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BJSW Advance Access published online on October 10, 2005
British Journal of Social Work, doi:10.1093/bjsw/bch322
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© The Author 2005. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved.

Article

Professional Perspectives on Decision Making about the Long-term Care of Older People

Brian J. Taylor 1* and Michael Donnelly 2

1 Lecturer in Social Work in the School of Sociology and Applied Social Studies at the University of Ulster, Northern Ireland
2 Reader in the Department of Epidemiology and Public Health, Queen’s University Belfast

* To whom correspondence should be addressed.
Brian J. Taylor, E-mail: b.j.taylor{at}ulster.ac.uk


  Abstract

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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