Older people want to live at home for as long as possible and expect a system of care to enable this. This desire is also recognized in many national policies, where ageing in place with the support of informal caregivers is increasingly seen as a viable solution to institutional care. Despite this, refusal of such care at point of delivery can create further health issues for individuals as well as organizational challenges for care providers. This study aims to explore older people’s perceptions of why homecare is, or may be, refused. It builds on a quantitative study, where 18 per cent of instances of non-delivery of homecare in one major care provider in Scotland were categorized as ‘Service Refusal’. Data from a convenience sample of 17 people, aged 65 years and older, with experience of homecare, from the Greater Glasgow and Clyde area in Scotland, underwent framework analysis. In contrast to the quantitative study, this study uncovered an unexpected propensity for service acceptance; living at home was the presiding value and the main motivating factor to accept homecare, irrespective of its quality. This study provides a deeper understanding of the complexities of homecare from those who receive it, highlighting critical insights to inform governmental initiatives and homecare service providers. Allowing people to remain at home for as long as possible with appropriate and sustainable homecare should be central to national outcomes in Scotland, with the findings of this study also providing useful insights for homecare providers internationally.

This paper brings together Lipsky’s street-level bureaucracy framework and the concept of everyday bordering to interrogate mechanisms through which diverse social care professions – working with migrant families – enact and/or resist the UK’s hostile policies towards immigration. We show that, in contexts of mixed welfare provision, and hostile bordering practices, who is an actor in policy implementation is unclear. Instead, we conceptualise that ‘networks of support’ services develop, which are characterised by provision: directly provided by the state; commissioned by the state but delivered by non-governmental organisations (NGOs); and funded by independent bodies and delivered by NGOs. In turn, we theorise that ‘networks of enactment’ and ‘networks of resistance’ develop, whereby practice interactions simultaneously perpetuate and dilute hostile environment ideologies. By delineating these networks, we offer new ways of distinguishing between the types of bordering practices that occur in social care provision within mixed welfare economies – these being ‘statutory bordering’, ‘co-opted bordering’ and ‘shadow bordering’ – as well as strategies employed to resist state exclusionary bordering practices. In doing so, we advance the theories of everyday bordering and street level bureaucracy, offering a more nuanced perspective on the relationship between the state and diverse social care professions.

Mental health social care is an emerging and evolving field of practice and research within mental health care in the UK. It recognises the significant role played by social determinants in the development of mental illness and distress, and in recovery and well-being. By considering mental health social care as a distinct health and care research system, this paper outlines key priorities for research, funding and capacity building. It argues that mental health social care should be an essential component of mental health service delivery, and calls for a move towards holistic, person-centred care that addresses the social determinants of mental health, alongside biological and psychological factors.

Meeting social need is usually associated in social policy with the provision of benefits and public services, and the role of taxation often confined to an acknowledgement of its revenue-raising function for the purpose of funding them. Against a backdrop of multiple concurrent challenges shared by many high-income societies, including inadequate social care for an ageing population and unprecedented waiting lists for health care, the UK’s experience of the short-lived Health and Social Care Levy is used as a case study to reveal how the relationship between taxation and social need is complex, mediated by a range of factors, and how these contributed to its abolition. The article proposes five different relationships between taxation and social need evident in the story of the rise and fall of the Levy.

This paper considers how a diagnosis of dementia affects people's planning for future social care needs and associated costs. It addresses the gap in knowledge about how people recently diagnosed with dementia, and their family carers, engage with planning for social care needs that are uncertain in timing and scale. The paper also considers people's attitudes to planning for care that they may need to pay for privately, and what facilitates or hinders acting on such plans. We conducted and undertook thematic qualitative analysis of 39 in-depth interviews with 27 people newly diagnosed with dementia and/or their carers over a two-year period. Topics included current care and support, planning and co-ordinating care, paying for care, and expectations and planning for the future. The research took place in England. Our findings indicate that whilst people recognised they would have future care needs, with associated financial implications, this knowledge did not necessarily translate into actively planning for care or its cost. A key reason that recognition did not translate into action was uncertainty, manifested in three areas: the timescales and trajectory of their dementia and thus need for care; the potential for care needs to change and so negate care planning efforts; and uncertainty over their own capabilities to plan for and access paid-for care, given the perceived complexity of social care and associated financial arrangements. The paper discusses how anticipated regret may affect decision-making and contributes to debates about appropriate professional support for older self-funders with dementia. It suggests the task for those involved in the care of people with dementia is to identify the points and places in the care system where worries about future self-funded care can be addressed, and carers and the people they care for can be prompted and supported to act.

Social prescribing is poorly defined and there is little evidence for its effectiveness. It cannot address the social determinants of mental health and it is unlikely to produce enduring change for that part of the population that suffers the worst physical and mental health, namely the most deprived and marginalised. It has emerged at a time of growing health inequity. This has occurred alongside the neglect of social care and of the social aspects of mental health intervention. Social prescribing gives a false impression of addressing social factors, and as such is counterproductive. We can do better than this.

UK policy discourse presents technology as a solution to challenges facing care services, including issues of quality and the mismatch between care workforce supply and demand. This discourse characterises technology as ‘transformative’, homogenous and wholly positive for care delivery, eliding the diversity of digital devices and systems and their varied uses. Our paper draws on data gathered through 34 interviews with care sector stakeholders and four in-depth case studies of UK homecare providers to comparatively analyse ‘storylines’ of technological solutions expressed by policy (macro-level), sector stakeholders (meso-level) and homecare managers and care workers (micro-level) alongside enacted experiences of technology-in-use. The ‘storylines’ presented by care sector stakeholders and homecare managers converged with those of the policy discourse, emphasising technology’s capacity to enhance quality and efficiency. Our case studies however highlighted several implications for care work and organisational practice in homecare provision: the technologies we observed sometimes produced additional tasks and responsibilities, undermining the efficiency and quality storylines. The experiences of care providers and workers engaging with technologies in homecare warrant further investigation and greater prominence to challenge a discourse which is at times overly simplistic and optimistic.

Recent scholarship has highlighted the experiences of, and various challenges faced by, dying persons and the workers tasked with end-of-life care. However, research has not sufficiently considered what symbolic resources – such as beliefs, rituals and vocabularies – are drawn upon by care workers when caring for dying and deceased residents in care homes, together with how this is informed by financial regimes. I address this deficit by drawing upon an extensive ethnographic study, undertaken in southern England (United Kingdom) between 2013 and 2014, at two residential care homes (one low-cost and one high-cost) for older people. Counter to analyses of death and dying that too frequently foreground the extraordinary, rather than the mundane and everyday, I examine the gaping disparities between two differently priced settings. In the low-cost home, residents experience a social and moral death. The dying and the dead are treated with disregard and indifference. In the high-cost home, caring for the living was extended beyond the biological termination of life. This was influenced not only by the marketing of ‘high-quality’ care, but also by workers and residents who, in their gestures and rituals of honouring, remembering and mourning the dead, made high-quality care possible. My analysis shows, then, how cavernous inequities unfold within the care sector and how, in turn, experiences of death and dying are deeply fragmented by the market. I conclude by arguing that researchers must both take the normative and symbolic culture of care work seriously and examine how the availability of this is directly impacted by the costing and funding of care. Doing so, I argue, allows us to work towards establishing a care sector that is equitable both for older people and care workers.

Marketised models of social care provision in Australia are placing pressures on service providers and driving changes in work organisation and employer practices, with potential to degrade social care jobs. While international experience of marketised social care has demonstrated the vulnerability of social care workers to wage theft and other violations of employment laws, Australia’s relatively strong industrial relations safety net might be expected to be better able to protect these low-paid workers. Nevertheless, there is emerging evidence of negative impacts on the pay and entitlements of frontline workers in the expanding community support and homecare workforce. This study investigates the paid and unpaid work time of disability support workers under Australia’s new National Disability Insurance Scheme. The research takes a novel approach combining analysis of working day diaries and qualitative interviews with employees to expose how jobs are being fragmented and work is being organised into periods of paid and unpaid time, leaving employees paid below their minimum entitlement. The article highlights the role of social care policy along with inadequate employment regulation.

Quizzes are a ubiquitous part of the dementia social care landscape. This article explores why. Using an ethnographic approach which draws on close analysis of communication, we examine dementia quizzes as a ‘social practice’, and what such a lens can tell us about their popularity in social care settings. Vignettes of real interactions drawn from ten different quizzes recorded in four different group settings attended by 28 people living with dementia and 15 staff members are presented to highlight particular issues. We show that the conditions of post-diagnosis dementia social care are uniquely well suited to an activity such as quizzes which are malleable, requiring little preparation or materials, and impose a communication framework which can help to organise the interactional space. Quizzes also draw on previously forged interactional competences, such as turn-taking and question–answer sequences, a skill that has been shown to persist even as dementia progresses. Finally, we argue that the meaning of quizzes with people with dementia feeds into wider societal values and associations attached to memory, dementia and personhood. The extent to which quizzes are akin to a ‘test’ or a fun and enjoyable social activity rests in how they are enacted. We suggest that practice can be adapted, developed and made more inclusive through input from people living with dementia themselves.

Meeting individuals' social care needs is a core element of UK social policy. However, the conceptualisation and operationalisation of ‘unmet need’ remain a challenge. This paper advances our understanding by incorporating a temporal dimension into the conceptual framework on unmet need to investigate the dynamics of met and unmet need for social care over time. Using data from Waves 8 and 9 of the English Longitudinal Study of Ageing, this paper examines five possible trajectories among individuals with a social care need for bathing or dressing at baseline: (a) no longer having such a need; (b) having continued needs met; (c) delayed needs met; (d) newly arisen unmet needs; and (e) repeated unmet needs. The results indicate that amongst those with need at baseline, unmet need has decreased over time – indicating that some needs for social care may be fulfilled with a delay. However, a significant proportion of older people experienced repeated unmet needs, particularly those who were younger, with no spouse or civil partner, and those whose activities of daily living index scores worsened over time. Understanding the dynamics of unmet need can support policy makers in better ensuring that those facing an elevated risk of repeated unmet need over time do not fall through the social care safety net.

Since the 1980s, “personalisation” is at the centre of the evolution of disability policies and more generally of the Welfare state. It refers on one hand to the question of self-determination through the allocation of personalised budgets, and on the other to the adaptation of care to the specificities of a given person, through the development of “person-centred” care. In this article we study the issue of the personalisation of care from a point of view intermediate to these two dimensions, that of the transformation of social care organisations. Using the example of care provided to people with multiple impairments in France, we analyse how new social care organisations have addressed the diversity and specificity of the needs of these people. This analysis thus proposes a new way to think about the personalisation of policy responses implemented by the welfare state.

Social care to assist with the activities of daily living is a necessity for many older people; while informal care provided by family members can be a first step to meeting care needs, formal care provided by professionals is often needed or preferred by older people and their families. In England, the number of older people paying for formal care is set to rise, driven by an ageing population and the limited resources of local authorities. Little is known about how older people and their families experience the potentially disruptive processes of deciding upon, searching for and implementing such care, including the financial implications. This paper explores accounts of seeking self-funded social care in England, told by older people and their families in 39 qualitative interviews. These accounts, which we call ‘care chronicles’, include stories about the emergence of care needs and informal care-giving, the search for formal care, including interacting with new systems and agencies, and getting formal (paid) care, either as the recipient or an involved family member. Stories are analysed through the lens of biographical disruption, and analysis demonstrates that such disruptions can occur for older people and their families across the entirety of the care chronicle. Needing, seeking and getting care all have the potential to cause practical and symbolic disruptions; moreover, these disruptions can be cumulative and cyclical, as attempts to resolve or minimise one disruption can lead to new ones. While the concept of biographical disruption is a mainstay in medical sociology, it is less frequently applied to issues relating to social care, and most often takes embodiment as a key focus. This study is novel in its application of the concept to experiences of seeking self-funded care, and in its introduction of the concept of ‘care chronicles’, which invite a longer and broader view of biographical disruptions in the lives of older people with care needs and their families.