Outcomes and policy in long-term (social) care

Abstract: Long-term care (LTC) services are conventionally provided to help people manage the consequences of impairment in undertaking activities of daily living (ADLs). More recently, policy has embraced the ideas of personal empowerment and independence for people with impairment and disabilities. Services should improve the person’s care-related quality of life through helping them achieve ADLs (e.g. washing, dressing, feeding), but also as regards the ‘higher order’ domains, such as personal contact, occupation, and having control over one’s life.

In line with this focus on the individual care recipient, a strong emerging policy theme is for the performance of public care systems to be assessed by measured their effectiveness at improving service users’ quality of life.

This presentation has two aims. The first is to describe our estimation of the marginal effectiveness of services when measured in terms of the impact on the care recipient’s quality of life. The second is to explore the policy implications of an outcomes-focused approach to resource allocation and commissioning in social care.

A ‘production-function’ approach was used with survey data. We expect a correlation between service utilisation rates per person (e.g. amount of home care per week) and people’s quality of life, and these relationships can be modelled statistically. This method seeks to limit endogeneity issues by controlling on observable confounders and by using instrumental variable (IV) estimation to tackle selection on unobservables. A specifically-designed survey was undertaken which sampled people using publicly-funded long-term care services provided by local authorities in England. The analysed sample includes 770 service users with physical disability or sensory impairment or mental health problems.

We found that community-based LTC in England significantly improved the care-related quality of life of cared-for people, showing diminishing marginal effects and being differentiated by baseline condition severity.

There are implications for how support is allocated in the social care system. Currently, the system operates on a ‘needs’ threshold basis, that is, the amount of support is assessed in proportion to need severity for people with an assessed severity of need about the threshold. An allocation that accounts for the potential for people to benefit from services would lead to a different distribution of resources by client type.