Implementing Consumer Choice in Long‐term Care: The Impact of Individual Budgets on Social Care Providers in England

In common with many advanced welfare states, England has increasingly relied on consumerist principles to deliver both greater quality and improved efficiency in the long‐term care system. The Individual Budget (IB) pilots marked the next step in this process, through a new system of funding whereby greater control of resources is given to service users, in lieu of direct in‐kind care provision. IBs have the potential to transform the market for care services as well as the relationships between key stakeholders within it. Purchasing will increasingly be shaped by the demands of IB holders, with providers expected to deliver a wider range of personalized services. What will this mean for providers, and what can they do to prepare for these changes? These questions are relevant not just in England but in many other countries adopting similar mechanisms for devolving control over the design, delivery and funding of care to the end‐user. The article explores the early impact of IBs on providers' services, on their workforces, and on the administrative implications for providers of managing IBs. The study finds that providers were positive about the opportunities for better‐quality services that IBs can bring about. However, participants highlighted a number of obstacles to their effectiveness, and reported a range of potentially adverse administrative and workforce consequences which have the potential to jeopardize the consumerist policy objectives of increased choice and efficiency.     

The future of gerontological social work: a case for structural lag

The US population is aging. Traditional perspectives have emphasized that a substantial increase in the number of gerontological social workers is needed to care for this population. However, published evidence demonstrates that, along with population growth, economic and social factors must be taken into account before predicting future gerontological social work demand. Structural lag theory is introduced to explain how these factors affect the profession and may limit its presence in gerontological work settings. Recommendations are made to correct the lag, allowing the social work profession a more substantive voice in the aging enterprise.     

Tests for properties of residual life

The lOOα -percentile (0 < α < 1) residual life function at time x is defined to be the lOOα -percentile of the remaining life given survival up to time x. Joe and Proschan (1982b) develop tests for testing the alternatives representing decreasing 100α-percentile residual life (DPRL-α ) and the property ‘new better than used with respect to the lOOα -percentile’ (NBUP-α ). In this paper, tests are developed for DPRL[α, l) and NBUP[α, l) alternatives, where DPRL[α, l) is the class of life distributions which are DPRL-β distributions for all a ≤ β < 1 if 0 ≤ α < 1 and for all 0 < β < 1 if α = 0, and NBUP[α, l) is similarly defined. When α = 0, the DPRL[α, l) class of life distributions corresponds to the increasing failure rate class and the NBUP[α, l) class of life distributions corresponds to the new better than used class, and the test statistics are respectively asymptotically equivalent to the Hollander and Proschan (1975) test statistics for decreasing mean residual life and new better than used in expectation alternatives.     

Gender Differences in Characteristics of Chinese Treatment-Seeking Problem Gamblers

A total of 952 (841 men and 111 women) Chinese treatment-seeking problem gamblers completed self-report assessment forms. Female in contrast to male gamblers were more likely to be older, married, less educated, and without employment. Female gamblers also started gambling at an older age, had a shorter gambling history, preferred casino and mahjong gambling, and reported more somatic complaints and suicidal thoughts. Male and female gamblers accumulated similar amount of gambling debt and reported an average of 12 gambling-related problems on the Chinese version of the South Oaks Gambling Screen [Lesieur and Blume (Am J Psychiatry 144:1184–1188, 1987)]. Both groups were similarly troubled by their indebtedness, inability to control gambling, and gambling-related interpersonal problems. However, female gamblers had fewer means to pay their gambling debt. Given that significant gender-related differences were observed in Chinese problem gamblers, prevention and treatment services should attend to specific needs of male and female gamblers.     

Environmental education evaluation: Reinterpreting education as a strategy for meeting mission

Critical consideration of the role of environmental education in meeting conservation outcomes is increasingly necessary for environmental agencies and organizations. Evaluation can help move organizations to alignment between educational goals and organizational mission. Moving theory-driven evaluation into mission-based program theory, this chapter examines the ways in which educational goals can and should be linked to conservation outcomes for an agency or organization.