Assignment 3: Drawing on evidence from online government statistics and at least one other online source outline current trends in the provision of home care and discuss the implications of these trends for ways in which people obtain care and support themselves.
Introduction
Home care, which is also known as domiciliary care, pertains to the provision of care in the residence of the patient by professionals making visits or staying with the patient or by family members, friends or other people. Home care provided by professionals refer to formal care although this is done outside of the tradition care environment or setting while care given by family members, friends and other people pertain to informal care. (Kirk & Glendinning, 1998)
The core idea of home care is to provide assistance to service users to support their independent functioning and continue living in their own domiciles. As a general concept, home care encompasses a wide range of services from the preparation of meals, assistance in transport, or provision of day care. Direct payments received by providers of home care are exempt from taxation. (Department of Health, 2007)Home care has grown in importance over the past years because of the high cost of obtaining care in the traditional venues. While, home care also involves financial, psychological and social costs, this has become an alternative mode of care for many people. Financial costs expenses especially in formal home care. Psychological cost pertains to the burden especially on informal carers of handling the difficulties involved in providing care. Social cost refers to the loss of social life of informal carers by engaging in home care. (Kirk & Glendinning, 1998) Another reason for the growth in the importance of home care is the value given to independent living. People are innovating on more and more ways of obtaining care and supporting themselves. It is of due importance to consider trends in home care and the implications of data on the ways that people obtain care.
Current Trends in the Provision of Home Care
The statistical data on the provision of home care for England and Wales and Scotland shows a common trend, which is the declining number of clients engaging home care and the increasing number of hours of home care involved. This means that while the number of people obtaining home care is declining, the number of hours of home care received is increasing.
In the case of England and Wales, the Department of Health (2007) reported that the number of home care clients reached 334,500 households or 346,700 individual service users obtaining 3.9 million hours of home care. The number of households and services users represents an increase by 3 percent relative to data in 2006. The number of hours represents a rise in the care contact of 4 percent when compared to 2006. The Scottish Executive (2006) reported that the number of home care users has increased to 70,657 clients representing a level off in number when compared to the year-on-year statistics since 2002. This supports the trend in England in Wales of the decline in the percentage increase in the number of home care clients. Furthermore, the Scottish Executive (2006) added that the total number of working hours involved in home care given to clients continue to be on the rise with percentage increase of 3 percent when compared to data in the previous year of more than 604,000 hours of care. On the average, the hours of care for every service user is increasing since the percentage increase in 1998 is 5.1 percent and it has now increased to 8.5 percent. The United Kingdom Home Care Association Ltd (2008), a private association of home care providers, reported a similar trend in Northern Ireland with 22,599 individuals engaging home care. The number represents a 32 percent increase in individuals obtaining home care when compared to data for the decade, although this also represents a declining rate of increase.
Another trend is the rise in the intensity of home care needs of clients. This explains the decline in the number of users of home care services but an increase in the number of hours received for home care. This implies that even for serious care needs clients are now considering home care as an alternative to traditional venues of care, particularly voluntary admission into care facilities and institutions in the long-term (Department of Health, 2007). In addition, there is also the prioritisation for home care services for serious care needs, as explained by the decline in the demand for minor care needs and the rise in the demand for serious care needs (United Kingdom Home Care Association Ltd, 2008). Moreover, another explanation is a growing preference for care arrangements that would allow individuals to live independently by obtaining the care they need at home (Scottish Executive, 2006; National Statistics, 2008).
Still another trend is the rise in the expenditures for home care across the United Kingdom including both private and public expenditure. For England and Wales, the total annual private expenditure reached £1.46 billion a year (Department of Health, 2007). In Scotland, the annual private expenditure is £34 million a year (Scottish Executive, 2006). In Northern Ireland, the number of private expenditures is insufficient to cover the value of home care making public expenditures the dominant source of home care expenses (United Kingdom Home Care Association Ltd, 2008). Public sector expenses for home care in the England £2.59 billion (Department of Health, 2007), £498 million for Scotland (Scottish Executive, 2006), and £109.8 million for Northern Ireland (United Kingdom Home Care Association Ltd, 2008). This coincides with the growth in the intensity of home care services, with serious care involving greater expenses when compared to minor care services.
Another important trend is the preference for independent care service providers. In England and Wales, there is a 13 percent increase in the number of households obtaining care from independent providers (Department of Health, 2007). This finds explanation from the purchase of the public sector of home care services from independent providers instead of providing care services themselves. In Scotland, the home care services provided by the public sector declined from 89 percent in 1998 to 56 percent at present (Scottish Executive, 2006). The same is true for Northern Ireland, although the public sector remains the primary provider of 65 percent of home care the private sector now provides 35 percent of home care, an increase compared to the previous years (United Kingdom Home Care Association Ltd, 2008). This implies a number of things. One is the development of the private home care sector indicating competitiveness and options for home care clients. The other is the greater interest of the public sector for commissioning, contracting, and outsourcing as a less costly option.
In terms of the types of service and service clients, these ranges from extra care housing, in-house supported living, rehabilitative service, intermediate care service, and community support team with the numbers all the intensity of demand for these services showing a year-on-year increase (Department of Health, 2007). There is an increase in demand for serious care services for longer periods (United Kingdom Home Care Association Ltd, 2008). An explanation is the growing number of demand coming from the older age groups, especially those aged 65 years and above for intensive home care services (Scottish Executive, 2006). This means that the type of home care services demanded has shifted to intensive types of home care that involve long-term care.
Implications on the Manner that People Obtain Care and Support
The trends have various implications on the way that people seek care and support for themselves. These implications revolve around the empowerment achieved by the public in the context of the appeal and preference of service users for an independent care setting as opposed to the traditional venues and modes of care.
One implication refers to the demographic changes occurring in the society. Apart from a longer life expectancy, there is also the breakdown of traditional family structures (Tarricone & Tsouros, 2008). This meant that people, especially the older age group have to fend for themselves. Moreover, the lesser reliance on family members made professional home care providers important. The need for care and support to continue independent living caused the rise in the importance of home care and the concurrent development of the home care as a professional service sector.
Another implication is the change in disease epidemiology. The greater understanding of the diseases and development in interventions or treatments led to greater freedom for care service clients. Interventions for mental conditions, physical disability, and other diseases are increasingly shifting towards care in the social context (Tarricone & Tsouros, 2008). The idea now is to provide support to ensure independent living instead of keeping them within the custody of institutions. This opened options for home care and home care services.
Still another implication is the pressure for the reconfiguration of the health care system to provide customised or individualised services (Tarricone & Tsouros, 2008). Technological developments and improved knowledge of options led to the preferential demand for customised service and home care became the answer to this demand.
Conclusion
The importance of home care is the offshoot of the developments in the condition of care clients and the public in general. With greater understanding of their care needs, the public is able to influence changes in care services by placing importance on home care relative to the traditional modes and venues of care. By influencing demand for home care services, care clients are also able to experience greater independence and control over their care needs, especially with options in service providers and flexibility in the types home care services.
References
Department of Health. (2007). Community Care Statistics 2007 Home care services for adults, England. Retrieved December 3, 2008, from http://www.ic.nhs.uk/webfiles/publications/Home%20Care%20(HH1)%202007/HH1%202007.pdf
Kirk, S., & Glendinning, C. (1998). Trends in community care and patient participation: implications for the roles of informal carers and community nurses in the United Kingdom. Journal of Advanced Nursing, 28(2), 370-381.
National Statistics. (2008). Households visited by home help and home care: Social Trends. Retrieved December 3, 2008, from http://www.statistics.gov.uk/STATBASE/ssdataset.asp?vlnk=6489
Scottish Executive. (2006). Statistics release: Home care services, Scotland 2006. Retrieved December 3, 2008, from http://www.socialworkscotland.org.uk/resources/pub/HomeCareServices.pdf
Tarricone, R., & Tsouros, A. (2008) (ed.). Home care in Europe. World Health Organization Europe. Retrieved December 3, 2008, from http://www.euro.who.int/Document/E91884.pdf
United Kingdom Home Care Association Ltd. (2008). UKHCA summary paper: An overview of the UK domiciliary care sector. Retrieved December 3, 2008, from http://www.ukhca.co.uk/pdfs/domiciliarycaresectoroverview.pdf
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