Paying for long-term domiciliary care: A comparative perspective

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.