Summary

In recent years, following the implementation of the community care reforms of the 1990s, there has been an increased emphasis on charging for social care. This chapter aims to provide a brief overview concerning charging for the care of vulnerable adults, encompassing deliberation of some of the historical antecedents, together with an exploration of systems of rationing. This is followed by an examination of current practice in this area, together with issues and dilemmas raised by such practice. Further exploration, through research findings, is tied to an examination of the ethical principles involved, notably justice and equity, as well as beneficence in relation to equitable treatment. Recent and potential developments within social work and care management practice are examined, together with a consideration of the framework for prevention, provision, protection and empowerment of vulnerable adults.

Introduction

One of the key social policy questions that has been examined over the past decade is the extent to which people should pay for their own care needs in later life, as opposed to the provision of publicly funded care for all those in need of such provision. This is a vital issue in the continuing debate concerning the financing of long-term care provision in later life. While Scotland has introduced free personal care for older people, England, Wales and Northern Ireland have introduced free nursing care in care homes but not free personal care, although the implementation of this system has varied across the different countries (Wittenberg et al, 2004). Charging older people for long-term care is an important contemporary issue, exemplified by the Royal Commission on Long-term Care (Sutherland, 1999). Work commissioned by the Joseph Rowntree Foundation has been ongoing in this area since an inquiry concerning the costs of long-term care, which was held in 1996. More recent work concerning this matter relates to projections of both future demand and spending on long-term care, with suggestions that spending on long-term care in the UK would have to increase by around 315% between 2000 and 2051 in order to meet both real rises in the costs of care and demographic pressures, assuming that existing patterns of care, funding arrangements and rates of dependency remain unchanged over time (Wittenberg et al, 2004).