The Capability Approach
The Capability Approach was first developed by the economist Amartya Sen. It proposes that the most important measures of Quality of Life (QoL) relate to a person’s level of functioning and the extent to which they can exercise this, which is termed their capability. It argues that measures of QoL where the primary focus is on resources (e.g. income) or utility (feelings of happiness and satisfaction with life) provide a flawed picture – although both can (and should) be included in the set of capabilities that we evaluate.
When Grewal and co-researchers1 set out in 2005 to develop the attributes for a QoL measure for older people it was with the intention of arriving at a utility-based set of attributes. What the researchers found from their interviews with older people was that the key elements of QoL for older people looked more like the functionings and capabilities described by Sen. What was important to people was what their functionings allowed them to do and to be. The findings of the 2005 research led to the proposal of five core attributes: attachment, role, enjoyment, security and control. This line of research continued at the University of Birmingham where these attributes were tested in more detail and formulated into the capability measure for older people, ICECAP-O. Around the same time, The Personal Social Services Research Unit (PSSRU) developed, with ONS funding, the Adult Social Care Outcomes Toolkit (ASCOT). This is a major piece of publicly funded research which has provided a research-standard set of tools for measuring adult social care outcomes. ASCOT is also grounded in the Capability Approach and describes its measures in terms of functionings and capabilities.
But while ICECAP-O and ASCOT are widely accepted, neither quite fits the requirements of a voluntary sector organisation seeking to provide support to older, typically vulnerable, people, living at home: ASCOT is aimed more at people with substantial and critical needs, while ICECAP-O is aimed more at older people in the general population, without identified needs.
The Capability Approach and low-level support
The Joseph Rowntree Foundation Older People’s Programme produced an important report in 2005 called ‘That little bit of help’2. It showed how older people value support which enables them to live in their own homes and have ‘a life worth living’, enabling them to retain choice, control and dignity in their lives. That ‘little bit of help’ referred to the kinds of support that meet a person’s needs for low-level assistance and, while rooted in health or social care-type services also address the wider needs of older people.
LEAF-7’s capability-linked Quality of Life questions recognise these wider terms of reference (which are also drivers of health and wellbeing) and which, when compromised, often provide early signs of impending deteriorations in health and wellbeing.
The scope of LEAF-7’s seven questions can provide a more far-reaching (and practical) appreciation of a person’s situation than, say, an assessment purely of mental wellbeing or of health status. This complements an agenda that prioritises a prevention or early intervention approach.
1“Developing attributes for a generic quality of life measure for older people: Preferences or capabilities?”
Grewal I., Lewis J., Flynn T., Brown J., Bond J., Coast J.,. 2006. Social Science and Medicine, Volume 62, Issue 8 1891-1901.
2Joseph Rowntree Foundation (2005). The Older People’s Inquiry: That little bit of help. York: Joseph Rowntree Foundation. Available on line at: jrf.org.uk/bookshop/ebooks/Briefing03.pdf
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