The impact of personal budgets on unpaid carers of older people

Woolham, John; Steils, Nicole; Daly, Guy; Ritters, Katrina

doi:10.1177/1468017316654343

Cited by 13 publications

(15 citation statements)

References 29 publications

(37 reference statements)

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“…Previous research has noted that ‘third-party organisations’ support improves outcomes for individuals with and without unpaid care [ 30 , 86 ]. Backed by qualitative research it has been widely accepted that DP support is critical to take-up of DPs [ 87 ], that absence of payroll support can put people off using DPs [ 38 ] and that DP support can ease the burden felt by unpaid carers [ 36 , 88 ] but the lack of a clear association between the role of support services and particularly support for recruiting care (as demonstrated in this study), has weakened the priority given to DP support.…”

Section: Resultsmentioning

confidence: 99%

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

Davey

2021

BMC Geriatr

119

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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.

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Section: Resultsmentioning

confidence: 99%

“…Attempting to address these issues, Woolham et al [ 36 ] compared the outcomes of DPs to managed budgets (MBs) among older people. Their findings suggest no significant differences in social care outcomes between the service types, although DP recipients scored higher for process outcomes (timing of care and satisfaction with services).…”

Section: Introductionmentioning

confidence: 99%

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

Davey

2021

BMC Geriatr

119

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“…There is some evidence of positive impacts of personal budgets for carers, especially in terms of the flexibility afforded, allowing carers to be able to better balance caregiving with their other responsibilities and make employment decisions (Larkin, 2015; Woolham et al., 2018). Other studies found that personal budgets supported carers to have free time for their own social, leisure or essential activities (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…However, there were also some negative aspects. Some carers report that managing personal budgets was stressful, even if this somewhat reduced over time (Larkin, 2015; Moran et al., 2012; Woolham et al., 2018). Carers also described that sometimes, they did not have enough confidence in those providing the support to be able to stand back from caregiving and feel less anxious (Larkin, 2015).…”

Section: Introductionmentioning

confidence: 99%

Family carers managing personal budgets for adults with learning disabilities or autism

Turnpenny

Rand

Whelton

et al. 2020

Brit J Learn Disabil

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Accessible summary Direct payments can help people with learning disabilities or autism to have good support. Often, family carers manage the direct payments for people who would find this very difficult. We asked family carers who managed direct payments to tell us why they decided to do this and what their experiences were. Family carers told us they found managing direct payments difficult and stressful at first, but this got easier over time. They also said that direct payments helped their family members to have more person‐centred support. Abstract BackgroundThere are a growing number of people with learning disabilities and autism who access personal budgets in the form of direct payments in England. Although they are often involved in decisions about their support, personal budgets are usually managed by someone else, typically a parent. This study examined the experiences of carers who manage personal budgets for adults with learning disabilities or autism with a particular focus on the challenges of securing suitable support and implications for their own well‐being. MethodsThis was a qualitative study using a descriptive phenomenological approach to investigate the lived experiences of family carers who manage personal budgets. We conducted semi‐structured interviews with 13 family carers. Interview transcripts were thematically analysed using the framework approach. ResultsOur analysis identified five main themes. The first theme relates to why carers decide to take up a personal budget in the first place and their initial expectations. The second theme, restricted choice, highlights the difficulties in securing adequate support and services in the context of what are often described as “complex needs.” The third and fourth themes relate to the tasks involved in managing a personal budget and the challenges associated with the dual role of the carer as a parent and a “professional.” The fifth and final theme, mixed emotions, describes the impact on the subjective well‐being of carers. ConclusionsFamily carers indicated that the benefits of personal budgets outweighed the difficulties and stress inherent in managing them. They need adequate support to ensure that personal budgets deliver personalised and self‐directed support and greater well‐being, and are sustainable arrangements.

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“…Building upon the principles of greater choice and influence of those who use services, and upon the existing system of Direct Payments (a cash payment to service users to pay for their own care), a proposal for Personal Budgets (a wider form of Direct Payment) for individual service users was developed (Department of Health, 2005), whether managed by the individual or by others, including care managers, on their behalf (Department of Health, 2008a). Subsequent studies have suggested that older people, in particular, placed less value on self-management of resources than others (Glendinning et al 2008;Slasberg et al 2012;Woolham & Benton, 2013;Woolham et al 2017Woolham et al , 2018 and support by a care manager or coordinator, from either public or non-statutory organisations, was viewed as important by older people in managing their care (Woolham et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Care Coordination for Older People in the Non-Statutory Sector: Activities, Time Use and Costs

Hughes¹,

Jasper²,

Worden³

et al. 2020

Journal of Long Term Care

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Context: Care coordination is one important mechanism to provide effective care at home for frail older people in a world with ageing populations. In England this has usually been undertaken by state funded local authority social care services. The Care Act 2014 promoted greater involvement of the non-statutory sector in the provision of care and support, including care coordination, for older people at home to offer greater flexibility and consumer choice. Objective(s): To explore how organisations in the non-statutory sector in England undertake care coordination activities, targeting, their staff time use and costs to support older people at home. Method(s): A case study approach was used involving semi-structured interviews with practitioners in 17 services selected from a national survey in 2015. Estimates of practitioner time use for a typical case, and associated costs for each service were calculated. Data were analysed to identify the range of care coordination activities undertaken, forms of targeting, patterns of staff time use and service costs. Findings: Two services undertook no targeting activities; of eight care coordination activities only two were undertaken in all services. Costs of care coordination activities varied both within and between services in two distinct settings: hospital discharge and memory services. More time was spent by practitioners in direct contact with service users and carers than on indirect activities in most care coordination services. Limitations: A case study approach is more difficult to generalise; recall bias may have influenced data on time use and costs from practitioner interviews; some costs had to be attributed using national data. Implications: Both service setting and gatekeeping mechanisms shaped care coordination activities. Where services were designed to substitute for statutory services their sustainability needs to be addressed in terms of length of contracts, extent of case responsibility and full costing.

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The impact of personal budgets on unpaid carers of older people

Cited by 13 publications

References 29 publications

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

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

Family carers managing personal budgets for adults with learning disabilities or autism

Care Coordination for Older People in the Non-Statutory Sector: Activities, Time Use and Costs

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