Elderly in the community: an examination of services for the elderly with particular reference to meals services in Scotland
Stanley, Gillian R.
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This thesis is based largely on the results of six inter-related national surveys of community meals services for old people arid thus includes an examination of meals on wheels services, lunch club services, and local authority home help services. Two of these services at least - the meals on wheels service and the home help service - have been the subject of critical comment from social researchers in the past decade or so as attention has become increasingly directed towards the needs of the old and handicapped in non-institutional settings. This interest has been further intensified by official policies which encourage the return to, or indeed, the retention in the community of those who, by virtue of ill-health, frailty, or handicap, would previously have been institutionalized. The meals services, particularly the domiciliary ones, are basic for the viability of community care. They should make a valuable contribution towards the maintenance of the infirm and incapable in their own homes. These studies were undertaken with the aim of assessing the kind and quality of contribution the meals services are making to the welfare of the old. Part I of this thesis is on current literature of some the social characteristics of health status; and finally, a concerned with a discussion based aspects of the 'problem' of old age old people and considerations of critical examination of communityprovisions for the aged since, while 'more' may mean 'better', this may be a non sequitur in some areas of social provision for aged. Questions then about the appropriateness of use of current health and welfare services are discussed. Part II describes the aims, methods arid outcome of the meals services surveys in Scotland. Questions relating to coverage, type and adequacy of services are raised with both service providers - the local authorities and voluntary organisations - and recipients. In addition, information was gathered concerning the provenance of recipients; their feelings about their health and abilities to care for themselves; their family ties and contacts, and factors such as housing and economic status which may so fundamentally affect a life-style. This study does not break much new ground. It certainly provides more detailed information about the organisation and administration of these services in Scotland than has been available before and, perhaps more significantly, it throws more light on the interface of relationships between voluntary organisers and local authorities, and the views of both towards the services they provide. Lack of change is among the main findings of this research. Although there has been an upward trend in the number of meals supplied over the last fifteen years, the increase has been slow and in that time the modal weekly figure of two meals per recipient has not changed. Both coverage and frequency remain inadequate by normative standards. The study also confirms that domiciliary meals are generally provided for those who score highly on accepted risk factors: most are old (seventy-five years or more); live alone; have no home help; have problems of self-care; and 'make-do' for food on days when meals are not provided. The study also underwrites criticisms concerning the unsuitability of some meals. The School Meals Service, the main supplier of meals for the elderly in Scotland, rightly caters for the needs of growing youth. High carbohydrate content is inappropriate and undesirable in the diet of old people. Menus too seem less than tempting for the aged palate. The views of organisers, local authorities and recipients go a considerable way towards explaining some of the noted inadequacies in provision. The fact that few organisers believe that services are not adequate, or actively search for new recipients, and the fact that most have variable rules and regulations governing acceptance practices must all affect service provision in some way. So too must local authority officials, many of whom judge their services to be inadequate but who, for a variety of reasons, may not be planning remedies. These, and other factors influencing the efficacy of community services, are discussed in Part III. This work then reports not only the results of six national studies but also attempts to place them in the context of the general situation of old people; to comment on them as indicators in the development of welfare provision; and to discuss some of their implications for community services.