Legislating community care: the British experience, with U.S. comparisons.

In 1990, Great Britain enacted the National Health Service and Community Care Act to reduce unnecessary institutionalization, improve coordination of community-based long-term care, and stimulate private service provision. An overview of four major principles of the legislation is provided: the elevation of the assessor/care manager role, the emphasis on inter-agency collaboration across the health and social care divide, privatization of service, and support of carers (caregivers). Preliminary findings related to their implementation indicate incremental rather than sweeping change. The elements of the new policy that borrow from American models of community care--and may be difficult to transplant--are highlighted.