Research into practice

Direct payments have been shown to be a major tool for improving independent living and the quality of life of disabled people. The choice, control and flexibility of direct payments have enabled disabled people using them to live lives closer to their choosing than did traditional directly provided services.

Since February 2000 this option has been open to older people, and the most recent estimates are that 2,700 older people have taken it up.¹ But do direct payments work as well for older people?

A recent study² undertaken in three different local authority areas in England suggests they do. A widow in her eighties, described direct payments as “like a magical door opening. It’s meant that, well, I’m living a life now.”

Like other older people involved in the study, she had voted with her feet out of traditional home care services because of dissatisfaction with their quality, she found care assistants just rushed in and out. But like others the benefits she gained from direct payments far outweighed her problems because what she really wanted was someone to take her to art shows, a life-long passion.

One of the great joys of direct payments is that support is not tied to one location as it usually is with home care services, so the woman was able to employ someone who could be a driver and personal assistant (PA). She had to subsidise her payments to cover the costs but this, she felt, was worth it.

Another older man used his direct payments to organise an alternative to institutional respite care. He was pleased in general to have the opportunity to organise his own support arrangements as he felt this “took a lot off” his wife. But when his wife went on a much needed holiday, he went on a fishing trip with his PA. He paid his PA £100 for three nights away and 24-hour cover. He had to pay some of this out of his own pocket but he said it was both cheaper and more enjoyable: “It’s brilliant, it beats staying in an old people’s home.”

For some older people, direct payments meant that they could enjoy the seemingly little but very important things in life, like being able to watch a football match on television without being put to bed before the final whistle, or simply having the home “ticking over so it’s comfortable”. Some older women really enjoyed going shopping with their PAs. Indeed for one group of older Somali women this was crucial because language barriers could make it difficult for them to observe their cultural norms: “Sometimes I don’t understand. I will choose food that I don’t eat. I get confused and end up eating something with alcohol or pork which we cannot eat, by mistake”.

All of the older people had personal care needs. Direct payments simply enabled them to use that assistance more flexibly. But having the control and the freedom to choose and direct their PAs meant that they felt happier, more motivated and better able to do things for themselves.

There were, of course, difficulties. Finding PAs was not easy, nor was managing the administrative demands of direct payments. However, older people are not alone in this and the difference was having help from direct payments support services. That meant that older people could take back control of their lives just at a point when some felt it was slipping away from them.

¹ Community Care Statistics 2002-3, Department of Health, 2003

Heather Clark researches social gerontology at the school of social studies, University College Chichester.