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BMC Geriatrics
Published in: BMC Geriatrics 1/2021

Open Access 01-12-2021 | Addiction | Research article

Influences of service characteristics and older people’s attributes on outcomes from direct payments

Author: Vanessa Davey

Published in: BMC Geriatrics | Issue 1/2021

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Abstract

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, unpaid care) 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.
Appendix
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Footnotes
1
Home care (also termed ‘domiciliary care’) is care provided at home. Where home care is state-funded, it is arranged through the local authority and usually provided by private home care agencies. These agencies recruit and train individuals to provide care per the service users’ support (or ‘care’) plan according to eligible assessed needs. This may include support with personal care, such as washing or dressing; cooking or preparing meals and/ or housekeeping or domestic work. Priority is given to personal care, nutrition and safety needs.
 
2
The pattern of local government in England is complex, with the distribution of functions varying according to the local arrangements. ‘Council’ refers to a council with social services responsibilities which include: London boroughs, Unitary authorities, Shire authorities and Metropolitan councils.
 
3
Direct payment support schemes provide support to people receiving direct payments. Services available may include support with: devising a support plan; budgeting; accountancy (and payroll, if hiring a personal assistant), recruitment and employee responsibilities. DPSS may also offer information on local homecare providers for service users who wish to purchase from a homecare agency, rather than recruit a personal assistant.
 
4
This context includes rigorous limitations on funding relative to need and consideration of available unpaid care prior to allocation of funds.
 
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Metadata
Title
Influences of service characteristics and older people’s attributes on outcomes from direct payments
Author
Vanessa Davey
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2021
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-020-01943-8

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