Changes over time: the motivations of independent-sector care-home managers and owners in England between 1994 and 2003 (original) (raw)
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Motivation and Commissioning: Perceived and Expressed Motivations of Care Home Providers
Social Policy & Administration, 2008
Commissioning of social care for older people has seen major changes since the early 1990s. Considerable responsibility now rests with local authority staff, whose views of care home providers’ motivations, their perceived strengths and weaknesses as service providers, will have a bearing on commissioning decisions. We examine commissioners’ views of provider motivations in eight English local authorities and compare their perceived motivations with providers’ expressed motives. Data were collected through semi-structured face-to-face interviews with commissioners and care home providers. Providers are generally perceived by commissioners as highly altruistic, but also relatively financially motivated individuals. Further analysis revealed significantly different views towards profit-maximizing, which commissioners perceive as very important, while providers consider it to be of little motivational value. Private sector providers are described by commissioners as significantly more motivated by personal income. Associations are found between commissioners’ perceptions of motivations and the nature of their relationships with providers. Perceptions of providers’ motivations appear important within the commissioning framework.
Social Policy & Administration, 2001
This paper examines the motivations of a sample of fifty providers of residential care for older people in England in . The theoretical point of departure is the "knights and knaves" categorization suggested by Julian Le Grand. A cluster analysis of the expressed motivations of the providers of residential care suggests three types: empathizers, professionals and income prioritizers. These combine knightly and knavish motives in varying degrees. Le Grand's recommendation that strategic policy towards actors in welfare services should be robust about motives is endorsed. However, a third, "mercantile", aspect of motivation is revealed reflecting providers' needs to exercise control over, and experience ownership of, their enterprises. This should also be taken into account in the design of policy. Policy decisions that are insensitive to this aspect of motivation are likely to be misguided and flawed.
MMU Psychology Journal (Dissertations), 2013
By investigating the experiences of staff and associated groups, this inquiry aimed to establish the foundations of a longitudinal study into the effects of privatisation and the influence of this process within geriatric nursing and residential care. Previous research in this area is purely circumstantial; traceable only to sources of bias, such as rudimentary journalist perspectives and tabloid newspaper articles, all of which focus on individual abuse cases as opposed to the broader institutional context. Accordingly, an extensive review of the literature reveals a distinct lack of inquiry and no empirical data to further validate these assertions. Participants gave their accounts during one-to-one semi-structured interviews, with the subsequent transcripts being analysed using Thematic Content Analysis. A superordinate theme of Interconnectivity was identified, alongside four master themes: Government, Advocacy, Staffing, and Motivation. The findings illustrate that staff dynamics ultimately determine care standards, which are in turn controlled by the level of governance and support provided. Conceptual models were formed in light of these findings and, combined with participant responses, served to develop feasible recommendations of ‘better practice’ for adoption by stakeholders and policy-makers.
Social Policy and Society, 2021
This article reports on a study assessing the incentives and deterrents to long-term care (LTC) supply in two local markets in England. The supply of LTC in many countries is facing the issues of rising demand, (lack of) workforce and the interaction of the public and private sectors. Findings from qualitative interviews of local council and provider stakeholders exploring barriers and enablers faced by LTC providers in two local authorities (LAs) are presented and discussed. The interviews provided insight in three main areas: staffing, demand and stakeholder relationships. Staffing, in particular, is crucial and we found that there are many difficulties for providers in maintaining their workforce. Consistent with previous research, we also found that public spending levels on LTC puts pressure on providers striving to maintain a good quality service, including improved remuneration of staff.
Regulating nursing homes: Caring for older people in the private sector in England
BMJ, 2001
Over half of all beds allocated for health care in the United Kingdom are in independent nursing homes for older people; this is a result of policies initially introduced to change the basis of social security payments 1 and now directed towards privatising long term care. Official statistics from the Department of Health indicate that between 1979 and 2000 the total number of beds in the NHS in England decreased from 480 000 to 189 000, while the number of beds in the independent sector, which is run mainly for profit, increased from 23 000 in 1983 2 to 193 000 in 2000. Experiences in the United States and Australia have shown the lack of political will to promote the interests of residents against the interests of the industry and its shareholders. 3 4 In Australia the industry successfully lobbied to replace legally enforceable regulations with less effective accreditation schemes; this has had disastrous consequences. In the United States the industry successfully opposed the introduction of robust standards for minimum numbers of staff, and the result is continuously declining health outcomes for residents. The risks to residents of nursing homes in the United Kingdom are considerable as subsidiaries of large US multinationals enter the United Kingdom 5 ; some of these companies have come under scrutiny in the United States for fraud and embezzlement of government funds and for abusing patients. 3 This paper considers whether the new regulatory framework for nursing homes in the United Kingdom offers adequate protection for patients.
2008
The social service care system for the elderly has undergone a number of changes during the last decades. These reforms, especially the purchaser-provider split, have changed the role of the state in this sector somewhat, from being a monolithic provider of tax-financed elderly care to primarily being a purchaser who might choose to purchase elderly care services from private providers. However, the state has still retained a public elderly care service. Needless to say, the reform paved the way for a number of private enterprises in the area, causing competition between public and private providers. Adherents of the reform have argued that private providers can improve efficiency, while opponents have claimed that the chase for profit might affect the quality of the care in a negative way. This study focused on the basis for this controversy by examining the relationship between factors such as profit, efficiency, care quality, incentives, motivation and productivity. The study was performed by interviewing thirteen employees and managers in four different care organizations (of which half were public and the other half private). Their answers were analyzed from three theoretical aspects; incentives and motivation, efficiency and productivity, and care quality.
2005
Much of social care of older people now takes place in the context of a market. As a result the welfare of many people is fundamentally dependent on the success of that market in terms of both availability of services and quality of care. This paper considers the functioning of that market to date and the challenges it is likely to face in the future. Social care is unlike most other markets in terms of the nature of the product, characteristics of consumers, the relationship between prices, fees and charges, and the dominant role and influence of the public sector. This paper starts by describing and defining what we mean by social care and the context in which the markets have developed. The extent and nature of the market are then outlined in terms of levels, distribution and types funding, the development of the commissioning role by public bodies and the impact on the market of changes in the regulatory system. The role of and involvement of service users as consumers in this m...
The Journal of Adult Protection, 2020
Purpose Strategic socio-political views are notably scarce among contemporary discourses on the causes of abuse of vulnerable older people in care and nursing homes. This paper aims to catalyse higher order consideration and discussion of one socio-political characteristic that has relevance to the issue of abuse, that is, the market-like environment in which care and nursing homes in England operate. In doing so, the paper argues that the now firmly established but imbalanced “quasi-market” of care that has developed over many years fosters conditions under which both poor care and abuse are more likely to occur. The evidence presented in the paper focusses primarily on the rise to dominance of for-profit care home provision and the contraction of public sector provision. The paper does not examine in detail the characteristics and market presence of the not-for-profit sector because it has not held a numerically significant market share either historically or contemporarily. Desig...