Social Care Crisis Research Articles

Consequences of Delayed Access to Community Social Care for Older Hospital Inpatients with Frailty

Abstract Background The social care system is currently under enormous pressure leading to delays in home care provision and often unnecessarily prolonged hospital stays for frail, older people. The risks of prolonged hospital admissions for frail older people are well-recognised. The aim of this study therefore was to examine the rate of hospital-associated complications (HAC) amongst older inpatients who are otherwise medically optimised for discharge but are awaiting home care to facilitate discharge home. Methods Electronic medical records of patients ≥65 years with delayed transfer of care (DTOC) while awaiting provision of home care provision were examined for incidence of delirium, falls and infection. A smaller cohort of current inpatients (n=14) awaiting home care were interviewed with focus on quality-of-life (CASP-19), loneliness (UCLA Scale) and depressive symptoms (CES-D). Results 59% (57/97) of patients (median 82 years, 60% female, median Clinical Frailty Scale 6) developed a HAC (delirium, fall or infection) while considered medically optimised for discharge. Logistic regression models demonstrated that for every additional day spent awaiting home care, the likelihood of a HAC increased by 4% (Adjusted Odds Ratio 1.04 (95% CI 1.00 – 1.08; p=0.027; z=2.21). Almost half of interview respondents reported that quality-of-life had declined while discharge home was delayed, while over 1/3 (5/14) met criteria for clinically significant depressive symptoms (CES-D-10 ≥10). Conclusion Almost 60% of frail, older inpatients who are medically optimised have a HAC while awaiting home care provision, with the likelihood increasing significantly for every additional day in hospital awaiting care. Long delays to home care package provision are having a hugely detrimental impact on the health of frail, older people in hospital. While addressing the crisis in social care is challenging, interventions to tackle this deficit in home care provision are required urgently.

A social reproduction analysis of digital care platform work

ABSTRACT Digital platforms are becoming an important factor in the process of reconfiguration and commodification of social reproduction during the neoliberal phase of capitalism. Developing a theoretical framework merging social reproduction theory and migrant labour regimes, this article argues that the introduction of digital platforms in the care sector is facilitating the expansion of precarised commodification of reproductive activities in a context of social care crisis. Through a mixed-method analysis, combining desk-based research with in-depth interviews of digital care platform work in Spain, the study examines the migrant labour regime of digital care platforms and how they take advantage of the international division of labour and global care chains to further exploit a highly precarious, informalised, feminised and racialised workforce. Our findings reveal that platforms use technology to rapidly access a reserve labour army, thus extracting more surplus value by restricting access to information, controlling the intermediation process and further fragmenting the workforce in reproductive activities.

Ending the Social Care Crisis: A New Road to Reform by Richard Humphries (2023)

Ending the Social Care Crisis: A New Road to Reform by Richard Humphries (2023)

Ending the Social Care Crisis: A New Road to Reform, Richard Humphries

Ending the Social Care Crisis: A New Road to Reform, Richard Humphries

Normative puzzles for local government: Managing the introduction of single-handed care in England.

A crisis in social care is apparent across the developed world as ageing populations put unprecedented demand on understaffed social care workforces. A recent popular response to this 'care crisis' within the UK involves the 'innovation' of single-handed care (SHC). SHC involves a care package with two or more homecare workers being reduced to one worker using advanced equipment and new moving and handling techniques. In this article, we explore how SHC is rendered in 245 documents from 52 local authorities in England. Using Actor Network Theory as an interpretative lens, we suggest documents attempt to satisfy three 'duties of care': to the individual wellbeing of citizens, morally and fiscally to the collective and to innovation. Each appeal to different stakeholder groups necessary for SHC to work, but the combination of duties can pose problems in enabling coherent stories of SHC. Duties can be kept apart in different documents, but at times they must be brought together in certain textual spaces to enact SHC as a coherent enterprise. Here, the potential tensions that emerge are routinely orientated to as (merely) problems of process that can and should be managed in and through a more refined approach to change management.

The social care crisis in context

Aysha Mendes discusses the ongoing crisis in the social care sector.

Covid-19 and the Crisis in Social Care: Exploring the Experiences of Disabled People in the Pandemic

Governments across the world have been slow in reacting to meeting the needs of disabled people during the pandemic. This has exposed existing inequalities in social policies, as well as new support barriers. Debates over social care have focused on Covid-19's impact on those living in residential care. Little is known about the experiences of disabled people who rely on daily support in their homes.This article reports on a year-long study examining the experiences of disabled people during the pandemic in England and Scotland. It focuses on the crisis in social care and offers evidence of how lives have been disrupted. For many, this resulted in a sudden loss of services, delayed assessments and break down of routines and communities. Findings underline the weakness of social care in its wider relationship with the NHS and show how the social care crisis has challenged the goal of independent living.

Editorial - A crisis in social care: time for rethinking?

The post Brexit “points based” immigration system does not list “care worker” as an eligible occupation on the “skilled worker” route;therefore, from January 2021, care workers cannot immigrate to take up these roles, and the pay for such workers falls well below the necessary salary threshold [1]. Relatively less attention has been paid to the crisis in support provided to older people in their own homes and to younger people with physical health conditions and impairments and learning disabilities, and relatively no attention has been paid to the social care needs of people with mental health challenges. (Wall, 2021, p. 2) The 2014 Care Act [4] imposes on local authorities a duty to promote an individual’s well-being, where well-being is defined in terms of nine principles [5]: personal dignity (including treatment of the individual with respect);physical and mental health and emotional well-being;protection from abuse and neglect;control by the individual over day-to-day life (including over care and support provided to the individual and the way in which it is provided);participation in work, education, training or recreation;social and economic well-being;domestic, family and personal relationships;suitability of living accommodation;and the individual’s contribution to society. (Crowther, 2019, p. 56) This vision very much resonates with recovery-focused transformation in the mental health sphere: a focus on the person in the context of their life and community where treatment and support are seen not as an end in themselves but as a means to enable people to live the lives they want to lead (see, Repper and Perkins, 2003, 2012).

Remote care technologies, older people and the social care crisis in the United Kingdom: a Multiple Streams Approach to understanding the ‘silver bullet’ of telecare policy

AbstractThe policy announcement in November 2018 by the Secretary of State for Health and Social Care that: ‘from today, let this be clear: tech transformation is coming’ indicates that confidence in care technologies, so apparent over the past decade in policy circles, remains unabated. This article suggests, based on evidence of significant limitations in technological solutions to care needs, that this confidence is misplaced. The focus is on remote care technologies – primarily telecare – which involve the passive or real-time monitoring of recipients, the majority of whom will be older people. These information and communication technologies (ICT) have been heralded by politicians, policy makers and industry interests alike as a solution to the challenges of demographic change and social care demand. While the research evidence suggests telecare works well for some people, in some circumstances, there are also significant complexities in its use, challenges presented to care relationships, and conflicting interpretations around its efficacy and cost-effectiveness. These critical issues have been marginalised in the mainstream discourse around telecare policy. This article explores the dissonance between this policy and the available evidence, drawing on a Multiple Streams Approach to analyse the emergence of, and continued confidence in, telecare policy based on a congruence of views across policy interests. To the extent that social care for older people is now in crisis, the article argues that the discourse around telecare represents an example of ‘silver bullet’ thinking: that is, too much focus on a single policy solution to address complex problems. Accordingly, the crisis in social care has deepened, without alternative policy proposals being available to address it. The renewed push for ICT-based solutions to this crisis in social care ought therefore to be viewed with some concern.

The crisis in social care

In what is believed to be the largest petition of its kind, more than 150 000 signatories have urged Prime Minister Boris Johnson to fix the social care crisis as a ‘matter of urgency’

NEWS ANALYSIS

It has been clear for some time that there is a funding crisis in social care. Now the former health secretary has admitted to this and has attributed the crisis to Government cuts.

Last Word: Crisis in Social Care

Last Word: Crisis in Social Care

Caring for adults in the EU: Work–life balance and challenges for EU law

Unpaid carers of adults, as a group, have, until recently, been largely neglected by the EU. While a number of provisions of EU law – including anti-discrimination measures and protections for part time workers – may benefit (some) carers of adults in the workplace, the existing package of work–life balance regulation falls well short of a coherent approach to addressing the needs of this group. Growing concern about a crisis in social care across member states, linked to an ageing demographic, has recently focussed attention on inadequacies in the formal care sector; on the vital economic contribution of unpaid care; and on a projected rise in the need for care coupled with a decline in the availability of informal care as the population ages and family structures change. It has prompted interest both in the need to develop the formal care sector, with the opportunities this may present to create employment, and in the need to support ‘informal’ carers in the workplace. This paper explores the various policy drivers for EU regulation to support informal carers in the workplace and consider the potential difficulties in establishing a coherent legal response.

Cuidados, género y transformación de identidades

Nowadays social care crisis facilitates the emergence of different institutional measures that try to reformulate the unequal distribution of care responsibilities between the market, the state, the family and the civil society, as it is, in the Spanish case, the development of the Law of the Promotion of Personal Autonomy and the Attention to dependent people. In this article, we analyze the frames of sense promoted by this law, as well as the current context in which the social organization of care is being transformed, to understand their contribution to a reformulation of the identities of the care givers and the gender’s social order. Also, the understanding of public policies as a result of the symbolic fights between different social actors, allows us to analyze the main interactions and the hegemonic discourses that influence the definition of social reality, related to social care recognition and its distribution.

Recent Developments in Welfare to Work in Hong Kong

Summary The Asian financial crisis (1997) has created a social care crisis resulting in rising unemployment, poverty, income inequalities and homelessness. Although faced with dwindling public finances, the Hong Kong Special Administrative Region (SAR) government had been compelled to tackle these problems. However, it has been attracted to the neo-liberal recipe: changing the subvention system to a block grant, curbing social spending, and tightening eligibility for social assistance. Notably, the introduction of the Intensive Employment Assistance Projects (IEAPs), which are the first welfare to work programs in East Asia, has become a major policy tool. This paper reports on a study of the impact of the projects, one of the key pillars for welfare to work programs. The IEAPs were found to have brought about positive changes in welfare clients' motivation to work and sense of self-reliance. Social workers from both traditional and progressive NGOs have etched, in various ways, their place in the welfare...