ABSTRACT
Given the high prevalence of chronic disease in older people, disability is a common problem. Th e majority of frail and disabled older people, including those with severe functional impairment, live in private households. Organising services for these patients requires careful assessment by a team approach to determine disease processes, functional ability, continence, cognition, mobility and social background. Th e National Health Service and Community Care Act (1990) (www.opsi.gov.uk/acts/acts1990/) gave local authority social service departments the lead responsibility for assessing individual need and planning, delivering and monitoring care for older and disabled people. Th e main objectives of the Act are:
To promote domiciliary, day and respite services to enable older people to live in ➤ their own homes wherever possible. To provide practical support to carers, such as fi nancial help and information ➤ about services. To assess need and have good management to ensure high-quality care. ➤ To promote the development of independent care providers. ➤ To clarify the responsibilities of care agencies; community care plans should show ➤ who is responsible for which services. To secure better value for taxpayers’ money. ➤
Th e characteristics and range of services provided by the diff erent agencies are summarised in Table 8.1. In the past local authorities were the major providers of services for older people, but increasingly the independent sector plays a greater part in providing basic services like meals, home helps and respite care.
