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Welfare Reform on the Web (January 2008): Care of the elderly - overseas

The conditions for health and social care policy: routines and institutions in the Dutch case of need assessment

A. van Raak, A. Paulus and J. van der Made

Public Administration, vol. 85, 2007, p. 1077-1095

In 1996 the Dutch national government introduced new rules for local assessment of care needs, which led to the establishment of a network of 84 Regional Needs Assessment Agencies (RIOs). The RIOs were assigned the task of carrying out needs assessments independently of care providers. This article analyses the case of assessment of care needs of elderly people in terms of institutions (rules for action) and routines (patterns of behaviour). The Dutch national government introduced new rules for needs assessments which led to both change and maintenance of behaviour patterns (routines) by actors such as municipalities and home care agencies.

The impact of integrated care on direct nursing home care

A.T.G. Paulus and A.J.A. van Raak

Health Policy, vol. 85, 2008, p. 45-59

Applied to nursing home care, integrated care refers to a demand-oriented delivery of services (ie the demands of residents dictate what care is delivered, when, how often and by whom) by caregivers from different disciplinary backgrounds. Caregivers have to cooperate and coordinate the provision of services to meet the demands of residents in a home-like environment. This longitudinal study in the Netherlands found that the introduction of integrated care mainly leads to increases in the duration and frequency of the total package of direct care activities but not of individual, separate activities. This is because a large proportion of care delivery represents patterned behaviour (routines). Because existing routines are difficult to get rid of, we should not have too high expectations about the effect of integrated care on service delivery.

Regulating aged care: ritualism and the new pyramid

J. Braithwaite, T. Makkai, V. Braithwaite

Cheltenham: Edward Elgar, 2007

The book is a new contribution to regulatory theory from three members of the regulatory research group based in Australia. It marks a new development in responsive regulatory theory in which a strengths-based pyramid complements the regulatory pyramid. The authors compare the accomplishments of nursing home regulation in the US, the UK and Australia during the last 20 years and in a longer historical perspective. They find that gaming and ritualism, rather than defiance of regulators, are the greatest challenge for improving safety and quality of life for the elderly in care homes. The book shows how good regulation and caring professionalism can transcend ritualism. Better regulation is found to be as much about encouragement to expand strengths as incentives to fix problems. This study provides an impressive evidence base for both theory development and reassessment of policy and practitioner responses in the field.

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