Care of the elderly: An analysis of placement, process and cost.

This thesis is concerned with the issues of placement, process and cost in care of the elderly. Each of these aspects of care are treated separately, though some effort is made to explore the relationship between them. Placement has an affect on process, in the sense that care in the home is very different to care in an institution. However, there may also be variation in the process of care among institutions, with the result that care patterns may not be homogenous, even for similarly dependent elderly persons. The caring process and the manner in which resource use is quantified and valued has implications for costs; this is obvious when the care provided by family and friends is included in the analysis. Finally, the cost of care has a major influence on placement, particularly in recent years, as budget constraints have become tighter and decisions on where to treat old people are being made, more and more, on the basis of value for money. The thesis has three main objectives. The first is to investigate the factors that affect the placement of old people. An analysis of placement using a logit estimation procedure will facilitate a discussion as to why some old people are more likely to end up in institutional care than others. The second objective is to examine the process of care within institutions and at home. Of particular interest is the quantitative relationship between the dependency of old people and the care provided by health care professionals in institutions. If differences in the caring process do emerge among institutions caring for similarly dependent old people, it may be evidence of technical inefficiency, and an important first step in the identification of optimal practice. The final objective is to provide an estimate of the cost of care for vulnerable old people living in the community. An opportunity cost framework is used to calculate costs. Consequently, the contribution of informal carers is both quantified and valued. Four main conclusions emerge from the research. First, the placement of old persons is affected by disability characteristics, social factors and the availability of community care services. Second, there is not a simple positive linear relationship between dependency and care provision in long-stay institutions, at least for some disability characteristics. Third, different practices exist among institutions in respect of the care of long-stay patients. Finally, the opportunity cost of care in the community is relatively high and increases with dependency