PAYING FOR LONG-TERM DOMICILIARY CARE - A COMPARATIVE PERSPECTIVE

Concerns over growing numbers and proportions of older people in indus trialised societies have prompted interest in the development of cheap er ways of providing long-term care for older people. While debate in the UK is currently focused on the costs of residential and nursing ca re, other European and Nordic countries have introduced schemes design ed to encourage or sustain the provision of 'social' care by family me mbers, friends and 'volunteers', on the assumption that this can be pr ovided at lower net public expense than either residential care or for mally-organised domiciliary services. Drawing on material from a detai led comparative study, this paper describes four different models on w hich 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 fam ily 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 frai l older people and those who support them. They therefore highlight th e importance of considering both financial support and services in com parative studies of social welfare provision. However, further evaluat ion and policy development is hindered by the lack of evaluation of di fferent models of paying for care and a lack of evidence about the exp eriences of older people and care-givers.