Explaining Low Uptake of Direct Payments in Residential Care: Findings from the Evaluation of the Direct Payments in Residential Care Trailblazers

Ettelt, Stefanie; Williams, Lorraine; Perkins, Margaret; Wittenberg, Raphael; Lombard, Daniel; Damant, Jacqueline; Mays, Nicholas

doi:10.1017/s0047279417000794

Cited by 11 publications

(22 citation statements)

References 20 publications

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“…The plan was that the remaining local authorities would learn from the experience of the trailblazers and that direct payments would be made available to all residents in care homes from April 2016. However, in 2015 (Ettelt et al, 2017). The aims of the evaluation were to understand how direct payments could be introduced in residential care and to assess the potential impact of direct payments on care home residents, their families, local authorities and care home providers.…”

Section: Introductionmentioning

confidence: 99%

Evaluating direct payments in residential care: the perspective of care home providers

Lombard

Wittenberg

Ettelt

et al. 2019

International Journal of Care and Caring

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This paper reports findings from the evaluation of the Direct Payments in ResidentialCare Trailblazers in England (2014-16). It focuses on the perspective of residential care providers on implementing direct payments, which were aimed at improving the level of choice and control over care available to their residents. The paper explores the views of providers using interviews and survey responses of care home managers and owners. Concerns expressed by providers include issues that have arisen in domiciliary care but also issues specific to residential care, especially challenges in facilitating greater choice and control in settings that provide care collectively for substantial numbers of residents.

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Section: Introductionmentioning

confidence: 99%

Evaluating direct payments in residential care: the perspective of care home providers

Lombard

Wittenberg

Ettelt

et al. 2019

International Journal of Care and Caring

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“…The model of funding recommended by the jurors (a split between core and discretionary services) has some similarities to one of the models trialled within the pilot of direct payments in residential care in England described earlier. 10 The evaluation of the program found that this particular model of funding was however more difficult to implement than the other models and, as noted, that costs of establishing the scheme were high as was the administrative work involved in managing payments and organizing activities for all models. Uptake of direct payments in the English pilot program was poor and residents will be less likely to choose this model of care if it is associated with considerable administrative costs.…”

Section: Discussionmentioning

confidence: 99%

“…While the main recommendation relates to redistribution of existing funding to core and discretionary funding, there will be administrative costs in establishing this as found within other programs. 10 As there are issues around risk management, extensive work would need to be undertaken to detail the rights and responsibilities of the provider, the resident and their families.…”

Section: Discussionmentioning

confidence: 99%

“…A pilot of direct payments in residential care in England identified three main models of funding: providing the resident with the full amount of money to spend; continued payment of the residential care fee by the local authority and providing the resident with some additional funds to spend; and dividing the money between the resident and the local authority, each taking responsibility for some of the payment. 10 The evaluation of this pilot found that users reported some benefits including a greater sense of empowerment and the ability to access different services. Uptake of the scheme was poor within councils and among residents, suggesting that the approach was not particularly desirable for either group.…”

Section: Introductionmentioning

confidence: 98%

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Introducing consumer directed care in residential care settings for older people in Australia: views of a citizens’ jury

Laver

Gnanamanickam

Whitehead

et al. 2018

J Health Serv Res Policy

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Objectives Health services worldwide are increasingly adopting consumer directed care approaches. Traditionally, consumer directed care models have been implemented in home care services and there is little guidance as to how to implement them in residential care. This study used a citizens' jury to elicit views of members of the public regarding consumer directed care in residential care. Methods A citizens' jury involving 12 members of the public was held over two days in July 2016, exploring the question: For people with dementia living in residential care facilities, how do we enable increased personal decision making to ensure that care is based on their needs and preferences? Jury members were recruited through a market research company and selected to be broadly representative of the general public. Results The jury believed that person-centred care should be the foundation of care for all older people. They recommended that each person's funding be split between core services (to ensure basic health, nutrition and hygiene needs are met) and discretionary services. Systems needed to be put into place to enable the transition to consumer directed care including care coordinators to assist in eliciting resident preferences, supports for proxy decision makers, and accreditation processes and risk management strategies to ensure that residents with significant cognitive impairment are not taken advantage of by goods and service providers. Transparency should be increased (perhaps using technologies) so that both the resident and nominated family members can be sure that the person is receiving what they have paid for. Conclusions The views of the jury (as representatives of the public) were that people in residential care should have more say regarding the way in which their care is provided and that a model of consumer directed care should be introduced. Policy makers should consider implementation of consumer directed care models that are economically viable and are associated with high levels of satisfaction among users.

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“…Choice policies are currently being extended via the use of personal budgets for residential care, where users are allocated direct payments or managed budgets to allow them greater control over provider and service choice (Ettelt et al . 2015). A large proportion of people funding their own care have always been able to select their provider of choice, subject to their own financial limitations.…”

Section: Introductionmentioning

confidence: 99%

Information and choice of residential care provider for older people: a comparative study in England, the Netherlands and Spain

Trigg¹,

Kumpunen

Holder

et al. 2017

Ageing and Society

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This study compared how older people use quality information to choose residential care providers in England, the Netherlands and Spain (Catalonia). The availability of information varies between each country, from detailed inspection and survey information in the Netherlands, through to a lack of publicly available information in Catalonia. We used semi-structured interviews and group workshops with older people, families and professionals to compare experiences of the decision-making process and quality information, and also to explore what quality information might be used in the future. We found that most aspects of the decision-making experience and preferences for future indicators were similar across the three countries. The use of quality information was minimal across all three, even in England and the Netherlands where information was widely available. Differences arose mainly from factors with the supply of care. Older people were most interested in the subjective experiences of other residents and relatives, rather than ‘hard’ objective indicators of aspects such as clinical care. We find that the amount of publicly available quality information does not in itself influence the decisions or the decision-making processes of older people and their carers. To improve the quality of decisions, more effort needs to be taken to increase awareness and to communicate quality in more accessible ways, including significant support from professionals and better design of quality information.

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Explaining Low Uptake of Direct Payments in Residential Care: Findings from the Evaluation of the Direct Payments in Residential Care Trailblazers

Cited by 11 publications

References 20 publications

Evaluating direct payments in residential care: the perspective of care home providers

Evaluating direct payments in residential care: the perspective of care home providers

Introducing consumer directed care in residential care settings for older people in Australia: views of a citizens’ jury

Information and choice of residential care provider for older people: a comparative study in England, the Netherlands and Spain

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