The Role of Community Care in Western Society
Community care is a British policy that involves social care services given to incapacitated people of the society in their homes rather than caring for them in hospitals. An example of a formal community care program was introduced in Britain, where Local Authority Social Services Departments are tasked with running a program following guidelines laid out in legislation dealing with the National Health Service and specifically in the National Health Service and Community Care Act of 1990 (National Health Service and Community Care Act 1990, 2012). Across many other western countries, community care services exist, albeit with different names in some cases: however, they involve roughly the same services. These include but are not limited to home/residential nursing, physiotherapy, day-care and respite care services, chiropody and occupational therapy services amongst others.
Before the establishment of community care, some people who had their relatives or friends in the social care institution did not appreciate the nature of attention given to their people. In addition, the service was costly for some families. They also felt like they were creating a distance between them and the person in the social institution. Therefore, Introduction of the policy by Margaret Thatcher that proved the importance of domiciled care. It was discovered that special attention could be given to a patient while at his home. The patient also feels less attached to his or her family and the family could learn to take care of the patient in case the community worker is not around. The scope of community care is not limited to the elderly alone. It also includes the disabled and other handicapped people. As long as the family is able to pay and the environment proposed is conducive then the family has a right to ask for community care services. The challenge for governments and other organisation involved in the planning and delivery of social welfare is to prepare for demographic changes, diversity, and changing community attitudes. It is essential that responses do not scapegoat or stereotype particular groups of people. (O’Connor, Hughes and Turney, 2006 p. 40).
The number one aim of community care is to provide specialised services to those in dire need of them, adult protection. Due to improved and well-maintained health systems in western countries, life expectancy has increased and in fact, in some western societies demography shows an ageing society. In the societies where there are fewer young people who can take care of the elderly and because of the tendency to have smaller families, specialised community care services for the elderly is a necessity for society. Cardio vascular illnesses and other long-term afflictions of older people are also to blame for the incapacitation of otherwise fit members of the society. The affected will obviously need community care services like physiotherapy so that they can be incorporated back in to society as able-bodied members. Adult protection or safeguarding adults, has only relatively recently been identified as a concern and an area of work in its own right. (Mandestam, 2008 p.22)
Community care services are also useful in the management or disposal of property belonging to a beneficiary of the services in cases where no other person can lay claim to these assets. When one is mentally incapacitated or one is at an advanced age where the management of their estate is no longer feasible, it is common for the community carers to dispose of these assets or to manage them in a fiduciary manner to benefit the affected individual and to offset the costs of community care service provision. It is vital to note that such an arrangement is usually governed by law. For example, a caregiver cannot take up the matrimonial property of a beneficiary of service if the other spouse is surviving and well. Department of Health guidance states that if a person has both the mental and financial capacity to arrange and pay for residential accommodation, then the local authority is not obliged to make the care home placement (Mandestam, 2008 p. 173).
Before community care services were introduced, institutional care was the norm, where the state had to set up specific institutions to administer services akin to those of community care but in an institutional set-up. Institutional nursing homes and homes for the elderly, institutional day cars and respite care services and the like were the norm. Whilst institutional care is synonymous with specialisation of care, it has two major faults. First, institutional care is very expensive to maintain and secondly it lacks the integration features of community care. This is why there was a shift to community care, to have an economically sustainable program as well as one which incorporated the benefits of community care for the recipients. Public expenditure in care services has therefore been reduced through the introduction of community care services.
As mentioned earlier a key advantage of the community care program is the fact that it takes place within the society from which the beneficiary comes. This way users are not detached from their usual surroundings and loved ones, just because they are old, mentally incapacitated, or physically challenged. If community care services were not accessible within one’s society then it would mean that one would be forced to leave their surroundings and environment to join an institutional care program. In such a program often, the beneficiary feels neglected by their family and former friends. According to Meredith (1995) people prefer care at home (or in homely environments) to those provided in large institutional settings (Victor, 1997 p.8).
Community care programs incorporate a number of players and professionals and in so doing such programs provide meaningful employment. These professionals assist in the assessment of need process. They also assist the service users to do their self-assessment. A system of self- assessment and personalised budgets suggests that service users will have more control over their care outcome (Brown, 2010 p.24). The proportion of expenditure in community care services is substantial and the key beneficiaries are the carers. Without these services then these service providers would be forced to seek employment in other sectors. It is essential to note that community care services are not materially affected by adverse economic changes and therefore stable employment opportunities are afforded. In this era of adverse economic challenges, like the economic recession witnessed recently in the United States and across Europe, it is wise for governments to rely on bedrock sectors of the economy, which are indirectly affected by such market fluctuations and community care service provision is one such sector. In addition, economically speaking, the stresses brought about by these recessions lead to an increased uptake of community care services.
Most western society families are nuclear families and are very small. Coupled with the fact that in some cases the upbringing of these families does not seriously value the principles of family care, where family members dedicate their time and efforts to take care of their disadvantaged siblings, children, and parents. It also important to note that, the daily activities family members engage in, especially economically, may not afford them the time to provide domestic care to their disadvantaged family members. On this basis that Community care has come up as a way of providing necessary care to the elderly, mentally, physically handicapped, children, chronically ill patients and all the others who require care. This care is now provided largely within a community set up. Community mental health services need to provide comprehensive and locally based treatment and care which is readily accessible to patients and their families (World Health Report, 2001 p.88).
Before the advent of community care services, some of the functions now performed by community carers were unnecessarily burdening the health care system. For example, community care services like physiotherapy and residential nursing fell strictly within the purview of health care services. Mental asylums are part of the health care system. It is therefore evident that with the introduction of community care the health care system has been somewhat relieved of some duties and is left to deal with very important health related issues. It is needless to emphasise that this has provided important cost savings for the health care provision sector. It is however important to note that community care works hand-in-hand with health care and is in no way a substitute to health care. For community care to operate at lowest net costs, the new costs of community care services must be substantially offset by savings on the use of existing services, such as institutional care (Crichton, 1997 p. 223) It only represents a splitting of some services from health care that could very well be handled by community care in a specialised manner: that is the advantage here.
Community care services have developed over the years as have other service sectors and nowadays in western society, there exists a mixed economy of community care services. This was the major reason behind the need for legislation affecting community care in Britain. There now, exists a variety of carers and care providers and as with all such services the more the providers the better the choice and the better the services. This also has an effect on increasing efficiency and providing reductions in the cost of service provision, all to the advantage of the beneficiary of service. The private sector is involved at levels in funding (insurance and out of pocket personal payments) and in provision of services. (Hitchcock, Schubert, Thomas, 2003 p. 105).
To the beneficiaries of community care services, humane living conditions are afforded where one can lead a decent life despite being plagued by an incapacity, be it age related or due to mental or physical handicap. Without community care services, the disadvantaged members of society would be forced to lead, in some cases, destitute lives because of the challenges they are facing without any possibility of care from society. With the ‘baby boomer’ generation ageing in the USA and other western countries, perhaps it is prudent to imagine which living conditions this important group of senior citizens will face and how community care services will be of use to them in the near future. In the absence of community care services the living conditions of the ‘baby boomer’ generation in their old age will not be enviable, because institutional care cannot accommodate all of them and even if there were enough places, it would be too expensive to institutionalise the care of such a big population. Community care serves are the only alternative for such humane care. When local authorities place people in care homes, they have a duty to assess them financially and to decide what to charge for accomodation, if anything. (Mandelstam 2008 p.28)
In western society, Community care has been commercialised in some areas, especially in the USA. In areas where commercialisation has not been fully achieved still efficiency and innovation in care delivery is observed. The combined effect of population trends, fiscal pressures and developments in service delivery have increased pressure to ensure that resources available to the community aged care services are used in the most effective manner. (Nay and Garratt, 2009 p. 82). It is therefore common to find community care services with add-ons. The add-ons are other incidental services included in the basic community care service, which one is using. For example, one may sign up for a residential home care and nursing service but the contract can be spiced up by the addition of a provision for funeral arrangements should the beneficiary of the basic service (i.e. residential nursing), pass away under the care of a given community care service provider. Such add-ons can provide many benefits to the people taking these services. Running a community care system like that initially envisaged in Britain, where the Local Authority is in charge of assessment and service provision is now proving unviable in some capitalist western nations, who prefer to commercialise the whole venture and leave it in the hands of the private sector.
Community care service providers provide information vital in trend analysis and for planning purposes. Especially in the case of a local authority run community care service, information about various aspects can be freely accessed through the venture. For example, where the uptake of community care services increases in a particular area, then the cases can be closely studied and an underlying solution sought where necessary. If the uptake of home based nursing is on the increase in a given society a study can be undertaken to find the main cause of this increase and where appropriate plans can be made for further action in the future. Therefore, it is clear that in the provision of community care, vital information and data can be collected and crucial conclusions can be inferred from such data. The government, realising that many of the statistics around children in need, are unreliable, sought to produce a better quality database through a nationwide census of the work being undertaken (Cambridge Training and development, 2000 p. 300).
Community care has enabled the governments of the western countries to free their time and resources from care related complications to focus on other problems of the utmost importance. With the appearance of more players in community care service provision, western governments have taken a back seat in the development of community care services and their roles are becoming increasingly limited to legislation and the enforcement of policy. Such freed time and resources can be employed to address other, arguably more deserving challenges, faced by these governments. Health care provides a challenge to most governments, with skyrocketing budgets involved in maintaining a working health care system, and with all the cares of administering a working community care program, governments can hardly cope. It is therefore a welcomed thought for other players to be involved in community care service provision. The states and territories have the primary responsibility for the direct provision of health services, and the health responsibility of local government, which varies from state to state or territory, lies primarily with environmental control measures and a range of community based home care services (Hitchcock, Schubert, Thomas, 2003 p. 105). From the foregoing discussion, it can be noted that community care plays a very vital role in western society. There has been a notable change in terms of welfare from the time community care was not in existence, to its infancy and to where the status of community health is today. In the discussion above community, care has been found to be of useful importance in the provision of specialised and caring services to those in need in society, at an affordable cost.
A formal community care structure is present in almost all western countries and in some countries it is well legislated through acts of parliament and other laws. There has been a shift in the provision of community services from government based through primarily local authorities to a system with multiple players, in the form of professionals and service providers. This has further brought down public expenditure on community health related services. The aim of community care should not be forgotten in all these changes and that is to provide specialized care to those in need in a home environment. Community aged care packages allow older adults to receive the care they require without relocating; that is they are able to remain in their homes and in their communities. (Koutoukidis, Stainton and Hughson, 2012 p.242) Above all else this is the main aim of Community Care.
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