Costing intensive home care packages for older people. Funded/commissioned by: Social Work Services Inspectorate for Scotland

The amount and type of health and social care services received by older people living in the community varies considerably. A variety of factors influence provision, such as service availability, spending limits, care management arrangements and local relationships between providers. Perhaps the most significant determinant of service receipt however is the needs-related circumstances of older people themselves. The Personal Social Services Research Unit (PSSRU) has examined the relationship between user's needs, service receipt and the cost of care packages in a series of studies spanning several decades (Davies and Knapp, 1981, Challis and Davies, 1986, Davies, Bebbington and Charnley 1990, Challis et al, 1994, Bauld et al, 1998). User characteristics which influence the cost of care are many. Physical health and dependency play an important role, with factors such as functional limitations, visual and hearing impairment, and urinary and faecal incontinence having important implications for the amount of assistance required. Mental health also affects the cost of care. Cognitive impairment and behavioural problems, as well as the user's morale and the presence or absence of depression are all significant factors. Personal environmental factors including the quality of housing, accessibility of transport and adequacy of heating affect package costs. Perhaps most significantly, the availability of informal care is a crucial determinant of the amount of formal services required. The assistance that carers provide reduces the need for formal intervention, and therefore lowers service costs. In many cases, assistance provided by a carer is the key factor in preventing entry to institutional care. Knowledge regarding the needs-related circumstances of users is necessary if package costs are to be compared between individual users or groups of older people, or if the costs of community care services are to be compared with those in other care settings. This report therefore describes the circumstances of older people living in the community, and then outlines the weekly cost of services they are receiving. Twelve case studies are presented. These case studies are drawn from a longitudinal study currently being conducted by the PSSRU at the University of Kent at Canterbury and the London School of Economics. The project is entitled Evaluating Community Care for Elderly People (ECCEP) and is funded by the Department of Health. A brief description of the study and concepts used therein provides the background for the cases presented in this report.