BJSW Advance Access originally published online on October 10, 2005
British Journal of Social Work 2006 36(5):807-826; doi:10.1093/bjsw/bch322
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Professional Perspectives on Decision Making about the Long-term Care of Older People
Brian Taylor is Lecturer in Social Work in the School of Sociology and Applied Social Studies at the University of Ulster, Northern Ireland. His particular interests include assessment, care planning, risk, decision making and evidence-based practice.
Michael Donnelly is Reader in the Department of Epidemiology and Public Health, Queen’s University Belfast. He has undertaken extensive research into various aspects of community care policy and practice.
Correspondence to Dr Brian Taylor, Department of Social Work, University of Ulster at Jordanstown, Shore Road, Newtownabbey BT37 0QB, Northern Ireland. E-mail: b.j.taylor{at}ulster.ac.uk
With the increasing pressure on social and health care resources, professionals have to be more explicit in their decision making regarding the long-term care of older people. This grounded theory study used 19 focus groups and nine semi-structured interviews (99 staff in total) to explore professional perspectives on this decision making. Focus group participants and interviewees comprised care managers, social workers, consultant geriatricians, general medical practitioners, community nurses, home care managers, occupational therapists and hospital discharge support staff. The emerging themes spanned context, clients, families and services. Decisions were often prompted by a crisis, hindering professionals seeking to make a measured assessment. Fear of burglary and assault, and the willingness and availability of family to help were major factors in decisions about living at home. Service availability in terms of public funding for community care, the availability of home care workers and workload pressures on primary care services influenced decision ‘thresholds’ regarding admission to institutional care. Assessment tools designed to assist decision making about the long-term care of older people need to take into account the critical aspects of individual fears and motivation, family support and the availability of publicly funded services as well as functional and medical needs.
Keywords: Older people, risk assessment, decision making, long-term care
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