Choice in care for older people is all very well

Friday November 25th 2022


This View has been written by Mike Collier Managing Director of Plus Homecare Ltd

Choice in care for older people is all very well, but they must be made aware of the options that are available to them.

For people who find themselves in need of care in the twilight of their lives, and for families who want to support them in their care journey, embarking on a particular course of action may be the most important decision they ever make.

However, though it is crucial at this stressful time to make informed choices, many people do not fully understand which elements of care are which, or where to go and who to speak to in order to get the best impartial advice.

It is more than eight years now since Scotland made a first attempt to put the voice of the supported person at the heart of care processes with the passing of the Social Care (Self-directed Support) (Scotland) Act 2013 (SDS).

It was intended to deliver choice and control when accepting support, with agreement about individual outcomes and a range of options to achieve these outcomes if people were assessed as having identified needs and requiring a budget.

The Act imposed a duty on local authorities to take reasonable steps to facilitate a supported person’s dignity and involvement with the community and to explain the nature and effect of the four options available to them, which are:

– A direct payment to individuals to allow them to manage their own budget and procure their own care provider.

– The supported person chooses their own provider, but opts for a third party such as a local authority to manage their budget.

– The local authority or someone on their framework manages both the budget and the support provision, which was essentially the status quo ante.

– Lastly, a mix of all these.

Well-intentioned as these provisions may be, increasingly across the country social workers who are in place to advise clients are not even mentioning these options when they go to do assessments and, as a consequence, people remain in ignorance.

There has been intensive scrutiny by a number of agencies of SDS since it was implemented, mostly concluding that it had not yet been fully implemented and that its potential was not being realised.

Inconsistent knowledge across the workforce has been highlighted, which may explain the silence of social workers about the system, and it has been suggested that traditional care culture has been difficult to shift.

Certainly, option three – that is, direct delivery of services by the council, which prevailed before the Act – remains the dominant kind of provision and research shows that failure by social work staff to discuss the options is a common issue.

Most people would not of their own volition choose to go into live-in care and more needs to be done within the limitations of SDS to highlight alternatives such as domiciliary care, which enables older people to maintain a level of independence while staying in their own home.

In this milieu, professional carers can assist with meals, cleaning, shopping – and simple companionship – at a time and duration of the client’s choosing. It provides a sense of stability and normality which can be beyond value.

This is sometimes known as an hours service, since clients can choose the time carers are with them, in contrast to unpredictable, rushed and short home visits offered by councils which are under significant financial and resource constraints.

The main thing is for people to have a choice, and to be aware of the choices available to them. Speaking to a practicing care professional is often the best first step towards the right decision.

Mike Collier, Managing Director, Plus Homecare Ltd.

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