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Welfare Reform on the Web (April 2010): Care of the elderly - UK

Better government with older citizens: a test of democracy

B. Groombridge

Political Quarterly, vol. 81, 2010, p. 131-140

When launched in 1999, the Better Government for Older People (BGOP) initiative was welcomed as a flagship prototype, aiming to improve public services for older people by better meeting their needs, listening to their views and encouraging their contribution. After heaping praise on the programme, in 2008 the government started closing BGOP down. This article summarises BGOP’s history and considers alternative explanations. Two highly contrasting accounts of the closure of BGOP have circulated:

  1. that it had set a useful example and was worth celebrating, but was not as good as it needed to be, so it was time to move on and start again
  2. that BGOP, despite having to break new ground, was becoming too effective, so that those in power decided to snuff it out.

Coming out to care: gay and lesbian carers’ experiences of dementia services

E. Price

Health and Social Care in the Community, vol. 18, 2010, p. 160-168

This article reports on findings from a qualitative study that explored the experiences of 21 gay men and lesbian women who care, or cared, for a person with dementia. It focuses on one theme that emerged from the wider study: carers’ experiences of 'coming out' to service providers. For many carers, responses to disclosures of their sexuality proved to be a critical issue and one that coloured their experience of providing care. Service providers’ reactions ranged from, at best, a broad acceptance of gay and lesbian people’s circumstances, through to a pervasive disregard for their particular needs. Culturally appropriate responses to carers’ chosen lifestyles were, these findings suggest, a matter of personal choice rather than professional obligation, in spite of recent pro-gay legislation.

Early intervention in dementia care in an Asian community: lessons from a dementia collaborative project

V. Seabrooke and A. Milne

Quality in Ageing, vol. 10, Dec. 2009, p. 29-38

This project was established by the South East Dementia Services Collaborative to raise awareness of dementia in a long established Asian community in Kent and to facilitate early intervention. The pilot identified an appropriate primary care practice, established a link with a specially trained Asian nurse and devised a set of project materials. Older Asian patients with memory problems were invited by letter to make an appointment with the nurse and were provided with a culturally relevant information leaflet. The project evaluation suggests that, by working with a committed primary care practice, it is possible to engage a hitherto marginal group of older people in early intervention for dementia and to raise awareness of its benefits.

Elderly face inheritance tax to fund care plans

R. Prince

Daily Telegraph, Mar. 11th 2010, p. 1 + 2

The government is planning to offer older people a range of options for contributing to the costs of the proposed National Care Service. People could choose to:

  1. delay their retirement for three or more years and pay the pension they would have received into the National Care Service
  2. make monthly payments on retirement
  3. have their estates taxed on their deaths. It is understood that the third option is likely to involve a levy on estates of around 10%, rather than a flat rate 'death tax'.

HM Revenue and Customs: dealing with the tax obligations of older people

Committee of Public Accounts

London: TSO, 2009 (House of Commons papers, session 2009/10; HC 141)

Older people are a significant and growing group for HM Revenue & Customs (the Department), making up 18% of taxpayers. Older people are more likely to comply with their tax obligations than other taxpayers but are less likely to understand them, and many pay more tax than they need to. The Committee noted that errors occur because people's tax affairs often become more complicated when they reach pension age, and that the Department's systems do not cope well with their multiple sources of income. Older people may also be paying too much tax because they do not claim additional tax allowances available. Some 2.4 million older people have also overpaid around £200 million in tax because they did not have their savings income paid gross of tax. The Committee concluded that the Department should devise simpler systems so that older people can have peace of mind about their tax affairs. The onus is on older people to claim the age-related allowances, where the rules on eligibility are hard to understand and older people do not find the claim form easy to complete. It is also unacceptable that the Department does not have a clear idea how many older people are missing out and may therefore be paying more tax than they need to. Awarding the age-related allowances automatically, where information available indicates an individual's eligibility, would reduce the burden. The Committee recommended that the Department should have a more coherent plan for meeting the needs of older people efficiently and effectively and should improve the support it provides to this group by working more closely with other agencies in the third sector and across government.

Making a difference

R. Marks

Quality in Ageing, vol.10, Dec. 2009, p. 4-7

In April 2008 Wales appointed an independent champion for older people. This article reports progress made by the first Commissioner for Older People for Wales in carrying out the responsibilities of the role.

The National Evaluation of Partnerships for Older People Projects: final report

K. Windle and others

Department of Health, 2010

The Partnerships for Older People Projects initiative was funded by the Department of Health to develop services for older people to promote their health, well-being and independence and to prevent or delay their need for high intensity or institutional care. Twenty-nine councils in England were involved as sites for the pilots, which ran from 2006 to 2009. The evaluation suggests that nearly all the projects were cost-effective, and that there was particular success with the provision of practical help. The results also show that:

  1. partnerships require appropriate funding and performance management to succeed
  2. savings from decommissioning should be reinvested in new services
  3. early engagement with stakeholders is critical for success.

A new vision for adult social care? Continuities and change in the care of older people

M. Lymbery

Critical Social Policy, vol.30, 2010, p. 5-26

Adult social care in England is undergoing major changes under the banner of personalisation leading to greater responsiveness to the desires of individual users. This paper suggests that there are several problems with the new policy, particularly in relation to the care needs of older people, which have been overlooked by the government. Of these, the inadequacy of the resources allocated to adult social care is the most significant; consequently, rationing of scarce resources will continue. There is also little understanding of the realities of the lives of older people using social care services. Older people may struggle to exercise control over and choice of the services they receive, and are in need of protection as much as of enhancement of their independence.

The personalisation of dementia services and existential realities: understanding Sikh carers caring for an older person with dementia in Wolverhampton

K. Jutlla and N. Moreland

Ethnicity and Inequalities in Health and Social Care, vol. 2, Dec. 2009, p. 10-21

The South Asian community is not homogeneous, and there are clear differences among members based on class, caste, experiences of migration, and origins (from rural or urban areas). This paper discusses the diversity and complexity of migration patterns among Sikhs living in Wolverhampton. It explores some of the ways in which these migration patterns influence experiences, patterns of care and access to services among migrant Sikh carers looking after an older person with dementia.

Residential care will be 'free' under Labour plan

R. Watson and T. Baldwin

The Times, Mar. 30th 2010, p.1

Andy Burnham, the Health Secretary, has announced plans to overhaul the current system of care for the elderly. Elderly people who have been in residential care for two years will have the costs paid for the rest of their lives. The £1 billion proposal is aimed at allowing thousands of families to retain their homes and savings whilst also providing a variety of options about how long term care is paid for.

(See also The Times, Mar. 31st, 2010 p.17)

Securing good care for more people

R. Humphries, J. Forder and J.-L. Fernandez

King’s Fund, 2010

This report proposes a model for paying for care for the elderly based on co-payment. Under the partnership model proposed, a minimum of 50% of the bill would be paid by the state, topped up with £0.50 for every £1.00 a person contributed to their own care. Those with less than £23,000 in savings would see the whole bill paid by the state. This extra help for middle-income pensioners would take the projected public cost of adult social care to £15.5bn by 2026, compared to £12.1bn if no change is made. The extra cost would be offset against cuts in other areas of public spending on elderly people, such as attendance allowance, free bus passes and winter fuel payments.

Sheltered housing and care for older people: perspectives of tenants and scheme managers

B.J. Taylor and A. Neill

Quality in Ageing, vol. 10, Dec. 2009, p. 18-28

Sheltered housing for older people in the UK has developed slowly over decades and was given new impetus by the community care reforms of the early 1990s. However, there is little research on what sheltered housing schemes provide and what makes them work well. This study gathered data on sheltered housing provision for older people in the north Antrim area of Northern Ireland through 10 focus groups with tenants and 16 questionnaires administered to managers. The results suggest that well-planned and well-located supported housing schemes which both promote independence and encourage social interaction lead to good self-reported quality of life and satisfaction among tenants.

Social care

Health Committee

London: TSO, 2010 (House of Commons papers, session 2009/10; HC22)

This report reviews the current system of social care for the elderly in England and the government’s proposals for its reform. It concludes that the present system excludes many people with moderate needs, penalises those with relatively modest financial means and places unreasonable demands on carers. There are wide variations in what councils offer, as they have considerable autonomy in deciding what to offer, what to charge and who should pay. The Committee also criticised the government’s options for future funding of the system, on the grounds that it had failed to put a figure on the likely rise in costs of care provision over time. It called for a debate on whether social care should be funded out of general taxation, an option ruled out by the government.

Supporting people with dementia at home: challenges and opportunities for the 21st century

D. Challis and others

Farnham: Ashgate, 2009

The book centres on an intensive case management scheme designed for older people with dementia at risk of entry to residential care. It uses a quasi-experimental approach, where individuals in the care of one community mental health team for older people received case management and were matched to those in a similar community mental health setting without such a service. The evidence was analysed in relation to the eventual placement of the older person, their quality of care, quality of life and overall needs, and also the needs of their carers. Detailed analyses were carried out of the ways in which case managers undertook their work and how they addressed the problems and needs of the older people and carers in the study.

Tagging and the freedom of movement

V. Pitt

Community Care, Mar. 4th 2010, p. 28-29

When people with dementia wander, they become disoriented and lost, causing stress and worry to their carers. One solution, supported by the national dementia strategy, is for people to carry global positioning systems (GPS) so that they can be located easily. However, opponents say that monitoring people’s movements may breach their human rights.

The 'Twice a Child' projects: learning about dementia and related disorders within the black and minority ethnic population of an English city and improving relevant services

D. Jolley and others

Ethnicity and Inequalities in Health and Social Care, vol. 2, Dec. 2009, p. 4-9

Dementia is found in all races. Within the UK, elders in black and minority ethnic communities are often unwilling or unable to access health and social services when they develop dementia. A series of research –based studies in Wolverhampton have demonstrated that working with community leaders and family carers can identify strengths as well as areas for improvement in service arrangements. Some areas for development are those shared by all individuals and families with dementia, while others are specific to the cultural group. Areas for action include: the lack of understanding of the normal and pathological features of ageing; fear and stigma associated with mental disorders in BME communities; lack of knowledge of dementia; and service inflexibility and insensitivity. Knowledge gained from a collaborative review of the situation can be used to plan and deliver iterative improvements.

Uncovering history: private sector care homes for older people in England

J. Johnson, S. Rolph and R. Smith

Journal of Social Policy, vol. 39, 2010, p. 235-253

In conducting his research for his classic study of residential care for older people, Peter Townsend visited 173 public, voluntary and private care homes in the late 1950s. Drawing on his data, now archived at the University of Essex, the authors traced the subsequent history of these homes and visited a sample that were still functioning in 2006. This article focuses on the 42 private care homes visited by Townsend and explores why a quarter of them have survived while the rest have not. Finally, it compares the surviving homes then and now and contributes some insights into the poorly charted history of the private sector provision of care homes for older people since the early decades of the British welfare state.

Using family group conferences in safeguarding adults

L. Tapper

Journal of Adult Protection, vol. 12, Feb. 2010, p. 27-31

Comic Relief has funded 15 projects in England and Wales to enable trials of different methods of combating elder abuse. In 2007, Daybreak received three years funding to pilot the use of family group conferences to safeguard vulnerable older people in Hampshire, Southampton and Portsmouth. This trial is now nearing its end, and is being evaluated for effectiveness and value. Hampshire County Council is working with Daybreak to expand the provision of family group conferences to all vulnerable adults where there are safeguarding concerns.

What works well in community care: supporting older people in their own homes and community networks

D. Seddon and G. Harper

Quality in Ageing, vol. 10, Dec. 2009, p. 8-17

This qualitative study sought to identify factors contributing to providing effective support to help older people with health and social care needs in their own homes and local communities. Government policy since the early 1990s has prioritised tailoring support arrangements to meet individual needs, but this research revealed a gap between policy and the experience of service users. Statutory organisations are often constrained by restrictive thinking and financial pressures lead to resource-centred rather than person-centred responses to individuals in need. Findings suggest that commissioners should be more creative in developing flexible provision in local communities and the authors consider approaches that may be helpful in achieving this.

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