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Welfare Reform on the Web (November 2003): Care of the Elderly - UK

ALL OUR TOMORROWS

N. Singleton and A. Painter

Association of Directors of Social Services and Local Government Association, 2003

Calls for a modern social care workforce to plan and commission joined-up services for older people. Argues that senior citizens should have an active role in planning services through the creation of older people's partnership boards. Other recommendations include development of local performance indicators, and modernisation of the workforce through the creation of generic care worker posts.

THE AMERICAN WAY

R. Lewis

Guardian Society, October 1st 2003, p.7

How do you keep frail, elderly people out of hospital? Airedale Primary Care Trust (PCT) in Yorkshire is working with a US organisation, brought in by the Department of Health (DoH) to tackle this challenge by providing "managed care" for at risk elderly people in their own homes. The commercial company, United Healthcare (UH), has run the scheme, called EverCare, since 1987 and assigns specially trained nurses to elderly people who are likely to become hospital in-patients. The DoH, which had contracted UH to lead the initiative in 10 PCTs in England, has been impressed by a US evaluation of EverCare that recorded a 50 % reduction in hospital admissions, a cut in the number of drugs prescribed and high rates of patient satisfaction.

THE EFFECT OF FINANCIAL INCENTIVES AND ACCESS TO SERVICES ON SELF-FUNDED ADMISSIONS TO LONG TERM CARE

A. Netten and R. Darton

Social Policy & Administration, Vol. 37, 2003, p.483-497

The study compares those who fund their own long-term care with their publicly funded peers. It focuses especially on the influences on self-funders in their decision to move to care homes and the resources on which they are able to draw. It finds that self-funders are admitted at lower levels of dependency than publicly funded residents. It also reveals that although there is a very strong financial disincentive for self-funders to have full-time residential care, local authorities prefer to place these people in homes rather than support them in the community. One in four self-funded residents are therefore admitted to care homes without needing to be. Self-funders were also receiving less community care than those who were publicly funded.

ENSURING THE EFFECTIVE DISCHARGE OF OLDER PATIENTS FROM NHS ACUTE HOSPITALS

Committee of Public Accounts

London: TSO, 2003 (House of Commons papers, session 2002/03; HC459)

On any given day some 3,500 older patients fit for discharge remain in hospital because arrangements are not complete for them to move on. The most common causes of delay are patients waiting for a care home placement or needs assessment, problems with transfer to further NHS care, or non-availability of public funding. To tackle the problem, successful co-ordination is needed between hospitals, primary care trusts, social services and independent sector providers.

AN EXAMPLE TO US ALL

M. Hunter

Community Care, Oct.16th-27th 2003, p.58-59

Local authorities in Scotland have succeeded in delivering free personal and nursing care to older people within current budgets. However, free provision does not extend to non-personal care such as meals-on-wheels or home help services. This has helped to control costs.

HEALTH VISITORS AND OLDER PEOPLE: "THINKING OUT OF THE BOX"

E. Rogers

Community Practitioner, vol.76, 2003, p.381-385

Paper reports on a qualitative study of 19 health visitors in both generic and specialist roles working with older people. The research examined the impact of management and bureaucracy on their professional autonomy and initiative. It also investigated the power of individuals to negotiate within bureaucratic constraints and provide the service they believe meets the needs of their clients and encompasses the principles of their profession. Barriers to developing effective programmes for older people included restricted resources, negative attitudes and ageism, but innovative work was facilitated by team support and encouragement from colleagues.

IN NEED OF AN ANCHOR

S. Lowe

Community Care, Oct.2nd-8th 2003, p.38-39

Explains why human rights legal protection for older people is vital when they are transferred between care homes. Unfortunately, respecting the rights of older people is not uppermost in the minds of the Department of Health, local authorities or care home owners.

INTEGRATING HEALTH AND SOCIAL CARE AT THE MICRO LEVEL: HEALTH CARE PROFESSIONALS AS CARE MANAGERS FOR OLDER PEOPLE

K. Weiner and others

Social Policy & Administration, Vol. 37, 2003, p.498-515

Elderly people with complex needs often require support spanning several areas of the NHS and social services. Under New Labour there has been a focus on promoting convenient, user-centred services and improving the integration of health and social care. This study investigates the arrangements in place in health authorities for health staff to work as care managers for older people. It reveals that there is no coherent policy, with health authorities operating a variety of management structures and training programmes. It concludes that arrangements for health staff to work as care managers have not been widely developed, that authorities focus on older people with mental health problems and that the emphasis seems to be on assessment rather than long-term care management.

INTERMEDIATE CARE FOR OLDER PEOPLE: AN IMPLEMENTATION

J. Young and others

British Journal of Health Care Management, vol. 9, 2003, p.340-343

Leeds Health Authority and Leeds City Council jointly developed a commissioning framework for older people's services in 1997. It was intended to develop intermediate care services aimed at moving people from medical dependence to functional independence. A series of services has been developed to provide support and rehabilitation for older people either at home or through short-term care home placements. Article describes an evaluation of the development and outcomes of the project.

THE ROLE OF TELECARE

J. Hennock and M. Hollywood

Working with Older People, Vol. 7, September 2003, p.35-38

One of the key roles of social alarm systems is to provide support, security and peace of mind for older people in sheltered housing. However much of the success of telecare is dependent on service quality.

SO MUCH MORE THAN JUST WALKING

N. Le Mesurier and S. Northmore

Working with Older People, Vol. 7, September 2003, p.11-14

The article explores the findings from an evaluation of pilot Age Concern social rehabilitation services. Social rehabilitation combats the isolation and loneliness experienced by older people following illness, injury or bereavement. It offers time-limited programmes of support to older people to help restore confidence and social skills.

SOCIAL WORK IN ACCIDENT AND EMERGENCY DEPARTMENTS: A BETTER DEAL FOR OLDER PATIENTS' HEALTH?

E. McLeod, P. Bywaters and M. Cooke

British Journal of Social Work, vol.33, 2003, p.787-802

Some 30% of accident and emergency departments in UK hospitals have a social worker as an integral member of the emergency team, with the aim of reducing admissions and providing readier access to social care. Social workers based in A&E departments can provide older patients with help in negotiating the hospital environment and better access to social services. However, community-based health and social care implemented through A&E can swiftly unravel due to lack of resources, leading to re-attendance at hospital.

'TSAR' TO TACKLE BED-BLOCKING IN HOSPITALS

J. Carvel

The Guardian, October 15th 2003, p.8

The government is to appoint a social care 'tsar' to patrol the troubled boundary between the National Health Service and Social Services. The role of the national director of local government and social care will be to spearhead an effort by the Department of Health to tackle the problem of older people being forced to stay in hospital when they are medically fit to leave.

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