Abstract:Background
The connection between choice, control and health is well established in the literature on the social determinants of health, which includes choice and control of vital health and social services. However, even in the context of universal health and social care schemes, the ability to exercise choice and control can be distributed unequally. This paper uses the case of the Australian National Disability Insurance Scheme (NDIS) to examine these issues. The NDIS is a major policy reform b… Show more
“…Direct Payments (DPs), cost-equivalent cash payments, are now core routes through which individuals eligible for publicly-funded social care can purchase care directly through their “personal” or hypothecated budget (PB). This is a policy drawing on US models of consumer-directed care [ 3 – 6 ], with similarities to recent developments in Australia [ 7 – 10 ] and across Europe [ 11 ]. Fig.…”
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.
“…Direct Payments (DPs), cost-equivalent cash payments, are now core routes through which individuals eligible for publicly-funded social care can purchase care directly through their “personal” or hypothecated budget (PB). This is a policy drawing on US models of consumer-directed care [ 3 – 6 ], with similarities to recent developments in Australia [ 7 – 10 ] and across Europe [ 11 ]. Fig.…”
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.
“…Additionally, it was also stressed that individualised funding schemes are essential for achieving personalised support. Reviewing the current evidence in line with previous research, it appears that people's circumstances can enable or constrain their access to supports [101,102] thus, within Australia and internationally, inequities within the population of PWD must be considered when contemplating the factors that influence the quality of support.…”
Section: Discussionmentioning
confidence: 82%
“…Theoretically, individualised funding models enable choice and control, but there is recent evidence demonstrating self-managed funding arrangements can compound inequities between people with different types of disabilities and socio-demographic backgrounds [101,102]. Due to the lack of specialist disability services in rural and remote communities, this review provides evidence that geographical location can limit access to support for PWD, in line with previous research [103], as well as concerns raised by the Productivity Commission [12] in Australia with the introduction of the NDIS.…”
Purpose: Theoretically, individualised funding schemes empower people with disability (PWD) to choose high quality support services in line with their needs and preferences. Given the importance of support, the aim of this scoping review was to understand the factors that influence the quality of paid disability support for adults with acquired neurological disability. Methods: A comprehensive scoping review of the published literature from 2009-2019 was conducted on five databases: Medline, CINAHL, Embase, PsycINFO and Scopus. Results: Of the 3391 records retrieved, 16 qualitative articles were eligible for review. Thematic synthesis of the findings revealed six key interrelated themes: (1) choice and control, (2) individualised support, (3) disability support worker (DSW) qualities, (4) DSW competence, (5) PWD-DSW relationship, and (6) accessing consistent support. The themes depict factors influencing the quality of paid disability support from the perspective of PWD, close others and DSWs. Conclusions: Although the evidence base is sparse, the factors identified were in line with international rights legislation and policy ideals. The findings can provide insights to PWD hiring and managing support, and facilitate the delivery of quality disability support. Further research is required to understand the interactions between the factors and how to optimise support in practice. ä IMPLICATIONS FOR REHABILITATION The quality of paid disability support is determined by a multitude of interrelated factors influenced by the disability support worker's qualities and competencies, the interaction between the person with disability and the disability support worker, as well as external contextual factors. Optimising choice and control for adults with acquired neurological disability and providing individualised support should be a significant focus for disability support workers. Training modules for disability support workers can be informed by five of the identified themes: (1) choice and control, (2) individualised support, (3) DSW qualities, (4) DSW competence and (5) the relationship between PWD and DSWs.
“…One method that could be used to develop such measures is the service design process, which enables policymakers to look at solutions through the eyes of persons with different types of disabilities (e.g., Beck et al, 2014). In practice, using this approach demands more personalisation of support schemes for persons with disabilities, given that the extent to which persons with disabilities can achieve a good quality of life is in uenced by the nature of their impairments; their individual, family, and community characteristics; as well as the environmental conditions created at local levels (Malbon et al, 2019).…”
BackgroundThe United Nations Convention on the Rights of Persons with Disabilities highlights the need to create proper socio-economic and political conditions for persons with disabilities, with a special focus on their immediate living conditions. According to the Convention, these conditions should be built to ensure that persons with disabilities have the potential to enjoy a high quality of life (QoL), and this principle is reflected in the notion of liveable areas. The crucial aspect of this framework is the relationship between the individual QoL and the environment, broadly understood as the socio-economic as well as the technical conditions in which persons with disabilities function.MethodsThe basic research problem was to assess the relationship between individual QoL for the population with disabilities as a dependent variable and liveability indicators as independent variables, controlling for individual characteristics. The study used a dataset from the EU-SILC (European Union Statistics on Income and Living Conditions) survey carried out in 2015 in Poland. The research concept involved several steps. First, we created a variable measuring the QoL for the entire population with disabilities. To measure the multidimensional QOL, we used Sen’s capability approach as a general concept, which was operationalised by the MIMIC (multiple indicators multiple causes) model. In the second step, we identified the liveability indicators available in the official statistics, and merged them with survey data. Finally, in the last step, we ran the regression analysis. We also checked the data for the nested structure.ResultsWe confirmed that environmental conditions, defined as all conditions focused on creating liveable areas, played a significant role in shaping the QoL of persons with disabilities, and that this relationship held even after controlling for the demographic characteristics of the respondents. Moreover, we found that in addition to the general environmental conditions, the conditions created especially for persons with disabilities affected the QoL of these individuals. ConclusionsThe results illustrate the need to strengthen policies aimed at promoting the QoL of persons with disabilities by creating access to community assets and services that can contribute to improving the life chances of this population.
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