Changing Patterns of Fieldwork: Organization: II: The Team Leaders' View

Correspondence to Dr. David Challis, Assistant Director, Personal Social Services Research Unit, Cornwallis Building. The University, Canterbury, Kent, CT2 7NF. Summary In an earlier paper we discussed the organization of fieldworkin Social Services Departments based upon a survey of headquartersrespondents. Here we discuss the findings from a survey of fieldworkteam leaders. A substantial trend towards client-group specializationwas noted, not only at team level but also in the caseloadsof individual workers. There was a trend away from patternsof generic working common in the early days after the Seebohmreorganization. This trend away from generic practice is discussedin the light of arguments about the relative efficiency andeffectiveness of alternative models of organization.     

A System for Monitoring Social Work Activity with the Frail Elderly

Summary This paper describes the development of a recording system foruse by social workers in the long term care of elderly peopleat home. The system can be used by individual staff to plottheir caseload activities and by management in considering problemsof resource deployment. The system consists of Assessment Document,Periodic Case Reviews, a Monitoring Chart and Costing information.The analysis of a cohort of cases in the early phase of theircare are discussed and the possible range of uses for such arecording system considered.     

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.     

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.     

An Assessment of the Potential for Community Living of Mentally Handicapped Patients in Hospital

Summary The paper examines the possibility of discharging mentally handicappedpatients from hospital to a wide range of community resources.Following the assessment of a sample of hospital patients theywere matched to appropriate care settings ranging from independentliving to relatively expensive hostel accommodation. A highproportion of patients were found to be capable of dischargefrom hospital, although for many this would be to relativelycostly settings. Factors which appeared to make some youngerpatients difficult to discharge from hospital were identified,suggesting that newer admissions were more disturbed, which,apart from resource considerations may account for some of thedifficulty experienced in plans to reduce hospital populations.     

Long Term Care for the Elderly: the Community Care Scheme

Summary The article describes the full evaluation of the Community CareScheme for the elderly in Kent. The evaluation compared therelative cost-effectiveness of the scheme for clients and carerswith the range of services which would otherwise have been received.It is argued that effective case-management by a key workeris an essential feature of more effective home care for thevery frail elderly and that the case-management role is an appropriatemodel of social work for other long term care groups. The newscheme appeared particularly appropriate for the extremely mentallyand physically frail who were living with others and for theless frail, socially isolated elderly person prone to minorpsychiatric disorder.