Care of Older People in the Community.
In this essay I want to carefully examine a broad range of issues concerning elderly people in contemporary British society today. In particular I will want to focus on community care policy and the issue of long-term care. I will want to pay attention to informal care and be able to assess how problematic that this form of care can be in contemporary society. I will also suggest changes that could be made in social policy that could help advantage retired and elderly people in this the twenty-first century.
Community care policies can be traced back to the 1950’s in British society and had grown as a result of the closure of large-scale institutions that had housed people with mental health problems and the mentally handicapped. This led to the emergence of smaller type homes and hostels for people who could not return to their own homes (Dalley, 1996). With improved medical facilities that had developed during and after the 2nd World War it was thought that mentally ill people could be treated outside of these institutions and in the community.
A good definition of community care can be found in the 1989 White Paper on community care, Caring for People, which stated that “community care means providing the right level of intervention and support to enable people to achieve maximum independence and control over their own lives. For this aim to become a reality, the development of a wide range of services provided in a variety of settings is essential. These services form part of a spectrum of care, ranging from domiciliary support provided to people in their own homes, strengthened by the availability of respite care and day care for those with more intensive care needs, through sheltered housing, group homes and hostels where increasing levels of care are available, to residential care and nursing homes and long-stay hospitals for those for whom other forms of care are no longer enough” (Department of Health, 1989, p.9).
The issue of long-term care had become a controversial issue since the late 1980’s and early 1990’s when problems began to arise in respect of who was responsible for providing the funds for long-term care. This was quite a frustrating time for elderly people needing care and for their families as they had to go through financial assessment and faced the prospect of losing valuable assets such as the family home under the new funding regime that had emerged in April 1993 under the 1990 NHS and Community Care Act.
In the run up to the General Election of 1997 the Labour Government who won the election paid a low policy priority to the personal social services putting it behind criminal justice, health and education. However, included in its manifesto commitments relating to community care was that a Royal Commission be set up to work out a fair system for funding long-term care for elderly people. Unfortunately the Government’s response to the Commission has fallen short of campaigners’ aims, and has delivered a bitter blow to those campaigning for equality in the care system.
In fairness the Government has accepted a lot of the recommendations put forward by the Royal Commission but has rejected the key recommendations, such as, personal care should be available after an assessment, according to need and paid for from general taxation. For example, the Government’s response to this recommendation was “the Government is making an unprecedented new investment over the next three years in improving older people’s services making them more responsive and more fairly funded. The Government’s investment would fund the cost of the Royal Commission’s recommendation. However the Government, does not believe that making personal care universally free is the best use of these resources” (cited http://www.longtermcare.co.uk/). Another recommendation put forward by the Commission which was “the Government should ascertain precisely how much money goes to supporting older people in residential settings and in people’s homes”. The Government’s response to this was “any division between acute and long term health care would be somewhat arbitrary. The Government believes that it is more important to get the right incentives in the system to promote older people’s independence and to provide care closer to home. This is what the proposals in the NHS Plan on intermediate care and associated services aim to do” (cited http://www.longtermcare.co.uk/). I think if the Government was able to ascertain how much money goes into supporting older people in residential settings and people’s homes the Government would have a clear idea of how to budget their finances more accurately towards elderly people. Thus have an idea of how to fund long-term care more efficiently.
On the key financial issues critics could argue that the proposals offer little comfort and do not fundamentally change the position. “The free nursing care is better than nothing but in real terms its value will be of limited benefit to the majority of individuals who will still have to use their savings and property to meet their care costs” (cited http://www.careaware.co.uk/news.html).
The current policy aims and objectives from the New Labour government have derived out of policy initiatives that had earlier been developed by the Conservative government back in the early 1990’s. Social security was playing havoc for the Conservative government in the early 90’s and so pursued policy changes in the 1990 Act such as controlling social security funding of residential care that was concerned with the elderly. In pursuing this policy it allowed policy-makers to set charges and raise the cost of home care and other community care services. As Dean and Sykes et al. (2000, p.135) state “the 1990 NHS and Community Care Act ended the social security-led incentives towards placement in residential care and transferred monies from the social security budget to local authorities to pay for people who would previously have claimed assistance with the costs of residential care”. They go on to state that “the new system also demanded assessment of the need for care, thus introducing explicit rationing, in addition to means-testing. This represented a ‘fundamental shift from a demand-led system, based on individual entitlement, at given income levels, to one based on assessment of needs but within a fixed budget’ (Health Committee, 1993, para.8)” (cited in Dean and Sykes et al., 2000, p.135). From here we can see how the Conservative government had been initiating policies that were putting greater responsibility for financing care on individuals and their families. From the time the 1990 NHS and Community Care Act came into being the Conservative government was placing greater emphasis on private health care and private pension schemes. This has been the policy of the Conservative government in the early 90’s making people become more responsible for their own health care.
It was these policies and others that were making elderly people pay for their own residential care by means of losing assets such as their own homes to pay for their care.
The approach of New Labour to the issue of long-term care has been very much a long the lines of the Third Way approach to social policy. Basically, Third Way politics is a way of balancing New Right ideology with that of Old Labour’s ideology and finding a middle ground between the two. The third way is based on theories from globalisation, economics and the environment. We could also say that Western ideas has shaped the third way approach e.g. the passing Clinton administration which had adopted many third way policies. We can place the third way approach to the centre left of the political spectrum.
However, the third way approach to community care and in particular the issue of charging elderly people for long-term care is proving undesirable among British people. As is stated in British Social Attitudes “people are in the main still keen to retain the provisory role of the state when it comes to key areas of welfare provision, this includes paying for the institutional care of elderly people for which greater provision was recently recommended by a recent Royal Commission report (Royal Commission, 1999), but rejected by the government”.
If we look at capitalism we can make the assumption that capitalism does not benefit the retired or elderly frail in society. Once we reach the age of retirement we are looked upon as dependent on the state and family for social support as people at this stage in life are stereotyped as being incapable of work. These are the negative stereotypes that many retired people face in our modern society today. We could argue here that capitalism has no role for the retired and elderly in society and more to the point that it actually strips older people of their many roles that they once had in society. Many of the government’s social policies tend to reinforce this in contemporary society.
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