome as well as on their life situation as a whole.     

Taking Care of Later Life: A Matter of Justice?

Correspondence to: Julia Johnson, Senior Lecturer, School of Health and Social Welfare, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK. E-mail: j.s.johnson{at}open.ac.uk Summary This paper reviews current policies and practices regardingthe provision of long-term care for older people. In particularit focuses on three aspects which are central to social workand care management: current developments in residential andnursing home care; charging for care; and the shifting boundarybetween health and social care. It argues that, in all respects,these policies and the ways in which they are being implementedare incompatible with the notion of social justice. Over thelast fifty years, the older generation has invested heavilyin the welfare state and continues to make a significant contributionto it. The security and well-being of those in need of long-termcare is, however, being threatened by the marketization andcommodification of care provision.     

Return of the Nanny: Public Policy towards In‐home Childcare in the UK,Canada and Australia

Research on early childhood education and care (ECEC) policy focuses overwhelmingly on formal, centre‐based provision and, to a lesser extent, on family day care (or childminding) provided in the homes of registered carers. Comparatively little research addresses the policy treatment of care provided in the child's home by nannies and au pairs. This article examines the position of in‐home childcare in Australia, the UK and Canada, and the varied nature and extent of public funding and regulation. Introducing a new dimension into comparative studies of ECEC, it also explores how shifts in migration policy in each country have intersected with ECEC funding and regulation to reshape the recruitment and employment of in‐home child carers. Australia, the UK and Canada are all liberal, market‐oriented countries, but there is considerable diversity in the way governments support and regulate in‐home childcare, their rationales for so doing, and in the connections between childcare and migration. We argue that connecting the analysis of in‐home childcare to migration policies raises new questions about the classification and comparison of ECEC policies.     

Leaving children unattended at home: decision-making on the use of self-care in Hong Kong

This paper examines decisions among low-income mothers in Hong Kong on the use of self-care, or the arrangement of leaving children unattended at home. An analysis of individual interviews with 23 mothers, based on a family ecology perspective, highlighted the contexts in which mothers make decisions based on economic, social and technical grounds. Findings showed that self-care was used with family orientated demands, in spite of the worries and fears associated with the self-care arrangement. Self-care was generally favoured when it was felt to be an efficient way of carrying out family and domestic tasks. An argument was also made that self-care encouraged appropriate independence in children. Nevertheless, mothers recognised the risks involved in self-care and planned to minimise the potential dangers of young children being left unattended. The views of the children themselves, as well as their fathers, often influenced the care arrangements made by mothers. Social policies in relation to unattended children are also examined. This analysis reveals ideological assumptions about the nature of good parenting that places great pressure on mothers to fulfil their responsibilities even though they often lack adequate economic, social and technical support. Rather than deploy deterrent legal measures, it is suggested that social measures, including the provision of `family life education', occasional child care services and enhancement of community support, be developed to help parents carry out their child-rearing roles effectively.     

‘Can I come home?’ The experiences of young runaways contacting the Message Home helpline

This paper reports the findings of a 3‐month survey of young people calling the Message Home helpline. Message Home is a national freephone helpline available to people who have run away or left home which allows them to send a message to their family or carer, to seek confidential help and advice and, if necessary, to be helped to a place of safety. The paper explores the characteristics, circumstances and motivations of the young people contacting the helpline. It also considers who the young people contacted through the helpline and the kinds of messages that were relayed to parents, social services and others. This study differs from most preceding studies of runaways in recording the views of young people while they are missing. The immediacy palpable in their accounts highlights the distress and isolation experienced by many of these young people who have run away or been forced to leave home.     

The gap in social care provision for older people in China

Because of its unprecedented sociodemographic changes, particularly rapid population aging, China faces huge challenges in social care. Using data from the 2012 Chinese Longitudinal Healthy Longevity Survey (n = 9,765), this article examines the need for social care, as well as the major sources of provision. The findings indicate that the majority of older people face some restriction in their daily living activities. From their perspective, however, the most urgent social protection services are related to health care and legal aid rather than services supporting daily living. Although Chinese Government policy since the 1990s has been a strategy of social welfare socialization, the role of government, both as provider and funder, is limited and focuses only on the most deprived and on urban areas. The result is a massive “care gap” between the need for social care and its supply. The primary responsibility for care provision is borne by the family. The direction of social policy in the future should focus on shared care between the family and the state, giving priority to expanding the coverage of social care services, especially in rural areas.     

Sheltered Housing and Community

This paper considers the role of sheltered housing following the introduction of new community care arrangements in 1993 and examines the continuing uncertainty about its exact role as community care continues to develop. It reports on a study conducted in Shropshire, using a postal survey and interviews with older people and service professionals. The study highlights the importance of sheltered housing for older people, particularly in relieving them of concerns about maintenance and repairs, social isolation and security. These factors were crucial for their overall peace of mind and quality of life. While only a small proportion of tenants received help under social services' community care arrangements, the additional support, monitoring and service coordination provided by wardens helped some of them to remain in sheltered housing when residential or nursing home care might otherwise have been necessary. Sheltered housing was overwhelmingly popular with older people — but their satisfaction was closely associated with the availability and quality of the warden service. Although sheltered housing is not currently in vogue in housing policy, the paper argues that it plays a vital role in local provision for older people and needs to be more closely integrated into community care policy, while at the same time preserving the characteristics that make it popular with its residents.     

Young children returning home from care: the birth parents' perspective

While a wide range of literature exists on the experiences of children in foster care or adoption, much less is known about children who return home from care to their birth parents. This paper focuses on the perspectives of a small sample of birth parents of young children who returned home from care. It draws on findings from the Northern Ireland Care Pathways and Outcomes Study that has been following a population ( n  = 374) of children who were under 5 years and in care in Northern Ireland on the 31st of March 2000. As part of this study, interviews were conducted with the foster parents of 55 children, the adoptive parents of 51 children and the birth parents of nine children who had returned home from care. The paper explores the birth parents' views on how they coped while their child was in care, how they were coping after the child had returned home and how their child was faring at home. Results revealed that these parents, and their children, were experiencing multiple difficulties and struggled to cope after the children had returned home.     

A prevalence study of children with imprisoned fathers: annual and lifetime estimates

In Australia, data are not routinely collected on the parental status of prisoners, so there are no official nationwide figures and few State‐based figures. The current study uses data collected in Queensland over a six‐month period to estimate how many Queensland children, in one year and in their entire childhood, experience paternal imprisonment. Additional data were collected relating to the provision of care for the child prior to, and during, their father's imprisonment. Participants were 303 imprisoned fathers (51 per cent of Aboriginal and/or Torres Strait Islander origin) who reported a total of 753 children. Using these data and population statistics, it was estimated that 0.8 per cent of children in Queensland experienced paternal imprisonment in one year while approximately four per cent experience paternal imprisonment in their lifetime. Indigenous children were nine times more likely to experience paternal imprisonment in one year and four times more likely to experience paternal imprisonment in their lifetime compared to non‐Indigenous children. Approximately half of the children (48 per cent) lived with their father prior to his imprisonment. Results are discussed in relation to whether children were living with their father as well as the possibility of pre‐existing risks in children's lives that may subsequently interact with their father's imprisonment.