Paying for Long-Term Domiciliary Care: A Comparative Perspective

Abstract

Concerns over growing numbers and proportions of older people in industrialised societies have prompted interest in the development of cheaper ways of providing long-term care for older people. While debate in the UK is currently focused on the costs of residential and nursing care, other European and Nordic countries have introduced schemes designed to encourage or sustain the provision of ‘social’ care by family members, friends and ‘volunteers’, on the assumption that this can be provided at lower net public expense than either residential care or formally-organised domiciliary services.Drawing on material from a detailed comparative study, this paper describes four different models on which such payments are currently based. These models are discussed and evaluated, taking into account factors which include the eligibility criteria for payments; maximising the autonomy of older people and family care-givers; and the relationships between financial payments and access to services.These models locate systems of payment within the broader context of financial and service support designed to help frail older people and those who support them. They therefore highlight the importance of considering both financial support and services in comparative studies of social welfare provision. However, further evaluation and policy development is hindered by the lack of evaluation of different models of paying for care and a lack of evidence about the experiences of older people and care-givers.

Social Capital as Exchange: Its Contribution to Morale

“…In this vein, cooperation (Mulford et al 1998), volunteering (Wilson 2000), marriage (Rosenfield 2005), social interaction (Liebler and Sandefur 2002), and providing social support (Magdol and Bessel 2003) are explainable by the realization or expectation of reward or compensation. Related research has shown that the reward and compensation can include the help recipient's earlier or later help (Hofferth et al 1999), caring (Feeney and Collins 2001) such as parenting (Travis and Stremmel 1997), payment (Glendinning et al 1997) such as inheritance (Izuhara 2002), and offering of gifts (Joy 2001), praise (Okun et al 1998), and other materials (Cnaan and Cascio 1999). In the creation of social capital, exchange theory implies that offering help is a result of calculation about investment and reciprocation (Cheung and Gui 2006;Mulford et al 1998).…”

Welfare State Policy and Informal Long-Term Care Giving in Austria: Old Gender Divisions and New Stratification Processes Among Women

“…As Ungerson (1995, p. 44) argues' `symbolic payments, will be part of the maintenance structure of the traditional provision of caring resources as these payments are likely to reinforce pressures on women to fulfil their expected role in the private domain. With cost-containment having been a major determinant of implementing payment for care programmes in Austria and elsewhere in Europe (Glendinning et al, 1997)' a system of 'symbolic payments' succeeds in securing relatively cheap ways of providing long-term care for older people.…”

The uncompassionate elements of the Compassionate Care Benefits Program: a critical analysis

“…The Carer's Allowance in both the UK and Ireland do not in any way protect informal caregivers from the long-term impact of being out of the paid workforce (17).…”