Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-05T06:22:18.256Z Has data issue: false hasContentIssue false
  • English
  • Français

The Cost of Residential Care for the Elderly: The Effects of Dependency, Design and Social Environment*

Published online by Cambridge University Press:  14 November 2008

Robin Darton  and
Martin Knapp
Robin Darton
Affiliation:
Personal Social Services Research Unit, University of Kent at Canterbury, Cornwallis Building, Canterbury, Kent, England.
Martin Knapp
Affiliation:
Personal Social Services Research Unit, University of Kent at Canterbury, Cornwallis Building, Canterbury, Kent, England.
Get access Rights & Permissions [Opens in a new window]

Abstract

Despite the important role played by cost considerations in policy decisions regarding services for the elderly there has been relatively little reliable research on this topic. A large nationally representative survey of old people's homes conducted by the Personal Social Services Research Unit in England and Wales in 1981 provides a firm foundation for the careful examination of the cost of residential care. Focusing on residential homes in the public sector, the cost function analyses reported in this paper have a number of policy implications. The empirical results help to explain cost inflation and allow the prediction of future cost trends, they inform ‘balance of care’ discussions and inter-authority and inter-sectoral comparisons, and they provide evidence on the cost implications of scale, group-living design, day care and sheltered housing. Finally, the relationship between cost and social environment (a central component in any quality of care assessment) is examined. The results suggest that there is no significant association between the two.

Type
Research Article
Information
Ageing & Society , Volume 4 , Issue 2 , June 1984 , pp. 157 - 183
Copyright
Copyright © Cambridge University Press 1984

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

NOTES

1 Webb, A. and Wistow, G. The personal social services: trends in expenditure and provision. Working Paper in Social Administration No. 5, Loughborough University.

2 See, for example, Kane, R. L. and Kane, R. A.Care of the aged: old problems in need of new solutions, Science, 200 (1978), 913–920CrossRefGoogle ScholarPubMed; Jarrett, J. E. The relationship of cost variation, prospective rate setting, and quality of care in nursing homes: a hedonic examination. Review of Business and Economic Research (1982), 67–77Google Scholar; Dusansky, R. On the economics of institutional care of the elderly in the US: the effects of change in government reimbursement. State University of New York at Stony Brook, 1983Google Scholar; Ruchlin, H. J., Levey, S. and Muller, C.The LTC market place: an analysis of deficiencies and potential reform by means incentive reimbursement. Medical Care, 13 (1975), 979–991.CrossRefGoogle Scholar

3 U.S. Department of Health and Human Services, Public Health Service, Office of Health Research, Statistics and Technology. Health Statistics, United States 1980. U.S. Government Printing Office.

4 See, for example, the collection of research in Goldberg, E. M. and Connelly, N. (eds), Evaluative Research in Social Care. Heinemann, London, 1981Google Scholar, and the research on the elderly reviewed in Goldberg, E. M. and Connelly, N.The Effectiveness of Social Care for the Elderly. Heinemann, London, 1982.Google Scholar

5 Davies, B. P. and Knapp, M. R. J.Old People's Homes and the Production of Welfare. Routledge and Kegan Paul, London, 1981.Google Scholar

6 Knapp, M. R. J.Cost information and residential care of the elderly. Ageing and Society, i (1981), 199–228.CrossRefGoogle Scholar

7 Knapp, M. R. J.The Economics of Social Care. Macmillan, London, 1984, chapters 4 and 9.CrossRefGoogle Scholar

8 Quoted in Community Care (7 July 1983), p. 4.

9 Koutsoyiannis, A.Modern Microeconomics. Macmillan, London, 1979.CrossRefGoogle Scholar

10 See Knapp, M. R. J.op. cit. 1984, chapter 9.Google Scholar

11 Darton, R. A.The PSSRU Survey of Old People's Homes. PSSRU, forthcoming, 1984.Google Scholar

12 Wager, R. A.Care of the Elderly. Institute of Municipal Treasurers and Accountants, London, 1972Google Scholar; Davies, B. P. and Knapp, M. R. J.Hotel and dependency costs of residents in old people's homes. Journal of Social Policy, 7 (1978), 1–22CrossRefGoogle ScholarPubMed; Knapp, M. R. J.Economies of scale in residential care. International Journal of Social Economics, 5 (1978), 81–92.CrossRefGoogle Scholar

13 Work by two of our colleagues at the PSSRU is based upon a carefully integrated collection of cost and output data for elderly clients of the personal social services living in their own homes. See Challis, D. J. and Davies, B. P.Matching Resources to Needs in Long Term Care. Gower, forthcoming.Google Scholar

14 Department of Health and Social Security. The Census of Residential Accommodation 1970. HMSO, London, 1975.Google Scholar

15 Darton, R. A. and McCoy, P. V.Survey of residential accommodation for the elderly. Clearing House for Local Authority Social Services Research (1981), 2, 23–41.Google Scholar

16 Department of Health and Social Security. Local Authority Personal Social Services, Summary of Planning Returns, 1977–78 to 1980–81. DHSS, London, 1979.Google Scholar

17 Knapp, M. R. J.op. cit. 1981.Google Scholar

18 Judge, K., Knapp, M. R. J. and Smith, J. The comparative costs of public and private residential homes for the elderly. Discussion Paper 289, Personal Social Services Research Unit, University of Kent at Canterbury, 10 1983.Google Scholar

19 Knapp, M. R. J.op. cit. 1984, chapter 9.Google Scholar

20 Of the original sample of 235 homes, 10 were excluded because of a lack of financial or other data and 7 were dropped because of low levels of occupancy at the time of the survey (less than 80 per cent) or because they had not been open for the full financial year.

21 It is also worth noting that thirteen of the 218 homes (6% of the sample) had standardised residuals with an absolute value larger than 2, and one home had a residual of 3.28.

22 On the distinction between final and intermediate outputs see Knapp, M. R. J.op. cit. 1984, chapter 3.Google Scholar See also Knapp, M. R. J.The outputs of old people's homes in the post-war period. International Journal of Sociology and Social Policy, 3 (1983), 55–85.CrossRefGoogle Scholar

23 Compare Willcocks, D. M., Peace, S. M., Kellaher, L. A. with Ring, J.The Residential Life of Old People: A Study of too Local Authority Old People's Homes, volumes i and ii. Polytechnic of North London, 1982.Google Scholar

24 Davies, B. P. and Knapp, M. R. J.op. cit. 1981, pp. 90–92Google Scholar; Weihl, H.On the relationship between size of residential institutions and the well-being of residents. The Gerontologist, 21 (1981), 247–256.CrossRefGoogle ScholarPubMed

25 On this point see Birnbaum, H., Bishop, C., Lee, A. J. and Jensen, G.Why do nursing home costs vary? The determinants of nursing home costs. Medical Care, 19 (1981), 1095–1107.CrossRefGoogle ScholarPubMed

26 These might also be related to the prices of staffinputs, although this interpretation should be made with some caution.

27 Davies, B. P. and Knapp, M. R. J.op. cit. 1978.Google Scholar

28 Unpublished work by R. A. Darton.

29 Knapp, M. R. J.op. cit. 1984, chapter 9.Google Scholar

30 Bebbington, A. C. and Davies, B. P.Territorial need indicators: a new approach. Journal of Social Policy, 9 (1980), 433–462.CrossRefGoogle Scholar

31 Darton, R. A. Residential accommodation for the elderly, 1970–81. Discussion Paper 277, Personal Social Services Research Unit, University of Kent at Canterbury, 1983.Google Scholar

32 op. cit.

33 Birnbaum, H. et al. op. cit.Google Scholar See also the literature reviewed in Judge, K. et al. op. cit.Google Scholar

34 The figures in Table 6 clearly demonstrate that, using the DHSS four-category index, the aggregate dependency of old people's homes' residents has increased markedly over an eleven-year period. The three-category DHSS index employed by two of our colleagues also reveals substantial changes in dependency. See Bebbington, A. C. and Tong, M.-S. Trends and changes in old people's homes: provision over twenty years. Paper presented at DHSS Seminar on Residential Care for Elderly People, London, 10 1983.Google Scholar Recent evidence from four local authorities collected over a two-year period, using Booth's dependency measures, shows no evidence of a continuing upward trend. See Booth, T. and Phillips, D., with Barritt, A., Berry, S., Martin, D. N. and Melotte, C.A study of trends in dependency in local authority homes for the elderly 1980–82. Research, Policy and Planning, i (1983), 1–9.Google Scholar

35 Recent North American evidence on cost inflation is provided by Jarrett, J. E.op. cit.Google Scholar

36 The best known in the British literature is that of Townsend, P.The Last Refuge. Routledge and Kegan Paul, London, 1962.Google Scholar

37 See, for example, the critical review by Bland, R. and Bland, R. E.Recent research in old people's homes: a review of the literature. Research, Policy and Planning, i (1983), 16–24.Google Scholar

38 Kleemeier, R. W. (ed.). Ageing and Leisure. Oxford University Press, London, 1961.Google Scholar

39 Lewin, K.A Dynamic Theory of Personality. McGraw-Hill, New York, 1935.Google Scholar

40 Murray, H. A.Explorations in Personality. Oxford University Press, London, 1938.Google Scholar

41 Lawton, M. P. and Nahemow, L. Ecology and the ageing process. In Eisdorfer, C. and Lawton, M. P. (eds). The Psychology of Adult Development and Ageing. American Psychological Association, Washington, 1973.Google Scholar See also Lawton, M. P.Environment and other determinants of well-being in older people. The Gerontologist, 23 (1983). 349–357.CrossRefGoogle ScholarPubMed

42 Moos, R. H. and Lemke, S.Assessing the physical and architectural features of sheltered care settings. Journal of Gerontology, 35 (1980), 571–583.CrossRefGoogle ScholarPubMed

43 Lawton, M. P.op. cit. 1983, p. 349.Google Scholar

44 See Davies, B. P. and Knapp, M. P. J.op. cit. 1981, chapter 5 for a review of theory and evidence on the ‘competence-press’ model.Google Scholar

45 These dimensions, and particularly their examination in previous applied research are discussed in Davies, B. P. and Knapp, M. R. J.op. cit. 1981, pp. 132–146.Google Scholar