Assembling their own care packages: payments for care by men and women in advanced old age

A study of 93 households containing only people over 75 indicated that 74% chose to buy some form of care from the private or voluntary sector. The study included households in a middle class and a working class ward of an outer-London borough where few elderly people had children or other relatives living within walking distance. More private services were available in the middle class area but frail elderly people who needed services, such as cleaning, gardening, grocery delivery or car hire, as necessities had to compete with younger, very much more affluent households who bought the services as amenities. Personal care was less used by those interviewed, but 28 people paid for chiropody, either because they were ineligible for a free service or because the free service was inadeaquate for their needs. Paying for care did not bring market power. Elderly people were marginal customers and usually did not feel able to complain if they got poor service. The study indicates that there is a demand for care which helps frail elderly people to continue as respectable members of their communities. At present these services are not provided by the state and are in short supply in less affluent areas. Community care policies which were user-led, or which aimed at preventive care, would expand the provision of such services.