Bleddyn P. Davies

Relying on informal care in the new century? Informal care for elderly people in England to 2031

The research reported here is concerned with the future of informal care over the next thirty years and the effect of changes in informal care on demand for formal services. The research draws on a PSSRU computer simulation model which has produced projections to 2031 for long-term care for England. The latest Government Actuarys Department (GAD) 1996-based marital status projections are used here. These projections yield unexpected results in that they indicate that more elderly people are likely to receive informal care than previously projected. The underlying reason is that the GAD figures project a fall in the number of widows and rise in the number of elderly women with partners. What this implies is that ‘spouse carers’ are likely to become increasingly important. This raises issues about the need for support by carers since spouse carers tend to be themselves elderly and are often in poor health. The article explores a number of ‘scenarios’ around informal care, including scenarios in which the supply of informal care is severely restricted and a scenario in which more support is given to carers by developing ‘carer-blind’ services. This last scenario has had particular relevance for the Royal Commission on Long Term Care.

Increased numbers of alpha receptors in sympathetic denervation supersensitivity in man.

Cardiovascular responses to intravenous administration of norepinephrine and the properties of alpha receptors on platelets were compared in normal human subjects and subjects with multiple system atrophy (MSA) and sympathetic degeneration. All the subjects with MSA had low plasma norepinephrine concentrations (in the supine position) (0.42 +/- 0.09 nM, normal 3.47 +/- 0.58 nM), which did not increase on tilt. The pressor sensitivity of subjects with MSA to norepinephrine infusion was increased 10- to 20-fold, demonstrating denervation supersensitivity to adrenergic agonists. Analysis of alpha receptors was by binding of [3H]dihydroergocryptine to platelets. Results are shown as mean +/- standard error of the mean. In the MSA subjects, the number of alpha receptors (1,712 +/- 699 fmol/10(8) platelets) was about sevenfold greater than in normal subjects (224 +/- 21 fmol/10(8) platelets), and the affinity, as measured by the equilibrium dissociation constant (Kd), was similar in both groups (MSA subjects, 9.6 +/- 4.3 nM; normal subjects, 4 +/- 0.5 nM). These observations suggest that an increase in alphaadrenergic receptor numbers may account for the denervation supersensitivity to infused norepinephrine in patients with sympathetic degeneration. All the subjects with MSA had low levels of the endogenous adrenergic transmitter norepinephrine: the simultaneous increase in alpha adrenergic receptors supports the theory of agonist regulation of receptor numbers.

A New Approach to Community Care for the Elderly

Organisations can absorb successfully only a few fundamental innovations within a short period of time. It is therefore important for the designers of innovations to ensure that they directly and substantially contribute to solving important problems, and for agencies to concentrate their innovative activity on those that do so contribute. The first aim of this paper is to analyse the policy context so as to clarify the nature of the problems that make innovation in the care of the elderly imperative and show how features of the Community Care Project contribute to their solution. The second aim is to provide some preliminary evidence of the success of the scheme. The analysis of data fpr seventy persons in the experimental and control groups shows that the experimental group fared better in a number of important ways; and that the gains appear to have been made at no extra cost to the social services department. Therefore, it is concluded, the adoption of the scheme may contribute to the technical progress needed in the provision of social service to the elderly with needs at or above the margin for residential care.

Equity and Efficiency in the Allocation of the Personal Social Services

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.

Caring for older people: an assessment of community care in the 1990s

Caring for Older People provides a unique insight into the world of community care in the 1990’s. It presents findings from a national study of social care from the perspectives of older service users, their carers and care managers. Descriptive findings from this longitudinal study – conducted by the PSSRU from 1994 and funded by the Department of Health – are set in the context of the history of community care and developments since the passage of the 1990 NHS and Community Care Act. The study’s findings highlight important challenges for policy and practice development in the new millennium. Link to Ashgate Publishing

The Social Production of Welfare and Consumption of Social Services

The social production of welfare provides a theoretical framework for the analysis of the consumption of social services and the impact of welfare policies. Based on the new home economics, it represents the unit of consumption as a unit of production of commodities. With the advent of disability this unit extends from the household to the informal care network. Social care agencies become involved when the production of basic commodities, such as nutrition and personal care, fall below threshold levels which threaten the survival of the informal care network. The social production of welfare allows comparisons across systems and provides the starting point for the development of tools for empirical analysis.

Efficient Targeting of Community Care: The Case of the Home Help Service

By 1985 community care, of which the home help service is one of the cornerstones, was on the brink of a major change which would fundamentally affect targeting. The new focus is a concentration on those in greatest need, responsiveness to the needs of carers, and to the potential for the self financing of care. The analysis given here indicates that huge changes in targeting of the service will have been needed from the situation in 1985 to meet these new policies, changes which might be expected to move the service away from its traditional role of monitoring the very old living alone. Analysis of the period between 1980 and 1985, using the General Household Survey, shows that the targeting effect of new policies is not easy to predict. The slight increase in home care during the period did not reflect an improvement in targeting on the demonstrably most needy, but instead apparently spread the service more widely. Re-examination of equity, territorial and gender issues shows that only limited progress had been made. Indeed, gender discrimination may even have increased. While the UK may not wish to go as far as some other countries in allocating community care according to fixed eligibility criteria, come what may, targeting concepts will be increasingly salient for monitoring the community care policys achievement.

Territorial Need Indicators: A New Approach Part I

Territorial indicators of need, describing variations in the characteristics of areas ranging from wards to standard regions of the United Kingdom, represent a mainstream application of social indicators in this country. The development of these indicators has, for the most part, been based on an intellectual tradition which has paid little attention to theoretical argument. In Part I of this article, a typology of existing need indicators is developed. By analysis of some of the best-known and most sophisticated examples, it is illustrated how this lack of theory has severely limited their usefulness in policy practice, particularly with regard to resource allocation, where they are potentially very important. A predominant symptom of the problem encountered with empirically based need indicators is the difficulty of establishing criteria for testing their validity. For the ‘meaning’ of a need indicator to be clear, the indicator must be theoretically based. More specifically, it should be rooted in theoretical conclusions about the policy of welfare interventions. In Part II of the article, the theory of the need judgement as a cost-benefit decision is used to provide a basis for a need indicator. This method is then explicated with regard to social services provision for the elderly, so as to provide an indicator which is in fact a standard level of expenditure for social services departments in England and Wales.

Motivations and Rewards of Volunteers and Informal Care Givers

resources to social services departments will keep pace with the rising level of demand. Nowhere is this more the case than in the care of the aged, particularly those over seventy-five, a client group increasing rapidly in numbers. Far from being able to extend the degree to which they will meet needs, the social services departments will be unable to provide for them as effectively as they do now,as long

Needs and Outputs

The importance of developing valid measures of needs and outputs is undisputed. Without such measures, the social-policy analyst can make only a limited contribution to the case for spending on social policy and can make fewer suggestions for using resources effectively. The crudity of the measurement hampers the development of studies of efficiency in service provision. It makes it impossible to estimate what benefits are produced from different combinations of resources. It makes the central-government control of local authorities more arbitrary, and prevents social-service agencies from monitoring their own success. It makes some simple questions difficult to answer, and makes other questions impossible to answer at all. It allows the political process to tolerate bad policy on major issues. Theories of territorial justice must remain primitive until needs and outputs are properly measured.