Cash-for-care schemes offering cash payments in place of conventional social services are becoming commonplace in developed welfare states; however, there is little evidence about the impact of such schemes on older people. This paper reports on the impact and outcomes for older people of the recent English Individual Budget (IB) pilot projects (-). It presents quantitative data on outcome measures from structured interviews with  older people who took part in a randomised controlled trial and findings from semi-structured interviews with  older people in receipt of IBs and with IB project leads in each of the  pilot sites. Older people spent their IBs predominantly on personal care, with little resources left for social or leisure activities; and had higher levels of psychological ill-health, lower levels of wellbeing, and worse self-perceived health than older people in receipt of conventional services. The qualitative interviews provide insights into these results. Potential advantages of IBs included increased choice and control, continuity of care worker, and the ability to reward some family carers. However, older people reported anxieties about the responsibility of organising their own support and managing their budget. For older people to benefit fully from cash-for-care schemes they need sufficient resources to purchase more than basic personal care; and access to help and advice in planning and managing their budget.KEY WORDSolder people, personal budgets, individual budgets, cash-for-care, choice and control.Cash-for-care schemes offering cash payments in place of conventional social services to older and disabled people are increasingly commonplace throughout developed welfare states. However, there is little evidence about the impact of such schemes on older people, and less still that gives voice to older people and to their individual experiences of cash-for-care schemes. This paper reports on an evaluation of a recent English cash-forcare scheme, the Individual Budget (IB) pilot projects (the IBSEN study). It highlights the impact and outcomes of IBs for older people through survey data; semi-structured interviews with a sub-sample of older IB users and their proxies; and semi-structured interviews with the IB project lead in each of the  IB pilot sites.Cash-for-care schemes that offer older and disabled people cash payments or access to a specified cash resource, instead of allocations of services in kind, are increasingly common in parts of Europe, Australia, Canada and the United States of America (Da Roit and Le Bihan ; Doty, Mahoney and Simon-Rusinowitz ; European Commission ; Glendinning and Kemp ; Leece and Leece ; Lord and Hutchison ; Timonen, Convery and Cahill ; Ungerson and Yeandle ). In some countries, such schemes are available to older people as part of arrangements for funding long-term care; elsewhere cash payments are only available to younger disabled people as part of moves to support independent living; in other countries cash-for...

This article aims to explore the concept of choice in public service policy in England, illustrated through findings of the Individual Budgets (IB) evaluation. The evaluation tested the impact of IBs as a mechanism to increase choice of access to and commissioning of social care services around the individual through a randomised trial and explored the experiences and perspectives of key groups through a large set of interviews. The article presents a reexamination of these interview data, using three 'antagonisms of choice' proposed in the literature -choice and power relations, choice and equity, and choice and the public nature of decisions -as organising themes. The randomised trial found that IB holders perceived they had more control over their lives and appreciated the extra choice over use of services, albeit with variations by user group. However, problems of power relations, equity and the constraints implied by the public nature of decision-making were complicating and limiting factors in producing the benefits envisaged. The focus on choice in policy, especially as implemented by IBs, emphasises an individualistic approach. The findings suggest that addressing broader issues relating to power, equity and an understanding of the public nature of choice will be of value in realising more of the benefits of the policy.

BackgroundPerson-centredness is promoted as a central feature of the long-term care of older adults. Measures are needed to assist researchers, service planners and regulators in assessing this feature of quality. However, no systematic review exists to identify potential instruments and to provide a critical appraisal of their measurement properties.MethodA systematic review of measures of person-centredness was undertaken. Inclusion criteria restricted references to multi-item instruments designed for older adult services, or otherwise with measurement properties tested in an older adult population. A two-stage critical appraisal was conducted. First, the methodological quality of included references was assessed using the COSMIN toolkit. Second, seven measurement properties were rated using widely-recognised thresholds of acceptability. These results were then synthesised to provide an overall appraisal of the strength of evidence for each measurement property for each instrument.ResultsEleven measures tested in 22 references were included. Six instruments were designed principally for use in long-stay residential facilities, and four were for ambulatory hospital or clinic-based services. Only one measure was designed mainly for completion by users of home care services. No measure could be assessed across all seven measurement properties. Despite some instruments having promising measurement properties, this was consistently undermined by the poor methodological quality underpinning them. Testing of hypotheses to support construct validity was of particularly low quality, whilst measurement error was rarely assessed. Two measures were identified as having been the subject of the most rigorous testing.ConclusionThe review is unable to unequivocally recommend any measures of person-centredness for use in older adult care. Researchers are advised to improve methodological rigour when testing instruments. Efforts may be best focused on testing a narrower range of measurement properties but to a higher standard, and ensuring that translations to new languages are resisted until strong measurement properties are demonstrated in the original tongue. Limitations of the review include inevitable semantic and conceptual challenges involved in defining ‘person-centredness’.The review protocol was registered with PROSPERO (ref: CRD42014005935).Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0229-y) contains supplementary material, which is available to authorized users.

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