John C. Baldock

Social Care in Old Age: More Than a Funding Problem

There is currently a debate about the future funding of long-term care for old people. Welcome as it is, there is a risk that the focus on finance will obscure equally important questions about who should provide the care and what models of care should be chosen. Many years of research and innovation in the care of the elderly have shown that the effective and efficient provision of simple care services is very difficult to achieve. Social care is at once everyday and peculiarly complex. Some essential characteristics of social care are described which make it unlikely that a solution to the funding problem will improve either the allocation or the outcomes of long-term care.

Culture: The missing variable in understanding social policy?

This paper questions the intuitive assumption that twentieth-century public welfare states have reflected the wider culture in which they operate. It is argued that the postwar welfare state was a “modernist” project designed to change mass culture. As a result, social policy analysis has tended to ignore the wider culture as both a source and context for welfare. At the beginning of the twenty-first century new patterns of risk and postmodern cultural formations are supporting eclectic policy-making which is more in tune with cultural majorities. This signals the end of the systematic welfare state.

Self‐talk versus needs‐talk: An exploration of the priorities of housebound older people

This article argues that the material and social circumstances of older people living with disabilities mean that their priorities and subjective evaluations of quality of life are likely to be categorically different from those used by service provider organisations. Based on a qualitative study of a purposive sample of older people, who are over 75 and have recently become housebound as a result of disability, the paper describes two modes of understanding: ‘Self‐talk’ and ‘Needs‐talk’. It is suggested that these two modes are to an extent irreconcilable and limit the degree to which care assessments and care‐management can satisfy users.

Book Reviews : OECD Caring for Frail Elderly People: Policies in Evolution Paris, Organisation for Economic Co operation and Development, 1996, 305 pp., ISBN 92 64 14892

duce ’awards for good quality’ into public services that are increasingly contracted out to the private sector. Constanzi, in her study of quality development in residential care for elderly people in Italy, emphasizes how this work must take root within the status quo (i.e., as with all attempts to innovate, understanding of and adaptation to context is crucial). Klein’s paper is different from most others in being based on comparative research a study of inspection of nursing and residential homes for elderly people in Britain and Germany. The differences are considerable, with the UK system being clearly more developed and satisfactory (the reviewer’s judgement). Unfortunately the writer missed the opportunity to address a key question in comparative work, namely how are differences between countries to be explained? This highlights a deficiency in this otherwise valuable text on an important subject about which little has been written. The book needed a conclusion to draw out and identify emerging themes, the principal differences between countries and reasons for them, and questions needing further comparative research. The reader is left with a greater understanding of this subject, an awareness of initiatives around Europe and a general sense that we are not at all sure yet about the application of methods such as TQM to the domain of the personal social services.