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Priorities for long-term care resource allocation in England: Actual allocation versus the views of Directors of Service and older citizens

Authors:

Paul Clarkson ,

University of Manchester, GB
About Paul
Senior Research Fellow, Personal Social Services Research Unit
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Sue Davies,

University of Manchester, GB
About Sue
Research Associate, Personal Social Services Research Unit
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Jane Hughes,

University of Manchester, GB
About Jane
Senior Research Fellow, Personal Social Services Research Unit
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Chengqiu Xie,

University of Manchester, GB
About Chengqiu
Research Associate, Personal Social Services Research Unit
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Karen Stewart,

University of Manchester, GB
About Karen
Research Associate, Personal Social Services Research Unit
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Paul Clifford,

FACE Recording and Measurement Systems Ltd, GB
About Paul
Director, FACE Recording and Measurement Systems Ltd
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David Challis

University of Manchester, GB
About David
Professor of Community Care Research, Personal Social Services Research Unit
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Abstract

Context: Decisions about resource allocation in long-term care are a perennial issue. The basis for deciding between different needs in prioritising allocation is contested. In England, this debate has crystallised with the advent of selfdirected support, where individuals’ expressed preferences drive resources.

Objectives: To compare perceptions of the priority given to needs for resource allocation in long-term care of older people by two stakeholder groups, compared with actual resource allocation.

Methods: Survey data, eliciting perspectives of senior service managers and older citizens, were used to rank the perceived importance of eight needs-related outcomes. Actual resource allocation from 17 local authorities was also modelled against these outcomes. A variable importance metric was used to rank the importance of these outcomes in determining actual resource allocation. Findings from each data collection were compared.

Findings: Differences in prioritisation of needs emerged between stakeholders compared with actual allocation. Older citizens and actual allocation prioritised basic and instrumental activities of daily living (ADLs). Directors’ rankings were more distinct, still prioritising basic ADLs, but ranking psychological well-being higher and instrumental ADLs lower.

Limitations: The model of actual allocation could not account for political and bureaucratic factors influencing resource allocation, nor the complexity of certain needs that might incur greater resources.

Implications: Discretion continues to influence resource allocation, which remains a contested area. Directors must account for overall spend and other extrinsic factors to maintain sustainability, whereas older citizens prioritise instrumental ADLs, despite these being considered lower priority in eligibility decisions. Overall, ADLs remain important drivers of allocation.

 

How to Cite: Clarkson, P., Davies, S., Hughes, J., Xie, C., Stewart, K., Clifford, P. and Challis, D., 2018. Priorities for long-term care resource allocation in England: Actual allocation versus the views of Directors of Service and older citizens. Journal of Long-Term Care, pp.13–23.
Published on 01 Sep 2018.
Peer Reviewed

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