Care Provision and Cost Measurement: Dependent Elderly People at Home and in Geriatric Hospitals. – book reviews
Changes in the relative balance of institutional and home-based care are a cause of concern in many countries. This study from Ireland was designed to estimate the costs of care in long-stay institutions by comparison with the cost of care in the community. Data were gathered from three surveys on dependent elderly people and the services provided to them for individuals in geriatric hospitals, elderly people living at home needing care and living with a carer and those using day-hospital services. Obviously the inclusion of only those elderly people with resident carers renders the role of carers in this study particularly problematic.
The conclusions reflect much of what has been found in UK studies. This includes the disjuncture between the level of resources devoted to institutional and community care for not dissimilar individuals and the importance of informal care as the most significant and most costly element of home care. The study identified a relatively low level of dependency amongst a significant number of patients in long-term care which raised questions about the quality and rigour of pre-admission assessment, the need for rehabilitation programmes and active discharge policies and the interdependence of home care and institutional care reflected in the effects of the relative extensiveness and quality of substitute community-based services. Other elements identified included the relatively low usage and level of provision of community care services.
The authors conclude that there was no evidence that community care was cheaper than institutional care, which is particularly pertinent when some home care provision was extremely low and frequently the major cost element, that of carers, is not included. Policy conclusions which emerged from the study also ring true to a UK reader. These include the need to integrate funding of institutional and community-based services if resources are to be used to best effect and the need to provide substantially greater degrees of help to carers. One interesting observation was that a very high proportion of carers identified the provision of payment to them as the best means of providing them with suitable assistance. The need for more integrated and coordinated care with the capacity to fill gaps in existing community services was also seen as important. In a conclusion which confirms much of the writing on community care in the UK, the authors note that transferring the burden of care from the Exchequer to families would be unacceptable given the paucity of community care services throughout the country and the lack of recognition which informal carers have traditionally received from the statutory sector. The findings of this book, which is a cost comparison of different services for elderly people, thus reflect writings about long-term care of frail elderly people in countries as diverse as the UK, the USA and Australia.
COPYRIGHT 1993 Oxford University Press
COPYRIGHT 2004 Gale Group