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Social care for older people: the role and function of direct payments
- Author:
- DAVEY Vanessa
- Publisher:
- London School of Economics and Political Science
- Publication year:
- 2018
- Pagination:
- 290
- Place of publication:
- London
Direct payments (DPs) are now a core route for publicly funded social care provision in the UK. DPs are allocated to meet needs of social care recipients in lieu of community-managed social care services. DP recipients must organize their own care even if external support is usually available for some tasks. There are long-standing concerns about the benefits of direct payments for older people. Perceived risk factors include frailty, limited social networks, a lack of information technology skills, spouse co-morbidity, overburdened unpaid carers. Little is known about how direct payments actually work for older people. This thesis investigates direct payments practice, analysing newly collected and previous data from a variety of perspectives. First, a general view on policy and practice developments is obtained by tracing the evolution of DP support in the past decade. A bottom-up perspective follows, analysing interviews with 82 older people receiving DPs. The unprecedented detail given by this data permits the identification of factors associated with greater gain from DPs and exploration of how DP-care fits within pre-existing patterns of care, both formal and informal. Two particular phenomena highlight the unique role of DPs. The first is the role of husband and wife teams. In these husbands, affected by chronic physical illness, provide very substantial levels of unpaid care. As the term suggests, the couples operated DPs as a team: a mechanism which enhanced their ability to manage. Direct payments were critical to increase these couples' health and social capital. The second explores the circumstances of working unpaid carers managing DPs for older people. Overstretched and overburdened, these carers still found multiple benefits from DPs, not least the ability to coordinate care with their employment, ensuring the quality of services and with it their peace of mind. The work contributes to understanding how directing care through DPs fits in a continuum in which unpaid carers interact with formal care in any caregiving scenario. Directing care represents an additional phase in adaptation to dependence. Resilience is viewed as a confluence of individual, social, physical and environmental factors. For those with the most complex or precarious caregiving role, increased control may have the greatest benefits. (Edited publisher abstract)
Influences of service characteristics and older people’s attributes on outcomes from direct payments
- Author:
- DAVEY Vanessa
- Journal article citation:
- BMC Geriatrics, 21(1), 2021, Online only
- Publisher:
- BioMed Central Ltd
Background: Direct payments (DPs) are cash-payments that eligible individuals can receive to purchase care services by themselves. DPs are central to current social care policy in England, but their advantages remain controversial. This controversy is partly due to their lack of historical visibility: DPs were deployed in stages, bundled with other policy instruments (first individual budgets, then personal budgets), and amidst increasing budgetary constraints. As a result, little unequivocal evidence is available about the effectiveness of DPs as an instrument for older people’s care. This study aims to partially fill that gap using data obtained during an early evaluation of DP’s that took place between 2005 and 07. Methods: Semi-structured 81 face-to-face interviews with older people (and their proxies) using DPs are analyzed. DPs contribution to outcomes was measured using a standardized utility scale. Data on individual characteristics (dependency, informal support) and received services (types and amount of services) was also gathered. Multiple regression analyses were performed between measured outcome gains and individual and service characteristics. A Poisson log-functional form was selected to account for the low mean and positive skew of outcome gains. Results: Levels of met need compared very favorably to average social care outcomes in the domains of social participation, control over daily living and safety, and user satisfaction was high. Benefit from DPs was particularly affected by the role and function of unpaid care and availability of recruitment support. The freedom to combine funded care packages with self-funded care enhanced the positive impact of the former. The ability to purchase care that deviated from standardized care inputs improved service benefits. Large discrepancies between total care input and that supported through DPs negatively affected outcomes. Conclusions: The results offer clarity regarding the benefit derived from receiving DPs. They also clarify contested aspects of the policy such as the influence of unpaid care, types of care received, funding levels and the role of wider support arrangements. Tangible benefits may results from direct payments but those benefits are highly dependent on policy implementation practices. Implementation of DPs should pay special attention to the balance between DP funded care and unpaid care. (Edited publisher abstract)
Direct payments: a national survey of direct payments policy and practice
- Authors:
- DAVEY Vanessa, et al
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2007
- Pagination:
- 149p., bibliog.
- Place of publication:
- London
Direct payments allow people to arrange their own social services. They give individuals control over the social care funding to which they are eligible, and are seen as an important vehicle for promoting independence and choice. Yet there are substantial variations in direct payment arrangements. This UK-wide survey suggests that direct payments packages are provided to people receiving more hours of care per week than the average social care recipient. Significant disparities between local councils were found in the proportions of eligible people receiving direct payments as well as in hourly payment rates, which may affect how individuals attain a fair stake in the market for social care. Also, there were wide variations in the proportion of local community care budgets spent on direct payments, both between areas and across user groups. These were largely reflected in the strength in developments for different users groups; 15.5% of the budgets of English authorities for people with a physical disability was spent on direct payments, compared to 1.1% for people with a learning disability, 0.8% for older people and 0.4% for people with a mental health problem.
Direct payments: a national survey of direct payments policy and practice: executive summary
- Authors:
- DAVEY Vanessa, et al
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2007
- Pagination:
- 5p.
- Place of publication:
- London
Presents the main findings of a UK wide survey of direct payments. The findings report on who was in receipt of direct payments, levels of expenditure, rates of payment, commissioning practices, the provision of support to direct payments users and factors aiding or hindering in the implementation of direct payments.
Schemes providing support to people using direct payments: a UK survey: executive summary
- Authors:
- DAVEY Vanessa, et al
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2007
- Pagination:
- 5p.
- Place of publication:
- London
The main findings of a survey of schemes providing support to people using direct payment are summarised. Issues briefly discussed are: origins and function of organisations providing direct payments support, staffing, income, expenditure, services provided to direct payment users, service utilisation, and factors aiding or hindering the implementation of direct payment. The final section summarises the discussion and conclusions of the main report, which illustrate the dynamics of the direct payments support infrastructure and its development across the UK.
Schemes providing support to people using direct payments: a UK survey
- Authors:
- DAVEY Vanessa, et al
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2007
- Pagination:
- 126p., bibliog.
- Place of publication:
- London
Support services for people who receive direct payments, allowing them to organise their own care, are only reaching a proportion of the people they are set up for. If they were to be used by all eligible direct payment recipients, they would struggle to cope. Direct payment support services, mainly funded by local authorities and often run by voluntary or not-for-profit organisations, are part of the government’s plan to make personalised care the cornerstone of public services. Yet the services have a limited capacity, high staff caseloads, and receive very variable amounts of funding - highlighting varying commitment to the scheme from local authorities. The researchers also found that many local authorities focused on funding services that promote uptake and support users to set up payments and meet the basic statutory requirements instead of funding support for the ongoing management of a self-directed budget. This is despite evidence showing the significance of ongoing support in ensuring access to and the success of direct payments for some users, and is probably a factor in the extent of variation in direct payments uptake.
Loose connections
- Authors:
- DAVEY Vanessa, HENWOOD Melanie
- Journal article citation:
- Community Care, 15.5.03, 2003, pp.40-41.
- Publisher:
- Reed Business Information
The Personal Social Services Research Unit (PSSRU) at the London School of Economics recently undertook some work to gauge the progress on integration between agencies providing services for older people. Looks at the results of interviews in two county councils, two unitary authorities and two London to explore the scale of integrated or joint commissioning services for older people.
Involving older people in commissioning: more power to their elbow?
- Authors:
- WISTOW Gerald, WADDINGTON Eileen, DAVEY Vanessa
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2011
- Pagination:
- 75p., bibliog.
- Place of publication:
- York
This research set out to investigate what happens when older people are given the opportunity to shape service commissioning and delivery. The study also raises wider question of whether it can change the nature of local power relations in the long term. Dorset and Salford were identified as two areas where structures and processes exist which encourage and facilitate the involvement of older people in local decision-making. Through focus groups the research examined: how older people in these areas were involved in commissioning and service delivery; what difference their involvement made; the factors which lead to successful engagement; and the barriers to involving older people. Key findings revealed that public policy has made increasing reference to voice and choice for service users. Yet there were few examples where users have a real say in commissioning and more strategic approaches to service planning. Older people and agencies felt that their local involvement processes were worthwhile and associated with identifiable results. National focus groups were more sceptical about whether outcomes justified the time and resources involved. In conclusion, involvement should concentrate specifically on outcomes more than on processes.