Community care

Differences in perspective between clients, carers and practitioners are familiar from the literature. Findings from two research projects are reported here, which identify mismatched perspectives and appear to question the foundations on which community care policy and practice rest. The article discusses features of the policy and practice context that contribute to the likelihood of divergent views about need and appropriate or effective service provision within community care.

Informal care provides the often hidden foundations of policies promoting care in the community and Ageing in Place. This paper examines the current impasse concerning those who are employed and seek to provide care, canvassing current and future possibilities for finding a way through the existing conflict between sustaining employment and providing informal care in the home. Focusing on the issues that emerge regarding support of older (aged) care recipients, the paper first considers the demographic, economic and democratic and governmental policy causes of the current problems.

Colin Dugdale, BSc, RMN, RGN, dementia trailblazer, NHS Executive North West. As a community mental health nurse team leader I was seconded to the NHS Executive North West for the role of dementia trailblazer to develop the Admiral Nurse Service in the north-west of England.

In France, a wide range of care and support services exist for community dwelling people with Alzheimer's disease (AD). These are coordinated by the general practitioner (GP). We investigated interventions that were ‘prescribed’ by French GPs and analysed their perceived barriers to arranging these. Thirty-nine percent of GPs responded to a postal survey, which was sent to 1105 physicians belonging to the Sentinel GP Research Network and to 524 GPs consulting in the Rhône-Alpes region of France.

This guide considers the potential of assistive technology to contribute to the care of people with dementia in the community. It has been written by members of the ASTRID project, involving the UK, Norway, the Netherlands and Ireland. It contains an introduction to the project, an account of technology in action, discussion of how to incorporate technology in a needs assessment, how to obtain and use assistive technology, and a review of ethical issues.

A study by the National Institute for Social Work suggests that estimates can be made about the length of time that a person with dementia will need community and long term care services. This can be done based on an assessment of the severity of dementia at the time of the community care assessment. The author highlights the need for an appraisal of local old age psychiatry services and eligibility criteria, and the importance of monitoring carers' ability and willingness to provide care.

Direct payments can now be made to older people. But a 12-month research project has revealed that service users, carers and junior staff still have little knowledge of them. The authors of the Shield research team, Anglia Polytechnic University, and Tower Hamlets Coalition of Disabled People explain that service users are cautiously optimistic about what direct payments offer them but are anxious about the practicalities.

The thesis pursued in this article is that an accelerating interest in elder abuse is central to understanding modern care policy as a social phenomenon. It will be argued that the 'discovery' of elder abuse legitimates practice in which the state monitors and co-ordinates but does not intervene. This has led to a social situation that has radically transformed social welfare of its traditional rationale as 'caregiver'. Simultaneously, informal care has become the centrepiece of social policy following the adoption of market forces to community care policies in the UK and elsewhere.

To review the evidence for different models of community-based respite care for frail older people and their carers, where the participant group included older people with frailty, disability, cancer or dementia. Where data permitted, subgroups of carers and care recipients, for whom respite care is particularly effective or cost-effective, were to be identified.

In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary.