Meeting individuals’ social care needs is a core element of social policy in many countries, including the UK. In their paper, Athina Vlachantoni, Maria Evandrou, Jane Falkingham and Min Qin (University of Southampton) explore how need and unmet need are both conceptualised theoretically and operationalised empirically by incorporating a temporal dimension in the analysis to investigate the dynamics of met and unmet need for social care over time. The scholars used data from Waves 8 and 9 of the English Longitudinal Study of Ageing and examined five possible trajectories among individuals with a social care need for bathing or dressing at baseline: (1) no longer having such a need; (2) having continued needs met; (3) delayed needs met; (4) newly arisen unmet needs and (5) repeated unmet needs.
They found that among those with need, unmet need has decreased over time, indicating that some needs for social care may be fulfilled with a delay. More specifically, about 66% of older persons with a need for bathing or dressing in Wave 8 reported not receiving any support with such tasks; but in Wave 9, it dropped to about 28%. However, a significant proportion of older people (about 22%) experienced repeated unmet needs between the two Waves. Experiencing repeated unmet needs was more prominent among respondents who were younger, with no spouse or civil partner and those whose Activity of Daily Living (ADL) index scores – that is their difficulties with performing ADLs – worsened over time.
When considering the dynamic patterns of unmet need for social care, this paper also highlights that when different indicators of vulnerability are considered at the same time, it is not the most vulnerable individuals who are at risk of having unmet needs with social care. This may be due to the fact that policy and services have been increasingly concentrated on those most in need, with the result of other at-risk groups placed just below the threshold for having their needs met.
The implications of these findings for policy are twofold. Firstly, the evidence reflecting dynamic patterns of unmet need implies that older persons’ needs assessment at regular intervals is pivotal, and such assessment should include not only individuals’ capacity to perform ADLs or Instrumental Activities of Daily Living (IADLs) but also their broader living environment and sources of support, both formal and informal. A second implication refers to the specific nature of activities examined in this paper, in that the source of support for particular tasks matters. Previous research has shown that among older persons reporting difficulties with ADLs/ IADLs – and receiving support – state or private formal support tends to be used for more basic and personal tasks, while informal support tends to be used for more instrumental tasks (Vlachantoni et al., 2015). If repeated unmet need with personal tasks is experienced by groups of individuals in society with particular characteristics, then local authorities need to ensure that formal support is available to such groups, especially where informal care support is not available. Understanding the dynamics of unmet need can support policymakers to better ensure that those facing an elevated risk of repeated unmet need over time do not fall through the social care safety net.
References
Burchardt, T, Jones, E and Obolenskaya, P (2018) Formal and informal longterm care in the community: interlocking or incoherent systems?. Journal of Social Policy 47, 479-503. doi: https://doi.org/10.1017/S0047279417000903.
Lewis, J and West, A (2014) Re-shaping social care services for older people in England: policy development and the problem of achieving ‘good care’. Journal of Social Policy 43, 1–18. doi:10.1017/S0047279413000561
Vlachantoni, A, Shaw, RJ, Evandrou M and Falkingham, J (2015) The determinants of receiving social care in later life in England. Ageing & Society 35, 321–345. doi: 10.1017/S0144686X1300072X