Social care packages: Coventry study shows direct payments do not guarantee choice and control for older people

25% of older people needing help with basic tasks still cannot choose when they eat, when to take a bath or shower or what time to go to bed, according to a study by researchers at Coventry University's Centre for Communities and Social Justice.

This is true for those who take their entitlement as a direct payment; for those with traditional, council-managed care packages the choice is even less.

"Although personal budgets give more control than council-run care, the idea they will put the user in control often falls short of expectations," said the study's principal investigator, Dr John Woolham of Coventry University.

"People like the idea of personal budgets, but having the cash to spend directly doesn't always give people more control – and we think many older people may be less interested in choice than in reliability and continuity of care."

The study explored whether the social care needs of older people were best served by taking their personal budget as a direct payment, and compared staff, user and carer experiences of social care between those with a direct payment and those with a managed personal budget.

It found that while personal budgets had the potential to give more choice, control and independence for older people, take up was limited due to lack of suitable services and information, low expectations, the stress of arranging care at a time of crisis and having someone willing and able to take on the administrative burden.

The timing of taking a bath or a shower was a compromise between what people would like and what was possible, or in over a third of direct payment cases people were given no choice at all.

27% could not choose what time they went to bed and 26%, and 36% had to compromise over the timing of meals and bathing or showering respectively. The figures for council-run services were higher, with 41% having to compromise over timing of meals and bedtimes and 43% over when they could have a bath or shower.

Services were often also far from 'personalised', with carers changing often and without notice. One unpaid carer said: "It would be nice if they didn't send new people a lot because you need to get to know your carers and trust them. And when they're doing personal care for you, I think it should be somebody you know, not a complete stranger giving you a bath."

Amounts allocated for older people's care packages were low at around £188 a week. This meant that once basic daily living activities were paid for there was little – if anything – left over to meet social needs, despite strong evidence of the negative impact of loneliness on older people.

Overall the study found little difference between people with direct payments and those with traditional managed budgets in relation to health, stress and social care related quality of life (QOL) outcomes. Unpaid carers of older people with direct payments reported higher stress levels, possibly due to the additional responsibilities of arranging, managing and accounting for care services.

Councils were working to make direct payments more useful and easier to administer by working with local service providers, streamlining administration and improving information, but managers acknowledged there was a long way to go. The study found that older people were more interested in receiving services that were reliable and offered continuity, enabling them to develop friendly and trusting relationships with their carers. This suggests that local authorities should focus more on the quality of care offered to older people and less on promoting autonomy and choice.

The full summary findings is available here.

For further information please contact the School of Social Care Research by email (sscr@lse.ac.uk) or call 020 7955 6238, or contact Dr John Woolham directly (john.woolham@coventry.ac.uk). Alternatively, contact Alex Roache, external press and media relations officer, Coventry University, on +44 (0)24 7765 5050 or email alex.roache@coventry.ac.uk.

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