The Darlington care management model and home-based elderly care

¶ … reading is to introduce the reader to the Darlington Care Management Model. The goal of the Darlington Project was to increase and improve collaboration and coordination of home-based care for the elderly. The hope was that this would reduce duplication of services, while ensuring that all necessary services were administered, in order to allow for home-based care in a situation where the elderly person would otherwise have to remain in a hospital setting. The chapter defines care management, discusses the origins of care management, and discusses the functions, goals, tasks, and recipients of care management. It then discusses the Darlington Project specifically, which dealt with a group of physically handicapped but mentally alert elderly individuals and attempted to show how community-based care could be used to care for them. Because this chapter was descriptive of a model, I neither agree nor disagree with the reading. I found it to be informative about the model that was being described. This chapter did not provide sufficient information about the Darlington Project in comparison with other community-based care projects for me to determine whether the project added value to the community-care model. Therefore, I am left with questions about the Darlington Project in comparison to similar community-care models.

Reading Response Week 8

The purpose of this reading was to help explain the ideology of home. It focuses on home from the perspective of the recipient of care and from the perspective of the caregiver. When a caregiver enters into a home, the caregiver is entering into a private space, which can make caregivers feel vulnerable when they first enter into a new client's home. Furthermore, clients have their own feelings about home, and may also feel vulnerable because accepting in-home care means that they are accepting a stranger into their home. In addition, how clients responded to caregivers in the home was greatly influenced by gender and social class, because those who have previously had in-home help were less intimidated by the idea of a home-based caregiver. While the homeowner retains the legal power to admit or exclude caregivers, they often feel as if accepting care transforms part of their home, a private space, into a public space. I agree very strongly with the idea of home as a private space and that introducing a caregiver to the home environment could be considered intrusive by those receiving care. I also agree with the idea that caregivers may feel funny and unwelcome entering into a stranger's home. In fact, I agree that normal conventions about appropriate behavior in other's homes might initially hamper caregiving relationships. I also understood the workers' ambivalence and sometimes animosity towards some of the care work they were required to do. The reading made me wonder if feeling that care work is a dirty job impedes a care workers ability to take care of their clients.

Reading Response Week 10

In this reading, Fine examines how coordination efforts have impacted the provision of health and social welfare services in Australia. He specifically addresses two different, but related issues: community-based care services for elderly individuals and people with disabilities, and increased coordination between different service providers such as community-based care organizations, residential care services, hospitals, and other healthcare providers. What he attempts to show is how increased coordination has led to clients receiving higher quality services at different levels of care, and should, ideally, result in clients being placed in the appropriate care environments. He also looks at governmental policies and how those policies impact coordination between care-providers, suggesting that when government policies do not support coordination, the natural result is fragmentation. I agree with what Fine has to say about coordination. I believe that much of Australia's caregiving approach remains very fragmented, so that the lack of coordination has a negative impact on the level of care that clients can receive. In fact, I believe that this lack of coordination results in some clients having inappropriate placements. Furthermore, I agree with Fine's seeming endorsement of Austin's opinion about care management, suggesting that care management is only necessary because of societies that emphasize outcomes and financial costs rather than focusing on health and the provision of healthcare. I am left wondering if there have been any real, significant changes in care management in Australia since Fine wrote his article, or if the capitalist influence on care provision makes real change impossible without restructuring the entire system.

Reading Response Week 11

In this reading, Brennan discusses the relationship between the government and civil society. Brennan posits that Australia's social services have come about through a unique relationship between the government and civil society, which makes that relationship a focus in any discussion of social services. That is because early Australian social services emphasized the contributions of charities and other non-governmental organizations. These private organizations served functions that would have been considered state functions in other countries. The government attempted to restructure the way that social services in Australia are provided by making more of it a governmental responsibility and less of a private responsibility. This governmentalization of social services led to an increase in accountability and a greater emphasis on administration. The Australian government and people were left trying to decide which services would be a public responsibility and which services would be a private responsibility. I agree with Brennan's historical discussion of the role that private organizations played in Australian social services throughout much of history. I believe her account to be accurate, though I admit that my own independent knowledge is sufficiently limited that I would not necessarily notice inaccuracies. The reading did leave me wondering if government is the appropriate means of distributing social services because large-scale government operations tend to lack the flexibility needed to be truly responsive to local concerns and issues.