title: Funding health and social services for older people - a qualitative study of care recipients in the last year of life.
abstract: OBJECTIVE
  This study explores the views of older adults who are receiving health and social care at the end of their lives, on how services should be funded, and describes their health-related expenditure.
  
  
  METHODS
  Qualitative interview study.
  
  
  METHODS
  North West England.
  
  
  METHODS
  30 people aged 69-93 years, diagnosed with lung cancer, heart failure or stroke and judged by health professionals to be in their last year of life. Sixteen participants lived in disadvantaged areas.
  
  
  METHODS
  Views of older adults on funding of services.
  
  
  RESULTS
  Participants expressed a belief in an earned entitlement to services funded from taxation, based on a broad sense of being a good citizen. Irrespective of social background, older people felt that those who could afford to pay for social care, should do so. Sale of assets and use of children's inheritance to fund care was widely perceived as an injustice. The costs of living with illness are a burden, and families are filling many of the gaps left by welfare provision. People who had worked in low-wage occupations were most concerned to justify their current acceptance of services, and distance themselves from what they described as welfare 'spongers' or 'layabouts.'
  
  
  CONCLUSIONS
  There is a gap between the health and social care system that older adults expect and what may be provided by a reformed welfare state at a time of financial stringencies. The values that underpinned the views expressed--mutuality, care for the most needy, and the importance of working to contribute to society--are an important contribution to the debate on welfare funding.
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, UK. barbara.hanratty@york.ac.uk
authors.forename: Barbara
authors.initials: B
authors.lastname: Hanratty
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lowson
authors.forename: Louise
authors.initials: L
authors.lastname: Holmes
authors.forename: Gunn
authors.initials: G
authors.lastname: Grande
authors.forename: Julia
authors.initials: J
authors.lastname: Addington-Hall
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
authors.forename: Jane
authors.initials: J
authors.lastname: Seymour
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D017028:Caregivers / Q000458:organization & administration; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D015577:Geriatric Assessment; D006295:Health Resources / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D015397:Program Evaluation; D036301:Qualitative Research; D011788:Quality of Life; D018570:Risk Assessment; D012946:Social Welfare / Q000191:economics*; D012947:Social Work / Q000191:economics* / Q000458:organization & administration; D006113:United Kingdom; D035862:Vulnerable Populations