Financing Long-Term Care for Elderly People

Last year’s report of the Royal Commission on Long Term Care (1) and the expected Government response have prompted fresh interest in the debate on how to fund long-term care. To inform this debate the Personal Social Services Research Unit (PSSRU) has conducted a study, funded by the Department of Health, of long-term care demand and finance. This has involved the construction of a computer model to make projections of likely demand and expenditures to 2031. This article describes the model of long-term care demand and expenditure developed by the PSSRU. It then presents some of the results obtained and sensitivity analysis around them

Re-conceptualising Territorial Cohesion Through the Prism of Spatial Justice : Critical Perspectives on Academic and Policy Discourses

Peer reviewe

To what degree have the British community care reforms met the pre-reform criticisms of targeting?

It was not until the late 1980s that there was evidence for detailed analysis of the relations between resources, needs, andoutcomes: persons in what need-related circumstances obtained publicly-subsidised and/or brokered access to how much of what kind of service, with what effects on whom, and at what costs to whom. Very soon we shall comparison of resources, needs and outcomes for users recruited in 1984/5 with those recruited in 1995. In what follows, I shall risk some tentative generalisations from the half-analysed results of a before-after evaluation of the community care changes. The study was based on two cohorts of persons assessed and allocated community social services. One cohort was recruited during 1984/5 [hereafter, 1985], and was followed for at least 117 weeks. The second cohort was recruited during 1995, and is still being followed. The evidence is particularly rich about the circumstances and perceptions of field-level triads of users, principal informal caregivers, and their care managers. Data are still being collected and analysed, making some comparisons impossible as yet. The generalisations must be tentative. The analyses for the second cohort are still in progress, and there has not been the analyses for both cohorts simultaneously to get the highest degree of precision achievable with respect to the precise question asked, the definition of variables, and model

Productivities. Efficiency, and Three Policy Propositions

This note applies ECCEP estimates of service productivity curves, service prices, and service utilisation, and the predictions about the consequences of achieving perfect efficiency, in the discussion of three policy propositions. It deals primarily with only two of the seventeen outputs for which productivity curves have been estimated. Section I: defines two dimensions of productive efficiency analysed, explains and justifies in the context of reform argument the choice of three scenarios setting the framework for deducing the implications of productivities, prices and information about utilisation for what would be the best allocation of resources, andrelates the targeting implications of making the best use of resources to targeting strategies for investment in efficiency improvement. Section II suggests what light the results throw on three policy propositions: allocate more to the less on the less dependent, if necessary, releasing resources by allocating less to the more dependentspend less on the older community services, andgive higher priority to caregivers, less to users</li

Elderly People in Residential Care. Survey design for SSA and other purposes. A paper for information and discussion with local government representative bodies.

1. This report proposes a survey of residential care (used here to encompass both residential and nursing home care) which has the purpose of improving SSA formulae for elderly people, and for which the Department of Health has identified related interests, including: the need for new analyses of the relationship between costs and dependency;information about non-publicly funded residents; appropriateness of placement decisions.2. For SSA purposes (section 2 of the report), the study will: lead to new estimates of the relative need for supported residential care under the new Community Care arrangements, based principally on an analysis of the circumstances of people currently being admitted, compared with elderly people generally; investigate whether the inclusion of the socio-demographic factors about elderly people living in an area would improve the estimate of the likely average cost of residential care under a standard level of services. Readers interested primarily in SSA aspects of the study need read only sections 1 and 2, together with the methodologydescribed in section 6 (admissions study, subsections 6.1-6.8). 3. Information about the relationship between dependency and costs would provide a basic building block of information which could be used for a number of analyses, including estimating national costs of provision, making cost projections and the estimation of lifetime costs of people admitted at different levels of dependency (sections 3 of the report). This last is of particular importance: the Audit Commission have identified the problems associated with local authorities taking on caring commitments with no clear idea how long these will last. 4. The type of information collections required to explore these issues would have a wide variety of applications, including the appropriateness of placements in residential care (sections 4 and 5 of the report). These will be greatly enhanced by links with other ongoing and proposed research studies. 5. A three part survey is proposed (section 6 of the report): An Admissions study would identify elderly people who will have a significant financial impact on local authority resources committed to residential care. This includes those people: for whom the decision has been made that they are to be admitted to residential care;who have been admitted on an emergency basis and need to be at least financially assessed by the local authority; who are already in residential care who are being assessed because they no longer have the resources to pay for residential care; who are moving from one home to another with important cost implications. Data would be collected about the characteristics of the person being admitted and the home they are being admitted to (see Box 1). 6. A Longitudinal follow-up study would provide information about: how long people stay in residential care and mortality; destinational outcomes; changes in dependency and financial arrangements over time. (see Box 4) 7. A Cross-sectional study would identify: the characteristics of the resident population currently in residential care; the characteristics of homes, including some assessment of quality of care; the characteristics of short stay emergency, NHS and private funded admissions to homes. (see Box 3) 8. Other studies that would provide valuable links include: an ongoing study of quality of life in residential care (led by Anthony Mann); a proposed longitudinal study of quality of life in residential care (led by Peter Huxley); an evaluation of community care of elderly people (ECCEP, led by Bleddyn Davies): the current programme of mixed economy of care (MEOC, led by Martin Knapp); validation and development of Resource Utilisation Groups (RUGS, led by Iain Carpenter). 9. At the time of writing a survey of admissions and the first wave of the longitudinal follow-up have been commissioned,though design details remain to be finalised in consultation with all interested parties. Outline approval has been given for the cross-sectional survey of homes. The earliest completion dates for the main field work and analysis of these studies is as follows: Admissions survey: May 1996. Longitudinal survey (first wave): December 1996. Cross-sectional survey (subject to contract): December 1996. 10. The value of a three part linked survey is that it will allow a wide variety of analyses and provide a benchmark from which future changes in the role and characteristics of residential care can be measured. The proposed methodology should allow a wide variety of comparisons to be made, over time, cross-sectorally and cross-nationally