Domiciliary care for the elderly sick--economy or neglect?

Abstract

This paper reports an investigation of the costs of domiciliary care for 139 elderly sick patients under the care of the home nursing service. The data suggest that there may be little economic advantage in home care for seriously disabled elderly people. The revenue cost of domiciliary care was equal to or greater than the average associated with residential or hospital custodial care in such patients. Even so, the cost of services received at home did not disclose the real need for domiciliary care, since at present this is obscured by compulsory rationing and the separation of responsibility between health and social services. It is suggested that the supposed economic advantage of domiciliary care will depend increasingly on restricting such services, thus increasing the degree of neglect to some patients.

Organization of rehabilitation services

“…The hospital at home concept has limitations for patients with complex disability and is not suitable for patients living alone or those who are very ill. 53 There are other problems too. Innovative schemes such as the attachment of a physiotherapist to a primary health care centre may not benefit the elderly, because of attention being diverted to younger patients and the lack of a team structure.…”

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

“…The origins of the BoC model have been attributed to the British government, 81,90 and the vast majority of subsequent studies have been undertaken in the British Isles. [91][92][93][94][95][96] Nothing in the approach, however, limits its use to this policy context, as demonstrated by studies from Italy 97 and Canada, 98 nor to the national level, with local studies predominating. 71,[97][98][99][100][101] The original model's applicability across multiple client groups was not found in later studies, with all but two focusing on just one population, older people.…”

“…92,95,112,122,123 A further fifth incorporated some of these elements. 71,91,110 The remainder considered only public expenditure which, depending on their foci, covered the costs incurred by health and/or social services.…”

“…However, some studies employed aggregate measures of available resources taken from routinely collected statistics, 80,93,94 whereas others undertook individual-level data collections similar to those above. 71,92,99 Approaches to identifying alternative care arrangements…”

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk THE BALANCE OF CARE APPROACH TO HEALTH AND SOCIAL CARE PLANNING Tramarin et al (1997) 97 Tucker et al (2005,2008) 117,118 Wanless et al (2006) 10 Wager (1972) 91 Challis et al (2000) 145 /Challis and Hughes (2002) 104 Kavanagh et al (1993,1995) 122,123 Mooney (1977,1978) 71 86 Opit (1977) 92 Plank (1977) 99 Knapp et al (1997) 112 Avon County Council (1980) 110 Wright et al (1981) 102 Whitfield and Symonds (1976) 109 Williams et al 98 Clarkson et al 96 Bebbington et al (1990) 103 Challis and Shepherd (1983) 106 O'Shea and Corcoran (1989,1990) 113,114 O'Shea and Costello (1991) 95 Audit Inspectorate (1983) 94 Canvin et al (1978) 119 / Boldy et al (1981/ Boldy et al ( , 1982 120,121 Klemperer and McClenahan (1981) 105 [two studies]…”