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Older people and personal budgets: challenges and possible solutions
Challenge: Direct payments seen as too burdensome by some older people; but council-managed personal budgets can limit choice.
Solutions: Councils are appointing third parties, such as family members or voluntary agencies, to manage direct payments, or using individual service funds, where providers manage the budget. These aim to maximise choice while relieving older people of the need to manage the budget.
Challenge: Older people's teams inexperienced in self-directed support (SDS) and not effectively promoting personal budgets to clients.
Solutions: One council has employed three senior practitioners, including a mentor/coach, to support the implementation of SDS in older people's teams. Another has merged older people's teams with physical disabilities teams who are more used to SDS.
Challenge: Care managers lack time and, sometimes, expertise to creatively support plan with older people, who may also lack friends or family to help them.
Solutions: Councils are outsourcing support planning to user-led/community organisations to promote more creative approaches and increase capacity.
Source: Improving personal budgets for older people: a review - Think Local Act Personal/Social Care Institute for Excellence
There are massive variations between councils in older people's experience of personal budgets with some authorities successfully overcoming delivery challenges as others struggle.
That was a key conclusion of a review examining how personal budgets can be improved for older people amid evidence that their experience of self-directed support is poorer than that of younger disabled adults.
The review, by Think Local Act Personal (TLAP), the sector coalition that supports the implementation of personalisation, and the Social Care Institute for Excellence (Scie), released its first report today, examining existing evidence, challenges and potential solutions in the delivery of personal budgets on older people.
Less positive outcomes
A re-analysis of the 2011 National Personal Budgets Survey of over 1,000 users, commissioned by TLAP, found older people reported less positive outcomes than younger disabled adults in five out of 13 areas, including feeling safe and having control over their support, and similar outcomes in the other eight areas.
However, the review found that this was not because personal budgets were inherently less suitable for older people, but because older people were less likely to receive budgets in a form that promoted positive outcomes.
For instance, the National Personal Budgets Survey found that outcomes were significantly more positive for people on direct payments than for those on council-managed budgets. But 83% of personal budgets for older people were managed by their council, compared with just over half of those for younger adults, according to last year's Association of Directors of Adult Social Services (Adass) survey of council progress on personal budgets.
But while the majority of councils told Adass that most older people tended to choose council-managed budgets, including because of the perceived burdens of managing a direct payments, direct payment rates among older people varied from less than 10% to over 70% between councils.
'Nothing inevitable about poorer outcomes"
"There is nothing inevitable about councils delivering a poor personal budget experience for older people, and some councils clearly manage to deliver a highly effective personal budget experience," said the Scie/TLAP review.
However, it warned that simply reproducing the good practice of some councils in others would not be easy at a time when council budget constraints left little free resource to change systems and possibly made older people less willing to change care arrangements.
The review then identified key challenges to making personal budgets work for older people, and ideas from some councils on how to overcome them, drawing on further analysis of responses to the Adass 2012 survey and a separate survey by In Control of North West councils' implementaiton of personalisation (see right)
Challenges included responding to older people and their families' reluctance to use direct payments and preference for "traditional" forms of care, such as day centres.
The report also said that resource and workload pressures left council care managers with little time to invest in creative support planning with older people, some of whom lacked family and friends to help them plan.
Share good practice
In the next stage of the review, TLAP and Scie will work with certain councils to identify good practice in delivering personal budgets for older people and develop recommendations for government.
The review team is particularly looking to hear about good practice in working with people who lack capacity to manage a personal budget and do not have family to support them. If you have information you would like to share, email Chelsea Beckford at TLAP.
Mithran Samuel is Community Care's adults' editor.
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