Personal Budgets for Elderly Care – A better choice, or no choice at all?

New research by Coventry University has concluded that the obvious benefits of direct payments are being compromised by a lack of funding and choice, and was highlighted in a recent article in The Guardian. Unfortunately, there is no surprise in this.

Choice – a meaningless promise

The idea that elderly people responsible for their budgets would opt for a visit to the swimming pool over essential assistance with personal care, when the budget being offered for personal care for the elderly is often at a minimal level, is laughable.

Indeed, the very nature of managing your own personal budget as a direct payment means you can only spend the money on services or equipment that meet your assessed needs. In theory this is supposed to mean that you can choose the ones that best suit you and your lifestyle. If the amount of funds available only covers basic needs anyway, then there is no true choice, and the statement is meaningless. This is very likely to be the case in most local authorities, since all have had to cut their budgets significantly.  Furthermore, the move towards direct payments is so far outside the cultural assumptions under which social services departments operate that it would be akin to suddenly switching to metric units after a life time of imperial. Advising people to be more independent is a difficult concept for local authorities to think through, let alone implement.

Personal decisions – compromised

The Guardian points out that the research found that a quarter of older direct payment users said decisions about when they ate, went to bed or had a bath/shower were compromised. There was never enough money to allow choice over different care arrangements or leisure items and it is made worse as personal budgets have been frozen.

Local authorities have crowed about the savings to Community charge rates, while bleeding care providers through restricted pay rates, often arrived at with a complete lack of commercial understanding. Many local authorities, including our local Royal Borough of Windsor and Maidenhead, have frozen rates each year for domiciliary care since 2009. Although inflation was only between 2.2% and 4.3% in the past five years, the impact of inflation alone to providers is a cost increase of 16%. The impact of cost rises on care workers is even greater, with petrol price hikes and a stubborn, continuing refusal by local authorities to pay for any travel time.

The net result is a reduction in the number of providers that are willing to quote for Local Authority work. No wonder Coventry University discovered a lack of innovation among providers for personalised budget holders!

Elderly care needs – different from those of others?

Another issue raised by the research is whether personalised budgets which were driven by the younger disabled lobby — where the budget is sometimes managed often by fit, healthy adults on behalf of the care recipients —  is appropriate for the elderly. Among the younger disabled recipients there is a much more positive view of personalised budgets than amongst the elderly, who feel much less confident when faced with managing their own budgets.

The care situation for the elderly is likely to deteriorate further: most of the information about personal budgets for elderly persons can be a challenge to access for older people, since they are primarily placed on web platforms, and there is the administrative burden of Local Authority bureaucracy to deal with. However, the biggest difference may come from something that was not made explicit in the Coventry research at all: the vast difference between elderly care packages and those for younger adults.  The baseline for the elderly care packages is care visits based on a miserly 15-minute slot – for others, it is often from longer, person-in-attendance type of care calls.

Budgets – making things worse?

Outcomes of other independent assessments this year, as reported in Pulse, a publication for GPs, attest that the personal care budget scheme was not only inadequate but could actually make matters worse for elderly care. It states that: “The assessment by experts at the University of Glasgow and King’s College London finds that on average personal health budgets cost £4,000 more per patient than usual care, but that in some cases it had a ‘negative impact’ on patient outcomes.” This is in direct contrast to what the Department of Health believes and the line it takes publicly.

In my experience giving control back to an elderly person to manage their care, although it is in many cases exactly what they want, can be pointless or even counterproductive if it is not accessible, sufficient, and realistic in relation to their real needs.

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