Concerns over growing numbers and proportions of older people in
industrialised societies have prompted interest in the development of cheaper
ways of providing long-term care for older people. While debate in the UK is
currently focused on the costs of residential and nursing care, other European
and Nordic countries have introduced schemes designed to encourage or
sustain the provision of ‘social’ care by family members, friends and
‘volunteers’, on the assumption that this can be
provided at lower net public
expense than either residential care or formally-organised domiciliary services.
Drawing on material from a detailed comparative study, this paper describes
four different models on which such payments are currently based. These
models are discussed and evaluated, taking into account factors which include
the eligibility criteria for payments; maximising the autonomy of older people
and family care-givers; and the relationships between financial payments and
access to services.
These models locate systems of payment within the broader context of
financial and service support designed to help frail older people and those who
support them. They therefore highlight the importance of considering both
financial support and services in comparative studies of social welfare
provision. However, further evaluation and policy development is hindered by
the lack of evaluation of different models of paying for care and a lack of
evidence about the experiences of older people and care-givers.