PLANNING FOR BALANCE OF CARE OF THE ELDERLY
| Published date | 01 June 1978 |
| DOI | http://doi.org/10.1111/j.1467-9485.1978.tb00242.x |
| Author | Gavin H. Mooney |
| Date | 01 June 1978 |
Scottish
Journal
of
Political
Economy, Vol.
25,
No.
2,
June
1978
PLANNING
FOR
BALANCE
OF
CARE
OF
THEELDERLY
GAVIN
H.
MOONEY*
Health Economics Research Unit, Departments
of
Community Medicine and
Political Economy, University
of
Aberdeen
I
INTRODUCTION
In
deciding upon the most effective use of resources in care of the elderly
one
of the most important questions relates to the balance of care by location
between community, residential home and hospital. This paper reports in
Section
I1
on
a
methodology for considering this question; in Section
I11
the
application
of
the approach in Aberdeen is outlined; some relevant char-
acteristics of the elderly population are presented in Section
IV;
Section
V
provides the costing information used in this study; and in Section
VI
some
implications of the results for planning purposes are presented.
In some studies (e.g. Gruer, 1975) of health care policy there is
a
tendency
to assume that “need” can be defined in some objective way, that frequently
the current level of provision of a service is only meeting some of this “need”
(“met need”) and that therefore there is some “need” which remains to be
met (“unmet need”). With a concept like need there is always the problem
that, as Cooper (1975) remarks “need, like beauty, is in the eye of the
beholder”. This type of study has inherent dangers. For example, it tends to
ignore the question of the relative value of meeting different needs and
obscures the issue of opportunity cost.
The approach of this paper does not
solve
the problem of relative value of
different policy options but provides cost data for, and information about
the dependency of, elderly clients likely to be affected by possible changes
in
supply, (The definition of dependency is considered in more detail in
Section
IV.)
It does this by examining the implications of realistic changes
*
I
would like to acknowledge the inputs made to the research reported in this paper by
Ianthe Fordyce and Elizabeth Russell of the Department of Community Medicine. Various
aspects have also benefited from discussion with my colleagues in the Department of
Political Economy and in particular Ron Edwards and David
Pearce.
An
earlier version
of
this paper was presented to the Health Economists’ Study Group, Newcastle, July
1977
and
I
am
grateful to the participants for their comments. Any errors remaining in the
paper
are
my sole responsibility.
I
would also wish to acknowledge the financial support
from the Scottish Home and Health Department for this research which is part of
a
wider
health economics research programme, formerly in the Health Services Economics Project
and now in the Health Economics Research Unit.
I
would
also
like to express my gratitude to the nurses and matrons who
so
willingly
cooperated
in
the surveys of the elderly. It was
a
pleasure to work with them.
Date of receipt of
final
manuscript:
2
March
1978
149
150
G.
H.
MOONEY
in supply of services. It avoids setting up largely arbitrary definitions of who
should or should not be cared for in different locations, and concentrates
on
examining those elderly clients who are close to the existing boundaries
between different care locations: i.e. those who can be transferred from one
type of care unit to another. Such individuals are referred to as “marginal”.
It should be emphasised that such movements are concerned not with
individual client care but rather the planning of services.
In
other words, what
are the costs for, and what is the nature of the dependency of, individuals
likely to be affected
if
the boundaries of care are moved?
The approach is thus much more clearly related to the work of Wager
(1972) in looking at domiciliary care and residential home care, and that of
Fanshel(l975) who examines the question of the “best policy” for balance of
care between home, residential home and hospital where “best policy” is
defined as that which “for any given budget.
. .
yields the maximum benefit
for the elderly, within the constraints of society”. No attempt has been made
to follow Wright (1974) in measuring the outputs of different forms of care
of the elderly, although the approach is such that any available measures of
output can be built into it.
The approach at the same time provides information on the relative costs
of care in different locations,
for
relevant
groups
of
the
population.
Thus
a
very close proxy for “like with like” comparison can be achieved if, for
example, those in residential homes, but close to a position of being able to
manage in the community, are compared with those in the community but
close to a position of having such difficulty
in
managing there that they may
be moved to
a
residential home. In this way evidence can be presented on the
relative costs of care for similar populations in different care locations.
In
so
far as the approach fails to measure output, effectiveness and benefit,
it has severe limitations. Nonetheless it does provide
at
little cost the
opportunity of allowing decision makers to be much more explicit about the
trade-offs and opportunity costs involved in approaching the issue of balance
of care
of
the elderly.
THE
APPROACH
The approach is primarily concerned with the issue of balance of care
between individual elderly clients’ homes, residential homes and hospital.
(Sheltered housing can be included but is omitted from consideration in this
paper.) In this analysis the approach considers only movements along the
individual supply curves, although with additional data it can be adapted to
examine shifts in the supply curves.
The approach can be used to consider (a) whether the existing deployment
of resources between the three locations
of
care is optimal;
(b)
in
which
location(s) any increase in resources
for
care
of
the elderly should be deployed
;
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