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Welfare Reform on the Web (February 2011): Care of the elderly - UK

900 monthly bill for care in your home

M. Butterworth

Daily Telegraph, Jan.21st 2011, p.1

A survey by Which? Magazine has shown huge variations in the cost and availability of home care for older people, with some local authorities charging more than 20.00 per hour, while others provide it free. Care can cost more than 900.00 per month for a couple.

(See also Guardian, Jan. 21st 2011, p.14)

Advance Care Planning in end of life care

K. Thomas and B. Lobo (editors)

Oxford: OUP, 2011

Advance Care Planning (ACP) is an essential part of the new NHS National Programme on End of Life Care, aiming to improve the chances of 'a good death' by discussing and planning how this might be managed. This is the first comprehensive overview of ACP in the UK which helps readers explore a wide range of issues and practicalities in providing ACP for their patients nearing the end of life.

Alzheimer's drugs made available

R. Bennett

The Times, Jan. 18th 2011, p.15

NICE has today reversed its decision to block access to drugs that can slow deterioration in early-stage Alzheimer's and improve quality of life for NHS patients with mild or moderate symptoms and has approved the use of four drugs.

'As people get to know it more': experiences and expectations of the Mental Capacity Act 2005 amongst local information, advice and advocacy services

K. Samsi, J. Manthorpe and P. Rapaport

Social Policy and Society, vol. 10, 2011, p. 41-54

Information, advice and advocacy agencies are important providers of support to older people in the community. This study explored the role of Age Concern staff across North London in providing timely information and advice relating to advance decision-making should capacity become impaired, particularly in relation to the new Mental Capacity Act 2005. Findings suggest that staff had varied knowledge of the Act and most lacked confidence in providing detailed advice.

Care cuts leave elderly stuck in hospital

D. Campbell

The Guardian, Jan. 5th 2011, p. 1

Thousands of older patients are being forced to stay in hospital long after they are fit to leave because of the government's cuts to council budgets for home care. In a survey of 502 doctors working in UK hospitals, 251 (50%) said the problem, known as bed-blocking and costing the NHS tens of millions of pounds a year, was worse than 12 months ago, while 200 (40%) revealed it had not improved.

Delivering public services in the mixed economy of welfare: perspectives from the voluntary and community sector in rural England

I. Hardill and P. Dwyer

Journal of Social Policy, vol. 40, 2011, p. 157-172

In recent years the voluntary and community sector (VCS) has been playing a greater role in public service delivery, and the challenges they face in providing rural services are being increasingly documented. In this paper, the authors draw on a qualitative study that focused on six community-based services delivered by the VCS which support older people to live independently in remote rural areas in England to illuminate the impact of two particular issues - uncertain funding regimes and reliance on volunteer labour - the sector faces in delivering public services.

Designing dementia-friendly neighbourhoods: helping people with dementia to get out and about

L. Mitchell and E. Burton

Journal of Integrated Care, vol. 18, Dec. 2010, p. 11-18

This article reports on the only research that has investigated the design needs of older people with dementia at the neighbourhood level. The research defined dementia-friendly neighbourhoods as welcoming, safe, easy and enjoyable for people with dementia and others to access, visit, use and find their way around. It identified six design principles: familiarity, legibility, distinctiveness, accessibility, comfort and safety.

Dire state of care homes for the elderly is only going to get worse, says top inspector: Head of Care Quality Commission says spending cuts will severely harm an already ailing system

O. Wright

The Independent, Jan. 27th 2011, p. 12

Dame Jo Williams, who heads the Care Quality Commission (CQC), says that conditions in nursing homes across the UK could deteriorate, as owners try to save money following the cuts in public spending. Reduced funding will mean that the amount of financial resources spent on training staff, repairing infrastructures, and activities for residents will inevitably be reduced. This, according to Dame Jo, will inevitably affect quality of care. A major problem identified by the head of the CQC is that, across the UK, the workforce in nursing homes is 'very patchy': whilst in parts of the country it is very stable in others, especially the Southeast, it is much more transient. Many care workers are already on the minimum wage; with the majority of costs for nursing home being labour costs, there is little room for further savings once cuts are introduced. The Association of Directors of Adult Social Services predicts that the amount of public funding for each nursing home place is likely to fall, in real terms, by around 3 per cent each year for the next three years. Against this stark financial background the Commission will take a tougher line to ensure that minimum standards of care are met and nursing home residents are treated with dignity. In addition, Jo Williams announced that, in order to better monitor the quality of care provided, the CQC is looking at new ways to identify failing homes.

Health and social care of older people: could policy generalise good practice?

C. T. Currie

Journal of Integrated Care, vol. 18, Dec. 2010, p. 19-26

Since 1948, health and social care have been funded and delivered separately. This division is having increasingly unacceptable consequences for the quality and cost-effectiveness of the care provided to older people with multiple pathologies and long-term conditions. More integrated care delivered at home could minimise the use of more costly options such as hospital admissions or institutional care while improving the quality of later life. This paper considers the background to the widely prevailing culture of separatism, presents quantitative evidence of the current postcode lottery in care, describes examples of current good practice, and considers some options for functional and structural integration.

'I live for today': a qualitative study investigating older people's attitudes to advance planning

K. Samsi and J. Manthorpe

Health and Social Care in the Community, vol.19, 2011, p. 52-59

The Mental Capacity Act 2005 enshrines in law the right to set out advance plans and decisions should circumstances arise where decision-making ability may be compromised. The Act enables people to make their views known concerning finances and treatment and care, and to appoint proxy decision-makers. This study explored experiences, opinions and attitudes of older adults living in the community regarding planning for their future in the context of the Mental Capacity Act.

Implementing the end of life care strategy: lessons from good practice

R. Addicott and S. Ross

King's Fund, 2010

This report cites examples of best practice in end of life care, using findings from ongoing research in several health economies across England. It identifies a number of mechanisms for improving the quality and efficiency of end of life care delivery and coordination. The important lessons follow the end of life care pathway as set out in the strategy, and focus on four broad themes: identification of needs, better communication among professionals and with patients, care coordination, and a multidisciplinary whole systems approach.

Patterns of commissioning, contracting and care management in social care services for older people in England

H. Chester, J. Hughes and D. Challis

British Journal of Social Work, vol. 40, 2010, p. 2523-2537

Policy guidance relating to the provision of social care for older people in England issued by central government affords discretion in its implementation in localities. As a result, there is considerable variation in commissioning, contracting and care management arrangements. This paper aims to explore whether local authorities can be categorised on the basis of this variation, using data from a national postal survey. Over two-thirds of local authorities responded and arrangements were categorised on an empirical basis, resulting in the definition of seven categories of authority. These were found to vary in the level of activity in three domains: commissioning and contracting arrangements; employment practices; and flexibility in service provision to individual users.

Pledge that hospitals will improve care for the elderly

N. Morris

The Independent, Jan. 17th 2010, p. 2

The overhaul of the NHS to be announced this week will set out moves to improve the complaints system with hit squads to be sent into hospitals in an attempt to drive up standards of treatment for the elderly - with checks in care homes likely to follow. As a first step, senior nurses will carry out spot checks in hospital wards treating elderly patients, focusing on whether patients are treated with dignity and respect and are served nutritious food.

Support, stay, save: care and support for people with dementia in their own homes

Alzheimer's Society


About 500,000 people in the UK are coping with dementia at home. However, a survey of carers suggests that half may not be receiving adequate support, leading to their being left bedridden, in unchanged incontinence pads and malnourished. More than half of carers were also being put at risk of stress, depression, and other serious illnesses because they were being left to cope without support. It is concluded that about 10% of dementia patients who could remain at home with better support are being admitted to residential care early, costing the taxpayer 70m for each extra month spent in an institution.


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