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The number of older self-funders in England is growing in the context of tight eligibility criteria and fixed financial thresholds to access statutory adult social care. Older people who self-fund their social care fall largely under the radar of statutory services and of research. Our study aimed to listen closely to the stories that older people tell about finding, managing and paying for their care. We interviewed 65 older people living in the community who were funding all or some of their social care. This paper focuses on narrative analysis of selected transcripts from these interviews. It sheds light on how older people represent their experiences of self-funding and what underpins these constructions. A key finding is that the disjunctions within older people's accounts between the care they want and the care they receive reflect wider political and structural tensions in the funding and delivery of care. Older self-funders temper their expectations in light of their experience of shortfalls in the system. This enables them to adjust to the deficiencies but obscures and perpetuates poor care. The discussion considers the findings in relation to: the fundamental incompatability of body labour and commodified care; the shared precarity of older people and care workers; and the individualisation of risks that makes older people and their carers responsible for making a failing care system 'work'. Our analysis adds to the case for major reform of adult social care, including a revaluing of the status and employment conditions of front-line care workers. [ABSTRACT FROM AUTHOR]

Across the world acute hospitals are under unprecedented pressures due to shrinking budgets and increasing demand, against this backdrop they are also experiencing record levels of activity in Accident & Emergency and delayed transfers of care. Reducing pressure on hospitals by avoiding unnecessary admissions and delayed discharges has risen up the global policy agenda. However, reviews of strategies and policies have rarely involved discussions about the role that hospital social workers play in achieving timely hospital discharge. Yet discharge planning has become a, if not the, central function of these professionals. This paper presents the results of a small-scale exploratory study of hospital social work in an acute hospital in Northern Ireland. The findings reveal that the work of hospital social workers is characterised by increased bureaucracy, an emphasis on targets and a decrease in the time afforded to forming relationships with older people. Hospital social workers highlight concerns that the emphasis on discharge planning and pressures associated with the austerity agenda limits their capacity to provide other more traditional roles such as advocacy and counselling. It is argued that hospital social work should not be narrowly defined as 'simply' co-ordinating discharge plans. The tension that arises between expediting hospital discharge and advocating for older people and their families is also discussed. [ABSTRACT FROM AUTHOR]

In the current ecology of care, social, rather than medical, support is critical in enabling frail older people to live at home. This paper reports findings from a qualitative study about how home care workers (HCWs) support persons with dementia living in the community. Semi-structured qualitative interviews were carried out in England with 14 family care-givers (FCGs) recruited from a single private home care provider. A thematic analysis of the data was undertaken using the constant comparative method. In every instance, it was FCGs who initiated domiciliary care for the person with dementia, highlighting ambiguity about who is the 'client'. Rather than focusing on the HCWs' work in undertaking practical tasks and personal care, respondents prioritised HCWs as companions, providing emotional and social support for their relatives. From an organisational perspective, respondents valued the capacity of the provider to deliver a consistent, personal, reliable and punctual service. These attributes were important in supporting their relative's agency and dignity. Respondents described HCWs engaging in skilled and sensitive communication with clients but considered 'character' and 'innate' caring abilities to be more important than those derived from training. The results highlight the need to acknowledge the family, rather than the individual client, as the functioning unit of care, and to recognise the highly skilled communicative and emotional work undertaken by HCWs. [ABSTRACT FROM AUTHOR]