Community care.

Community Care Julia Twigg L. C. Burbridge, The labor market for home care workers: demand, supply, and institutional barriers, The Gerontologist, 33, 1 (1993), 41-46. P. H. Feldman, Work life improvements for home care workers: impact and feasibility, The Gerontologist, 33, 1 (1993), 47~54N. N. Eustis, R. A. Kane and L. R. Fischer, Home care quality and the home care worker: beyond quality assurance as usual, The Gerontologist, 33, 1 (1993), 64-73. The three articles reported here all take as their subject the market for home care in the United States. In doing so they raise issues that are increasingly pertinent to the United Kingdom, as our health and welfare system moves, albeit tacitly, towards a North American model. Home care in the UK increasingly displays features of the US experience. What was formally the home care service is perceived not as a service so much as a field of activity where supply is fragmented, and delivered either by the private sector or by voluntary agencies operating on a market model. The purchaser/provider split looks fair to introduce a pattern of third party payment that is characteristic of the reimbursement systems found in the US. Finally the demise of what was left of the old citizenship model of home care, whereby home help was given to older people almost as a social right, gives increased salience to income in determining usage. Help with housework has been residualised as a form of welfare, available only to those with the money or those who can show a high level of need and little or no resources. The system is in the process of being marketised not simply in relation to the plurality of suppliers but also to sources of payment. For all these reasons, data from the US concerning the market in home care is increasingly relevant in Britain. Home care in the US has always been the poor relation of hospitalbased care. The familiar biases towards medical as opposed to social care and towards hospital settings that are found across the western world have been particularly acute in America. Traditionally there has been little in the way of home care (other than that provided by Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0144686X00001938 Downloaded from https://www.cambridge.org/core. IP address: 54.191.40.80, on 09 Sep 2017 at 12:13:00, subject to the Cambridge