From the workhouse to the home. The historical origins and development of domiciliary care services for older people in Ireland

Abstract

Purpose: Care of older persons in their own homes has in recent years received much attention in Ireland. The proponents of domiciliary care draw on both economic and quality of life arguments, many of which are identifiable in policy documents since the 1950s. However, little detailed analysis of the evolution of the formal care services for older persons, and the shift in emphasis from institutional to domiciliary care, has been presented. Methodology/approach: Using archival, administrative and policy sources, we traced the changing nature of formal care policies in Ireland, and analysed changes in key organising principles and features, including subsidiarity, the role of the Church and the basis of entitlements (residual vs. universal). Findings: The first type of formal care to emerge was institutional, and did not adhere to the subsidiarity principle as it was mostly delivered by the State. Subsidiarity came to the fore more clearly with the establishment of the earliest home care services by religious and voluntary organisations. The current trend towards cash-for-care (home care packages) is arguably a modern-day manifestation of the arm?s length attitude that the subsidiarity principle recommends the State take. Research implications: The fact that care services are increasingly delivered by private sector companies and informal carers operating in the grey market increases the complexity of the care regime and therefore makes the task of developing social care regime classifications more complicated; it also means that regulation of the care sector in Ireland is a particularly urgent task that is yet to be undertaken in a comprehensive manner. Practical implications: The policy challenges involved in attempts to regulate the complex care mix are considerable. Originality/value of paper The article utilises both historical methods and policy analysis to highlight the changing meaning of key concepts such as subsidiarity.