Coming of age: the cost of social care support

<p>The increasing population of elderly people over the coming decades will have a profound effect on the demand for and costs of social care support. In the development of policies about the provision of social it is essential that we are clear:<.p><p><p><li>what it is we mean by social care?;</li><p><p><li>how social care is provided?; and</li><p><p><li>who it is that bears the cost?</li><p><p>None of the answers to these questions are fixed and the future costs of social care will depend as much on changes in the answers to these questions as on the expected growth in the numbers and proportion of very elderly people in the population.

<p><p><p>While health care focuses primarily on alleviating or mitigating the cause of disability, social care is concerned with the effects of disability on normal domestic activities. It is the results of these everyday activities rather than the activities themselves that need to be produced and the results that services aim to provide. Thus social care is concerned with ensuring elderly people have adequate nutrition, housework, personal care and so on. Changes in society's expectations about these "commodities" lead to changes in definitions in what social care services should be concerned with. For example, changes in perceptions of the importance and expected quality of housing tend to result in a corresponding increase in concern about the issue of shelter in the social care of elderly people.

<p><p><p>Mainstream services, however, tend to provide social care in the form of relatively inflexible services. While needs and informal methods of provision are very variable, services tend to come in fixed ways and, frequently, levels. Thus meals-on-wheels may provide three meals (or nutrition) directly weekly to people with widely varying disabilities and needs. Recent legislation is designed to improve choice for consumers and delivery of social care but simply adding on a "care manager" to existing services may increase costs without improving the benefit felt by the consumers. Devolved budgets allow a more flexible approach to the provision of social care and getting away from service based descriptions of social care may encourage new ways of thinking about how social care is best delivered.

<p><p><p>Most social care is produced by carers and elderly people themselves (or informal care networks). The informal sector both provides and bears the costs of care. Demographic and economic changes mean that the capacity of the informal sector to produce care may be reduced and/or unable to meet the increasing demands of the growing elderly population. However, the capacity of elderly people and their carers to purchase care is likely to increase. There is a need for a coherent policy which will address the issue of the burden of costs borne by the state and the informal care sector (including elderly people themselves). This must:

<p><p><li>take account of opportunity cost, not expenditure;</li><p><p><li>consider both levels and proportions of the cost burden borne by the informal sector;</li><p><p><li>take into account future expectations and inter-network relationships;</li><p><p><li>apply across taxation, social security, centrally and locally funded provision.</li>

<p><p><p>In examining the resource implications of the expected rise in demand for social care the discussion must be extended from the narrow restrictive definition of expenditure on social services. There needs to be an increased awareness of what it is the services are providing, how they are doing it and the resource implications for the mixed economy including the informal sector.