Choice and control for older people using home care services: how far have council-managed personal budgets helped?

Abstract

This paper reports the experiences of older people who use council-managed personal budgets (PBs) to fund home care services and their satisfaction with the level of choice and control they are able to exercise. Design/methodology/approach Data were collected from 18 older people from eight home care agencies across three councils in England. All interviews were semi-structured and face-to face. Findings Despite some optimism about improvements in choice and flexibility experienced by older people using home care services, the findings from this small study suggest that T people felt able to exercise to tailor home care services to their personal needs and preferences was restricted to low level choices. Other choices were constrained PB and council restrictions on what PBs can be spent on. O understanding of limitations in public funding/pressures on agencies and their reluctance to play an active consumer role including willingness from unsatisfactory care arrangements appeared to further challenge the potential for achieving greater choice and control through council-managed PBs. Originality/value The English organisational arrangements for managed PBs aim to promote user choice and control. This is the first study to report the experiences of older people using managed PBs under these new arrangements. The paper highlights areas of interests and concerns that social care staff, support planners and commissioners may need to consider.

Assessing satisfaction with social care services among black and minority ethnic and white British carers of stroke survivors in England

“…Some participants highlighted poor care from social care staff but then qualified this by saying that it was probably not their fault and was probably their employers’ responsibility or due to financial constraints. In line with some other research with older people, many participants appeared to prefer to accept poor care rather than to complain (Rabiee & Glendinning ). This may suggest that participants value these relationships, wanting them to work and may try to shift the responsibility away to relatively distant, anonymous organisations.…”

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

“…Existing research is also limited by amalgamation of data on older people that are taking their PB (or IB) as a council-managed budget or a provider-managed budget with those using DPs [ 25 , 27 , 31 ]. PBs managed by local authorities (where the personal budget is “paid to” the council), offer limited participation for recipients in services they receive [ 34 ]. Data on provider-managed budgets (also referred to as “Individual Service Funds”) is scarce [ 34 , 35 ].…”

“…PBs managed by local authorities (where the personal budget is “paid to” the council), offer limited participation for recipients in services they receive [ 34 ]. Data on provider-managed budgets (also referred to as “Individual Service Funds”) is scarce [ 34 , 35 ]. Consequently, outcomes data specific to older people in receipt of DPs are extremely limited.…”

Choice and control in social care: Experiences of older self‐funders in England

“…For some groups, such involvement has been associated with better outcomes (Hatton & Waters, ) and more personalized care (Rodrigues & Glendinning, ); however, the level of involvement some people want in making choices is limited. Rabiee and Glendinning () suggest that older people often do not want choice over how much care they need or which organization provides it. Choice and control for older people typically sits at the “micro” level of the individual's daily routine; people want to make choices about what to eat for lunch or what to wear, which care worker visits and at what time (Duncan‐Myers & Huebner, ; Rabiee & Glendinning, ; Steffansson, Pulliainen, Kettunen, Linnosmaa, & Halonen, ), but not about which care agency delivers the care.…”

“…Rabiee and Glendinning () suggest that older people often do not want choice over how much care they need or which organization provides it. Choice and control for older people typically sits at the “micro” level of the individual's daily routine; people want to make choices about what to eat for lunch or what to wear, which care worker visits and at what time (Duncan‐Myers & Huebner, ; Rabiee & Glendinning, ; Steffansson, Pulliainen, Kettunen, Linnosmaa, & Halonen, ), but not about which care agency delivers the care. Rabiee, Baxter, and Glendinning () also found, in a study of how support planning and brokerage assisted older people in using PBs to exercise choice and control, that the size of budgets and rules on their use appeared to limit choice.…”