This article seeks to understand the challenges of combining the distinct aims of personalisation and integration in adult social care. Addressing the local context of service delivery in England through interviews with key stakeholders, we identify how personalisation and integration activities require different, and potentially conflicting, approaches. We observe direct tensions when structural integration with health systems distracts focus from achieving personalised delivery of care or where a focus on clinical outcomes takes precedence over broader wellbeing aspirations. Integration can entail the prioritisation of health over social care and a population rather than personal orientation. We suggest that personalisation and integration are in ‘policy conflict’ (Weible and Heikkila, 2017) and that policy-makers need to acknowledge and address this rather than promise the ‘best of both worlds’.

The general discourse in health and social care policy purports digital technology as necessary to meet growing demands for long-term care and health care as a result of an ageing population. This needs critical investigation since public policy influences people's health and wellbeing. This study aims to interrogate critically what we call the ‘digital technology solution’ discourse in local Swedish health and social care policies. The main concern of our analysis is the discursive constructions of older people and their informal carers and how the concept of health is constructed. A discourse analysis was conducted of 61 local policy documents using the ‘What's the Problem Represented to Be’ method. Our analysis revealed that so-called ‘e-health strategies’ were rarely concerned with health. Health was often referred to as an activity and seen as a means to achieve independence among older people. The norm advocated independence, with the responsibility placed upon the older person, supported by digital technology. Informal carers were constructed as a resource within an older person's environment and largely taken for granted. We argue that the digital solution discourse ignores older people's agency and capacities as contributors to society, not least with regards to being providers of informal care.

The literature on older migrants often focuses on identifying the characteristics of ethnic groups that constitute ‘barriers’ for members of these populations to access care. This paper offers an alternative conceptualisation of access to care, by combining relational approaches to place and the notion of super-diversity. From this perspective, ‘access to care’ is perceived as an outcome of an individual's embeddedness in relationships of care in urban places. The objective of the study is to identify relationships of care that facilitate access to aged care for older first-generation migrants. Thirty-two semi-structured interviews were conducted with older migrants who were residents of Nijmegen or The Hague, The Netherlands. All interviewees had accessed home care, home aid and/or day care. Both relationships with minority-specific services and informal relationships of care, particularly those within local minority communities, were found to facilitate access to aged care. Past experiences with health and social care were also found to influence current relationships with formal care providers. This study, therefore, suggests that policy makers and care organisations should build long-term positive relationships with new and incoming migrant groups. In addition, it argues that policy makers and care providers should identify locally relevant shared migration-related (rather than ethnic) identities around which communities can be mobilised and targeted with appropriate services.

With an ageing society, the demand for health and social care is increasing. Traditionally, staff provide care for their clients rather than with them. In contrast, reablement aims to support people to maximise their competences to manage their everyday life as independently as possible. There is considerable variation between and within countries regarding the conceptual understanding of the approach. This variation affects the ability to evaluate reablement approaches systematically, compare and aggregate findings from different studies, and hinders the development of a robust evidence. Therefore, a Delphi study was conducted in 2018/9 with the aim of reaching agreement on the characteristics, components, aims and target groups of reablement, leading towards an internationally accepted definition of reablement. The study consisted of four Web-based survey rounds. In total, 82 reablement experts from 11 countries participated, reaching agreement on five characteristics (e.g. person-centred), seven components (e.g. goal-oriented treatment plan) and five aims (e.g. increase clients’ independency). Furthermore, most experts agreed that reablement is an inclusive approach irrespective of the person's age, capacity, diagnosis or setting. Based on these features, a definition of reablement was developed, which was accepted by 79 per cent of participating experts. This study is a significant step towards providing conceptual clarity about reablement. Future research should focus on evaluating the implementation of agreed reablement components to inform practice, education and policy.

This paper looks at alternative long-term care (LTC) funding models and options. It analyses six global models and the potential applications to the United Kingdom. The paper provides a demographic overview for each of the six countries to illustrate the increasing global demand for LTC and the funding thereof that is becoming a global critical issue. It examines the approaches each country has taken to address the funding issue with varying degrees of public/private co-operation and partnerships. The authors hope that the lessons learned from these other markets will assist the United Kingdom as they try to come to grips with their growing social care funding issue.

This paper looks at alternative long-term care (LTC) funding models and options. It analyses six global models and the potential applications to the UK. The paper provides a demographic overview for each of the six countries to illustrate the increasing global demand for LTC and the funding thereof which is becoming a global critical issue. It examines the approaches each country has taken to address the funding issue with varying degrees of public/private co-operation and partnerships. The authors hope that the lessons learned from these other markets will assist the UK as they try to come to grips with their growing social care funding issue.

In 1999 Hockey postulated the hypothesis that some older people experience a continual accumulation of small, individually minor events or difficulties that degrade their resilience until they ‘cannot cope with another thing’. She referred to this accumulation as cumulative trivia. The essence of cumulative trivia lies in their everyday nature, where regular occurrence and variety of challenge stack up to form perceived threats to an older person's ability to function independently. There is a strong overlap between this concept of cumulative trivia and an established concept in the health psychology literature called daily hassles. Consistent with the mainstream psychology approach, the vast majority of research into daily hassles has been quantitative. In the present article we adopt a critical stance to the knowledge produced from this research, questioning its foundations in the positivist epistemology. In particular the research is criticized for absenting the social context from our understanding of daily hassles, and for focusing too strongly upon the individual. The considerable lack of research into daily hassles in the lives of older people is also highlighted, indicating the need for work in this area. Using a social constructionist framework, we attempt to develop a holistic conceptualization of cumulative trivia, through which some key differences between the cumulative trivia and daily hassles concepts are indicated. We argue that cumulative trivia could be seen within the framework of the daily hassles literature but that this framework would require to be developed further and refined to accommodate the specific characteristics associated with Hockey's concept. We suggest that the social construction of ageing may serve to normalize experiences in ageing such that they become trivialized. Finally we examine how the social construction of independence as an ideal state may create or exacerbate the effects of cumulative trivia, and argue for its reconstruction to legitimize older people's experiences of minor difficulties. Through these arguments we relocate responsibility for cumulative trivia toward the social context.

Against a background of limited previous research, this paper examines the access to health and social care among older people in the farming communities of County Down, Northern Ireland. In-depth interviews were conducted with 45 people aged 60 or more years living on family farms to collect information about health care needs and service use and adequacy. In addition, interviews with service providers provided information on their perceptions of the farming communities' needs. The findings indicate that there are specific rural dimensions of access to services and that among the respondents there was substantial unmet need. For many farming families, using services is determined by much more than being able to reach them physically. The lack of reliable information, the culture of stoicism and the absence of appropriate services impeded obtaining effective support. Recent health care policies and strategies have stressed the importance of developing local services that are responsive to need in consultation with service users, but there is worryingly little evidence that this has occurred. It is concluded that if effective outcomes are to be achieved, policies must recognise the specific characteristics of rural populations and be sensitive to the needs, attitudes and expectations of farming families. The current lack of understanding about the distinct needs of these communities at present exacerbates the isolation and marginalisation of already vulnerable older people.

Some 50 years after the creation of the welfare state and at the start of the new millennium, this paper considers the current and future status of older people in Britain. It argues that as the population ages, the situation of older people is becoming an increasingly important element in social policy debates. The first half of the paper critically reviews developments over the last five decades, emphasising the salience of accommodation issues during this period. In the light of recent initiatives such as ‘Better Government for Older People’, the second half of the paper outlines a policy agenda for the early years of the 21st century. We argue unequivocally for an integrated social policy which addresses the broad needs of an ageing society as opposed to narrow age-based interests, or the interests of specific problematised or stigmatised groups. The creation and delivery of such an integrated policy for tomorrow's Britain rests, we contend, on three crucial dimensions: an explicitly articulated value base; a consideration of the educational, technological and spatial aspects of policy; and harmonisation of action at both local and national levels.