Problems of dependency groups: The care of the elderly, the handicapped and the chronically ill

Abstract

The handicapped, the chronic sick and the elderly are described by the author as ‘dependency groups’ to emphasise, despite their different diagnostic labels, their common status as citizens and patients. They share several crucial characteristics—they are not amenable to curative treatment and not being susceptible to professional skills are professionally uninteresting; they are potentially costly as long-term users of medical and social services; having multiple needs, they are not the clear responsibility of any one service; they are economically unproductive and hence economically and socially dependent. They pose the policy question : who should accept what degrees of responsibility for clients/ patients in these dependency groups and what form should support take? Public, political, professional and organisational responses to this question are reviewed and questions raised about the implementation of formal policies in the face of professional and organisational autonomy and separatism.