Costs and welfare outcomes of case managed community-care for the frail elderly in two routine programmes

Chesterman, John and Davies, Bleddyn P. and Challis, David J. (1992) Costs and welfare outcomes of case managed community-care for the frail elderly in two routine programmes. Personal Social Services Research Unit (The full text of this publication is not available from this repository)

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Abstract

<p>As a result of the growing numbers of frail elderly people needing support in Britain during the past twenty years combined<p><p>with the increasingly inadequate and ill-coordinated domiciliary services which they received (Goldberg and Connelly, 1982) a number of case-managed schemes in different local authorities were set up, designed to maintain these people in their own homes for a longer period by providing enhanced care. In these schemes a social worker acted as Case Manager, carrying a restricted caseload of elderly people who were at the level of eligibility for institutional care. After screening out inappropriately targeted referrals, a detailed assessment was made of each new case. After close consultation with the elderly person and any support network, a mix of statutory and voluntary services and informal help were mobilised which would best respond to these identified needs. The process was facilitated through the Case Manager being provided with a budget, allowing a greater flexibility of response. <p><p><p>One important use of the budget was in allowing helpers from the local population to be recruited and paid on a quasi-informal basis to visit the elderly person and assist principally with personal care tasks and in providing companionship at times when this support was most needed. In addition to resources financed by the budget, the Case Manager could negotiate with service providers within the Social Services Department for more traditional resources such as home help, meals on wheels, day care and short-term residential care for each of their cases. However, the average weekly expenditure by the Social Services Department on an elderly person was not normally to exceed two-thirds of the cost of a place in a local authority residential home, save with the prior agreement of the area manager. Also the Case Manager could negotiate with other statutory and voluntary organisations for resources such as Community Nursing, Day Hospital or Voluntary Day Care or clubs. Further details of the work and a full evaluation are available for the original Kent Community Care project (Challis and Davies, 1986; Davies and Challis, 1986) and the Gateshead Social and Health Care Schemes (Challis et al, 1990). <p><p><p>All these schemes received considerable support from the University of Kent in both setting up and maintaining them. Their<p><p>purpose was to show that intensive case management of a suitably targeted group of frail elderly people, using devolved<p><p>budgets, could improve cost-effectiveness. <p><p><p>The first of these schemes was located in Thanet, a seaside retirement area in East Kent. Its success led to the local<p><p>authority offering local managers in other parts of Kent the opportunity to start schemes in their own divisions in response to a budgetary incentive from the centre. Consequently, over a period of some six years the scheme expanded across the authority until it was part of standard provision for the elderly throughout Kent. This expansion took place without any significant contribution from the University of Kent. <p><p><p>In what follows, two early examples of these schemes set up in contrasting parts of Kent are described, and their costs and benefits determined. These results could therefore demonstrate what was possible for schemes running essentially under their own steam.

Item Type: Research report (external)
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Personal Social Services Research Unit
Depositing User: Rosalyn Bass
Date Deposited: 20 May 2011 14:39
Last Modified: 20 May 2014 11:12
Resource URI: http://kar.kent.ac.uk/id/eprint/27235 (The current URI for this page, for reference purposes)
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