Formal Social Care Research Articles

Eksistensi Kepedulian Sosial dalam Membangun Ukhuwah Wathaniyah pada Masyarakat Kec. Tanjung Beringin, Kab. Serdang Bedagai

This research examines the existence of social care in building ukhuwah wathaniyah in the community of Tanjung Beringin District, Serdang Bedagai Regency. Ukhuwah wathaniyah, as a concept of brotherhood that transcends ethnic and religious barriers, is an important foundation in strengthening social relations in a diverse society. This research focuses on how forms of social care, such as gotong royong, humanitarian assistance, and cooperation between citizens play a role in creating harmony and solidarity in the midst of society. The method used in this research is a qualitative approach with data collection through in-depth interviews, observation, and documentation. The data obtained were analyzed using descriptive analytical method to describe the patterns of social interaction that support ukhuwah wathaniyah. The research findings show that social care in Tanjung Beringin Sub-district is a key factor in strengthening ukhuwah wathaniyah. The local community shows a strong commitment to maintaining and improving social harmony through various activities that involve all levels of society. The results of this study provide a deeper understanding of the importance of social care in building ukhuwah wathaniyah in a multicultural society. It is hoped that this research can serve as a reference for policy makers and related parties in formulating inclusive and sustainable social development strategies in Tanjung Beringin Sub-district as well as other areas with similar social characteristics.

Projections of Socioeconomic Costs for Individuals with Dementia in China 2020-2050: Modeling Study.

Previous estimates on future socioeconomic costs of dementia in China are inconsistent, and the main drivers of these costs are unclear. This study projected future socioeconomic costs (healthcare, formal social care, and informal care costs) and value of quality adjusted life years (QALYs) lost to dementia in China and assessed drivers of socioeconomic costs. Based on our prior projection on dementia cases to 2050 by a Markov model, we forecasted future socioeconomic costs and the value of QALYs from a societal perspective, utilizing the China Health and Retirement Longitudinal Study and the Chinese Longitudinal Healthy Longevity Survey. In our main analysis, dementia incidence increased by 2.9% annually, while sensitivity analyses considered a flat or 1.0% annual decrease in the temporal trend of dementia incidence. Furthermore, we decomposed socioeconomic costs changes (2018 US$) into population growth, population aging, dementia prevalence and average socioeconomic costs per case. The annual socioeconomic costs and value of QALYs lost to dementia will reach $1,233 billion and $702 billion by 2050. If dementia incidence stays constant or decreases by 1.0% annually, the costs and QALYs would respectively decrease by 34% or 43% in 2050. Informal care is currently, and projected to remain, the largest share of socioeconomic costs. Population aging and rising dementia prevalence will mainly drive the growth in socioeconomic costs through 2050. Dementia casts an increasingly large economic burden on Chinese society, mainly driven by fast aging population and growing dementia prevalence.

Avoidable Hospitalizations in Frail Older Adults: The Role of Sociodemographic, Clinical, and Care-Related Factors

ObjectivesThis study aims to investigate the relationship between frailty and avoidable hospitalization risk, and the moderating role of sociodemographic, clinical, and care-related factors. DesignLongitudinal population-based cohort study. Setting and ParticipantsA total of 3168 community-dwelling individuals, aged ≥60 years, from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). MethodsWe operationalized physical frailty using baseline SNAC-K data (2001-2004). In line with the Swedish Board of Health and Welfare and Association of Local Authorities and Regions, avoidable hospitalizations were considered those that could have been prevented through proper and timely outpatient care and identified through the Swedish National Patient Register. Participants were followed from baseline until first avoidable hospitalization, death, drop out, institutionalization, or maximum 12 (median 7.6) years. The association between frailty and avoidable hospitalization was explored through flexible parametric survival models, with stratified analyses to investigate age, gender, education, civil status, multimorbidity, cognitive status, and informal and formal care as potential modifiers. ResultsThe adjusted 12-year cumulative incidence of avoidable hospitalization was significantly higher for frail persons (cumulative incidence 33.2%, 95% CI 28.9%-38.1%) than for prefrail (cumulative incidence 26.6%, 95% CI 24.5%-29.0%) and nonfrail (cumulative incidence 25.2%, 95% CI 22.5%-28.3%) individuals. In addition, prefrailty [hazard ratio (HR) 1.21, 95% CI 1.00-1.45] and frailty (HR 1.91, 95% CI 1.47-2.50) were associated with increased avoidable hospitalization hazards. Furthermore, the association between frailty and avoidable hospitalization was stronger in older adults aged <78 years (HR 3.12, 95% CI 1.99-4.91) and those with relatively fewer chronic diseases (HR 3.88, 95% CI 1.95-7.72), whereas provision of formal social care (HR 1.15, 95% CI 0.77-1.72) seemed to act as a buffer. Conclusions and ImplicationsOur results indicate that older community-dwelling adults with prefrailty and frailty are at increased risk of experiencing avoidable hospitalizations, highlighting a need for better care of these individuals at the outpatient level. Formal social care services and close monitoring of particularly vulnerable subgroups of frail persons may mitigate this risk.

Implications of treatment duration and frequency for value and cost-effective price of Alzheimer treatments.

Disease-modifying Alzheimer treatments are becoming available. The value of the treatments will be attenuated by their complexity of delivery and monitoring, creating additional medical cost and caregiver burden. To estimate net treatment value using different assumptions for treatment duration and intensity. We estimated the lifetime value of hypothetical treatments that reduce disease progression by 30% from a payer perspective, which considers cost offsets, i.e., reduced medical and formal social care costs, and quality-adjusted life-year gains, and a societal perspective, which adds reduction in caregiver burden. Estimates for gross value of the treatment were based on a prior publication, medical cost on Medicare payment rates, and caregiver time use on a survey of 21 clinics. We analyzed 5 hypothetical treatment scenarios: treatment until progression to moderate dementia with (1) biweekly and (2) 4-weekly infusions, and time-limited infusions every 4 weeks for (3) 72, (4) 52, and (5) 24 weeks. Treatment until progression to moderate dementia would take 5.7 years and generate gross value of $20,734 in direct cost offsets, $83,761 from a payer and $87,749 from a societal perspective, respectively. Added medical cost and caregiver burden for the 5 scenarios would be $44,179, $24,875, $21,632, $20,416, and $14,350, respectively. The maximum value-based price per year would be $7,687, $11,088, $47,708, $67,273, and $158,954. Assuming identical efficacy and safety, the net value generation of time-limited treatment is projected to be larger than that of chronic treatment. Such determination of net lifetime value can be useful to determine value-based prices for different treatment types.

P059 Informal care for those with multiple longer term conditions - a hidden burden?

Abstract Background/Aims Multiple long-term conditions (MLTC) refers to the co-existence of two or more chronic conditions. Rheumatic diseases (RMDs) are important long-term conditions which are common in individuals with MLTC. The effect of rheumatic disease on disability is well known and often requires support with activities of daily living, i.e. social care. However, while the presence of MLTC is known to be associated with social care need, the role of RMDs in driving social care need is unknown. This lack of data capture of social care resource use undermines healthcare strategy. We carried out two surveys in different parts of the country to ascertain the social care burden amongst those with RMDs. Methods An online cross-sectional survey to identify and characterise formal and informal social care use was sent to two different groups of patients with rheumatic and musculoskeletal disease. The first comprised participants within Norfolk Arthritis Register, who were emailed an invitation to complete the survey between March-July 2023. As part of Assembling the Data Jigsaw programme, the second group comprised patients attending the Salford Royal Hospital Rheumatology Department with text message invitations sent between October 2022-September 2023 via the DrDoctor app. All participants answered identical questions on formal and informal care provision and demographic characteristics. Logistic regression was used to identify factors associated with needing support. Results A total of 184 participants within the NOAR cohort completed the survey, comprising 128 (70%) women with a median age of 64 years. A total of 439 participants completed the survey in the Salford Royal Hospital cohort, comprising 326 (74%) women with a median age of 58 years. Rheumatoid arthritis was reported by 93 (73%) of the NOAR recruits and 136 (31%) of the Salford Royal Hospital cohort, with osteoarthritis the next most common with 37 (20%) and 112 (34%) of each cohort reporting this condition. Using self-reported data, 47% and 64% of the respective cohorts met the criteria for MLTC. For both cohorts, 30% reported needing four hours or fewer assistance per week, and 19% reported requiring &amp;gt;10 hours a week. Although infrequent or occasional help was usually provided informally by spouses, partners, family members or friends, 42 (23%) of the NOAR cohort and 70 (16%) of the Salford Royal Hospital cohort arranged formal care provision themselves without involving the council. Multivariable logistic regression of both cohorts found that those who were younger were more likely to have reported needing assistance with ADLs in the last month. MLTC was also associated with requiring help. Conclusion The majority of individuals engage informal support or arrange care without help from local authorities. These data are important for describing social care resource use and for determining healthcare strategy. Disclosure M. Yates: None. M. Soomro: None. A. Onajole: None. A. MacGregor: None. W. Dixon: None. J. McBeth: None. J.H. Humphreys: None.

The functioning of European social protection systems in fulfilling the needs of persons with disabilities during COVID-19 – a semi-systematic review

Previous research has shown that pre-existing social and economic inequalities deepened during the COVID–19 pandemic. Persons with disabilities were among the most affected social groups. This article focuses on the social support that persons with disabilities and their families received during the coronavirus pandemic in Europe. A semi-systematic literature review was conducted: 578 records were identified, and 31 empirical papers were included. Four themes emerged from thematic analysis: (1) challenges in formal social support and care, (2) challenges in informal social support and care, (3) access to information and assistive technology, (4) positive practices, innovative methods and opportunities. In public policy, health-related needs overshadowed the needs to be met by the social support system, revealing the already existing dysfunctions of social protection systems.

DETERMINANTS OF INFORMAL CARE TRAJECTORIES IN ENGLAND

Abstract In the context of an ageing population, combined with long-standing challenges in the delivery of formal social care for older people, unpaid caregivers play a key role in promoting the quality of life of older people and their extended families and ensuring that needs for care and support are met. Although many studies have provided snapshots of informal care provision, few so far have examined longitudinal patterns of informal care provision among older people. This paper aims to describe caregiving trajectories in later life and to examine how socioeconomic, demographic, and health characteristics of older adults relate to these patterns (including needs and enabling factors). Using six waves of the English Longitudinal Study of Ageing, we conduct latent trajectory analysis to cluster people’s diverse trajectories into a finite number of groups. The intensity of informal care provision is also considered when identifying longitudinal trajectories. Preliminary results show five distinct trajectories of informal care provision (including those who never provide informal care, those who provide sporadic informal care, those with increasing and decreasing commitment to care provision, and those who care throughout). Gender, age, health, income, living arrangements, and family compositions all relate to long-term trajectories of informal care, with younger married women in good health more likely to provide informal care throughout. Support should be provided to this group of caregivers, given that engagement in long-term caregiving might be detrimental to mental health.

Understanding people's experiences of the formal health and social care system for co-occurring heavy alcohol use and depression through the lens of relational autonomy: A qualitative study.

Heavy alcohol use and depression commonly co-occur. However, health and social care services rarely provide coordinated support for these conditions. Using relational autonomy, which recognizes how social and economic contexts and relational support alter people's capacity for agency, this study aimed to (1) explore how people experience formal care provision for co-occurring alcohol use and depression, (2) consider how this context could lead to adverse outcomes for individuals and (3) understand the implications of these experiences for future policy and practice. Semi-structured qualitative interviews underpinned by the methodology of interpretive description. North East and North Cumbria, UK. Thirty-nine people (21 men and 18 women) with current or recent experience of co-occurring heavy alcohol use ([Alcohol Use Disorders Identification Test [AUDIT] score ≥ 8])and depression ([Patient Health Questionnaire test ≥ 5] screening tools to give an indication of their current levels of alcohol use and mental score). Semi-structured interview guide supported in-depth exploration of the treatment and care people had sought and received for heavy alcohol use and depression. Most participants perceived depression as a key factor contributing to their heavy alcohol use. Three key themes were identified: (1) 'lack of recognition' of a relationship between alcohol use and depression and/or contexts that limit people's capacity to access help, (2) having 'nowhere to go' to access relevant treatment and care and (3) 'supporting relational autonomy' as opposed to assuming that individuals can organize their own care and recovery. Lack of access to appropriate treatment and provision that disregards individuals' differential capacity for agency may contribute to delays in help-seeking, increased distress and suicidal ideation. Among people with co-occurring heavy alcohol use and depression, lack of recognition of a relationship between alcohol use and depression and formal care provision that does not acknowledge people's social and economic context, including their intrinsic need for relational support, may contribute to distress and limit their capacity to get well.

The Influence of the COVID-19 Pandemic on the CSR Practices in the Romanian Banking Sector

Abstract The COVID-19 pandemic has rapidly changed the Romanian banking sector, which was forced to adapt to digital technologies and to provide accessible banking services for all kinds of custsomers. The corporate social responsibility practices evolved during the pandemic, from general causes to more targeted initiatives, the Romanian banks offering innovative solutions to fight against the health crisis. The present paper provides a good insight in the corporate social responsibility practices before the pandemic and during the COVID-19 crisis, exploring the best practices of the most representative banks in terms of total assets. The investigation covers five years, from 2017 to 2021, and was based on a content analysis of the sustainability reports of the banks from the sample. The data was processed through the MAXQDA software, revealing a clear correspondence between the corporate social responsibility practices of the banks and the theoretical concept of sustainability: Profit – People – Planet. The qualitative analysis was completed by a quantitative investigation based on a questionnaire applied on a sample of 344 respondents. The comparative analysis outlines the moral implications of corporate social responsibility in the COVID-19 unique environment, considering the balance between the individual health of clients/employees and the profit dimension of corporate social responsibility. The paper focuses on the recovery stages of the banking sector after the critical point of restriction measures, emphasizing the clients’ perceptions and attitudes towards digital banking, as a form of social care during pandemic. The banks responses to the COVID-19 pandemic were examined by using a sequential mixed-methods approach, suggesting an amplified economic dimension of corporate social responsibility during the COVID-19 pandemic through digital banking services.

The relationships between informal and formal social care for older people in England: A comparison before and after the Care Act 2014

ABSTRACT Social care is an integral part of the UK welfare system and plays an imperative role in promoting the well-being of older people. This study investigates the impacts of receiving informal social care on formal social care use among community-dwelling older people in England before and after the implementation of the Care Act 2014. Data came from the Health Survey for England for the years 2011 to 2018 (N = 17,292). Bivariate probit models were used to address the endogeneity issue. The analysis shows that receipt of informal care substitutes for formal care. Informal care had a strong substitution effect on formal personal care before 2015, which was significantly weakened after 2015. While the receipt of formal personal care has been increasingly “carer-blind,” that of formal domestic care depends on the availability of informal carers and personal affordability, which may result in unmet care needs.

The Puteri Aisyiyah Orphanage Development at Banua Anyar

An orphanage is a social institution that protects and guides orphans, orphans, neglected and poor people for the welfare of foster children. Orphanages also have an essential role in educating and fostering foster children so that their behaviour can be controlled. This article describes strengthening character building through religious, social, skills and health guidance at the Puteri Aisyiyah Orphanage, Banua Anyar Village. The focus of the service participants was the children of the Puteri Aisyiyah Orphanage, Banua Anyar Village. Guidance is carried out by delivering material related to religion, social skills and health. Guidance is carried out every Sunday on 07, 14, 21 and 28 May 2023. The results of the dedication are presented, namely the problems we encountered, including a lack of character guidance carried out by caregivers for the children of the Puteri Aisyiyah Orphanage, considering that in this era, there are many cultures outsiders are coming in and of course, the younger generation must be able to filter out what is good and what is wrong. So that character building can form a person who is more ready to face future challenges. Community service as a concrete step is a form of social care from the Social Studies Education Department FKIP ULM.

Writing Letters as Counter-Archiving

Abstract Can counter-archiving be a form of social care? This essay is a dialogue on this topic among four Afro-Nordic feminists writing to each other in the form of letters over a five-month period during 2021. Using an explorative and intuitive practice informed by Black feminist thought, the authors dive into the archives of their families and of the communities that they relate to and are part of as a way to communicate how and why they approach counter-archiving. Black diasporic contributions to Nordic histories are widely erased, silenced, and forgotten, both in the past and present, which is why the authors write them into being. The aim of the essay is to communicate some of the specificities of living and negotiating a Black feminist life in the Nordics. The authors also want to inscribe the Nordics into the Black European archive. The following themes are used to organize the dialogue: 1) positionalities and contexts; 2) Multigenerational legacies: silences, gifts, stories, 3) Counter-Archiving (as) mobilization, transformation, refusal, 4) Imagining otherwise: letter writing as a practice of care. Finally, we argue that counter-archiving through letter-writing dialogue can be a pleasurable, caring, and collective form of knowledge creation that transgresses traditional academic forms.

The Theology of Poverty in the Perspective Al-Qur'an Maqasidi Interpretation

Poverty is a complex problem, the impact of poverty spreading to various aspects of life. Poverty is a phenomenon and a fact that has not been able to be resolved well since then. Such conditions need to be seen from the perspective of the Koran, how the Koran explains the problem of poverty. This paper is a qualitative research based on library research. This research uses the interpretation approach of maqashidi, where the basic principle is maqashid al-Qur'an and maqashid al-Shari'ah. The results of this study include; First, poverty is a state that will always exist, among its aims to balance the rich people as a form of social care and so that someone tries more to improve their quality of life. Secondly, attention paid to poverty is a form of contributing to islah al-Mujtama’, islah al-fard, hifz al-din, hidz al-mal, hifz al-nasl, dan hifz al-nafs.

Pengaruh Eco-control, Ukuran Perusahaan, dan Environmental Performance Terhadap Pengungkapan Corporate Social Responsibility (Pada Perusahaan Manufaktur Sub Sektor Makanan dan Minuman Yang Terdaftar Di Bursa Efek Indonesia periode 2016-2021)

very company has an obligation to be responsibility for the environment as a form of social care. But in reality, currently many companies in carrying out their activities are not in accordance with the guidelines for corporate social responsibility. Therefore, through environmental control efforts, the size of the company’s total assets, and good environmental performance, it is hoped that the company will be able to increase the tangible form of its obligations from the impact of ongoing operations. This study aims to examine and analyze the effect of eco-control, company size, and environmental performance on the disclosure of corporate social responsibility.The research method uses explanatory research, data collection techniques use secondary data obtained from the annual report. The research sample consisted of 22 manufacturing companies in the food and beverage sub-sector for the 2016-2021 period, the sampling method used was purposive sampling.&#x0D; The results show that eco-control has a positive effect on the disclosure of corporate social responsibility, the size of the company has a negative effect on the disclosure of corporate social responsibility, and environmental performance has a positive effect on the disclosure of corporate social resonsibility. This means that only the eco-control and environmental performance hypotheses are accepted. The ability of eco-control, company size, and environmental performance as independent variables can affect the disclosure of corporate social responsibility by 9.12% and the rest is explained by other factors outside the study.&#x0D; &#x0D;

Health and social care of home-dwelling frail older adults in Switzerland: a mixed methods study

BackgroundHome-dwelling frail older adults are often faced with multimorbidity and complex care needs, requiring health and social care systems that support frail older adults to age in place. The objective of this paper was to investigate the types of formal health and social care as well as informal care and social support used by home-dwelling frail older adults; whether they perceive their support as sufficient; and their experience with and preferences for care and support.MethodsUsing an explanatory sequential mixed methods design, we first conducted a secondary analysis of a subset of cross-sectional data from the ImplemeNtation of a community-baSed care Program for home dwelling senIoR citizEns (INSPIRE) population survey using descriptive analysis. Subsequently, we analyzed existing data from interviews in the parent study to help explain the survey results using applied thematic analysis. Results were organized according to adapted domains and concepts of the SELFIE framework and integrated via a joint display table.ResultsOf the parent population survey respondents, 2314 older adults indicating frailty were included in the quantitative arm of this study. Interview data was included from 7 older adults who indicated frailty. Support from health and social, formal and informal caregivers is diverse and anticipated to increase (e.g., for ‘care and assistance at home’ and ‘meal services’). Informal caregivers fulfilled various roles and while some older adults strongly relied on them for support, others feared burdening them. Most participants (93.5%) perceived their overall support to meet their needs; however, findings suggest areas (e.g., assessment of overall needs) which merit attention to optimize future care.ConclusionsGiven the anticipated demand for future care and support, we recommend efforts to prevent fragmentation between health and social as well as formal and informal care.

MEMAKNAI NILAI-NILAI PEDOMAN HIDUP ISLAMI WARGA MUHAMMADIYAH PADA PROSES PENGANGGARAN STIE MUHAMMADIYAH PALOPO

It is very necessary to enlighten all elements of Muhammadiyah's business charity management to make and apply the values ​​of the life guidelines of Muhammadiyah citizens in every policy and activity in the association without exception. The purpose of this study is to interpret the values ​​of Islamic life guidelines for Muhammadiyah residents in the STIE Muhammadiyah Palopo budgeting system. The researcher will use the Islamic life guidelines for Muhammadiyah residents as a researcher's perspective in observing the activities of the budgeting system at STIE Muhammadiyah Palopo whether the values ​​of these guidelines are used as one of the considerations in the operation of the budgeting system at STIE Muhammadiyah Palopo in accordance with the expectations of Muhammadiyah's vision. This study found that the budget as a form of welfare is not only valued in nominal terms in the form of rupiah earned, but welfare is when people who work at Muhammadiyah always feel sufficient and grateful for the sustenance that Allah SWT has given. As a Muhammadiyah citizen, working in a Muhammadiyah business charity is a comfort in itself and believes that the sincerity they do will be a welfare for them in the hereafter. With their sincerity in working in the charity business of Muhammadiyah, they get rewards from Allah SWT such as unexpected sustenance and blessings in the income they get. STIE Muhammadiyah Palopo provides convenience, relief, and assistance in paying tuition fees for students. STIE Muhammadiyah Palopo provides facilities and assistance to students as a form of social care and appreciation for cadres, namely the Lazismu Scholarship, Incidental Assistance, Relief for Brothers, and the free SPP Alumni of SMA/SMK Muhammadiyah Palopo

Improving health and social care services for slum-dwelling older adults: Perspectives of health professionals.

BackgroundBesides confronting the challenges of a growing older population, developing countries are dealing with limited resources and infrastructure, to ensure good health and social care services. One of these developing countries facing these challenges is Ghana. The healthcare system in Ghana currently does not have specialized geriatric services and is funded through the National Health Insurance Scheme (NHIS), private insurance companies and an out-of-pocket expenditure system. Social care services are important in improving Quality of Life (QoL) as it helps in building and strengthening relationships while also keeping slum-dwelling older adults active. There are various challenges with the health and social care of older adults in slums and practical ways to improve these have not been explored among the providers of this care.AimsThis study, therefore, aimed to explore (1) the views of health professionals on older slum-dwelling adults' health and social care needs, access, and use, and (2) recommendations for improving access to health and social care services among slum-dwelling older adults.MethodA qualitative exploratory descriptive approach was used among health professionals by conducting a focus group discussion (FGD) and interviews. A semi-structured interview guide was used to collect data from each participant.ResultsA total of 27 participants took part in the study. In the analysis of transcripts, 3 themes and 14 subthemes were conceptualized. Financial difficulties, queueing issues, distance to health facilities, health illiteracy and negative attitude of health professionals were identified as some barriers to the utilization of formal healthcare services. Social care services were described as non-existent, not structured, and having limited resources to cater for attendants. The health professionals also provided recommendations for improvement.ConclusionHealth professionals in this study discussed barriers to access and use of health and social care services. Addressing these barriers is essential to improve the use of formal health and social care services and diminish health inequity among older adults.

The use of linked administrative data to explore the impact of formal social care services involvement in childhood on education and offending outcomes.

Young people who are care experienced are overrepresented in the criminal justice system and in general have worse outcomes in education than their non-looked after peers (DfE &amp; Hinds, 2019; Prison Reform Trust, 2017). Recent evidence has reported that children who have a social worker (classified as child in need or those with a child protection plan), but who do not enter the care system, can have worse outcomes in education than those children who are looked after (DfE, 2019b). There remains little research evidence about the extent to which children with a social worker become involved with criminal justice services or how the age, duration and nature of formal social care service involvement may impact on education and offending outcomes. Researchers have been challenged by the lack of a sufficiently sized quantitative data, that crossed social care, education and offending domains. In work funded by ADR-UK, the present research project uses the newly linked DfE-MoJ administrative dataset to explore how different forms of formal social care services involvement impacts on education and criminal justice outcomes. Multi-level models will explore the role of formal child social care services amongst other multi-systemic risk and protective factors for education and offending. The presentation of his work will include preliminary statistics and insights into the challenges and potential further use of the linked dataset for researchers.

Care home closure and the influence of domiciliary care supply: Evidence from England

There is a general trend of increased marketization of long-term care (LTC) services across Europe, with the natural consequence that market forces will affect the supply of LTC. At the same time, there has been a rapid increase in the use of home-based provision for those requiring LTC support. However, there is little evidence about what the effects of growing domiciliary care provision has on the markets for institutional forms of care. This is important from a policy point of view in terms of managing local markets, access to services, the quality of services and inequality. Using data from England for all care homes and domiciliary care providers registered to provide care to older people during 2014–2016, we assessed if increased domiciliary care supply was linked to increased likelihood of care home closure. Using Cox proportional hazard models of care home closure controlling for care home characteristics including quality and local area measures of needs and income, the findings provide no evidence that domiciliary care provision is a substitute for care homes. In some specifications, there was even a complementary relationship between the two forms of social care: increased domiciliary care supply significantly reduced the likelihood of care home closure. Potential reasons for the complementary relationship and implications for European LTC policy are discussed.

A Missed Opportunity? How Health Care Organizations Engage Primary Care Clinicians in Formal Social Care Efforts.

Health care organizations increasingly recognize the impact of social needs on health outcomes. As organizations develop and scale efforts to address social needs, little is known about the optimal role for clinicians in providing social care. In this study, the authors aimed to understand how health care organizations involve clinicians in formal social care efforts. In 2019, the authors conducted 33 semi-structured interviews with administrators at 29 health care organizations. Interviews focused on the development and implementation of formal social care programs within the health care organization and the role of clinicians within those programs. A few administrators described formal roles for primary care clinicians in organizational efforts to deliver social care. Administrators frequently described programs that were deliberately structured to shield clinicians (eg, clinicians were not expected to review social risk screening results or be involved in addressing social needs). The authors identified 4 ways that administrators felt clinicians could meaningfully engage in social care programs: (1) discuss social risks to strengthen relationships with patients; (2) adjust clinical care follow-up plans based on social risks; (3) modify prescriptions based on social risks; and (4) refer patients to other care team members who can directly assist with social risks. Administrators were hesitant to increase primary care clinicians' responsibilities by tasking them with social care activities. Defining appropriate and scalable roles for clinicians along with adequate support from other care team members may increase the effectiveness of social care programs.