Production relations for old people's homes

Old people's homes pursue, either explicitly or implicitly, a number of goals or objectives. These may be specified at both an "intermediate" stage (in terms of beds or places provided, and services rendered) and at a "final" stage (in terms of improvements in the well-being of residents, and benefits to residents' significant others). Successful care may thus be described as care which achieved these objectives, if only partially, and the degree of success defines the intermediate and final outputs of the home. Three groups of factors will determine the degree of success or the outputs: the resource inputs (labour and capital), the personal characteristics and experiences of residents before, during and after entry, and the social environment and caring milieu of the home. These last two groups comprise the non-resource inputs into care. This "production of welfare" perspective on care is described and its relationship with the gerontology, social work and social policy literatures examined in the first half of the thesis. The perspective is also used as a structure to discuss some of the post-war developments in residential care for the elderly, although a comprehensive historical review is not attempted. The second half of the thesis uses the production of welfare approach to define the concept of "efficiency" in residential care, and to examine it from five different perspectives. Four of these perspectives or modes of analysis are applied using quantitative evidence for a number of samples of homes. Cost and production functions for intermediate outputs are estimated and their policy potential evaluated. The other two quantitative analyses focus on staff levels and ratios, and on staff turnover and vacancies. The final chapter examines the usefulness of cost effectiveness and cost benefit techniques for policy development and the pursuit of efficiency in the personal social services.