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Social care for older people: the role and function of direct payments

Davey, Vanessa (2018) Social care for older people: the role and function of direct payments. PhD thesis, The London School of Economics and Political Science (LSE).

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Abstract

“Direct payments” (DPs) are now a core route for publicly funded social care provision in the UK. DPs are allocated to meet needs of social care recipients in lieu of community-managed social care services. DP recipients must organize their own care even if external support is usually available for some tasks. There are long-standing concerns about the benefits of direct payments for older people. Perceived risk factors include frailty, limited social networks, a lack of information technology skills, spouse co-morbidity, overburdened unpaid carers. Little is known about how direct payments actually work for older people. This thesis investigates direct payments practice, analyzing newly collected and previous data from a variety of perspectives. First, a general view on policy and practice developments is obtained by tracing the evolution of DP support in the past decade. A bottom-up perspective follows, analyzing interviews with 82 older people receiving DPs. The unprecedented detail given by this data permits the identification of factors associated with greater gain from DPs and exploration of how DP-care fits within pre-existing patterns of care, both formal and informal. Two particular phenomena highlight the unique role of DPs. The first is the role of husband and wife teams. In these husbands, affected by chronic physical illness, provide very substantial levels of unpaid care. As the term suggests, the couples operated DPs as a team: a mechanism which enhanced their ability to manage. Direct payments were critical to increase these couples’ health and social capital. The second explores the circumstances of working unpaid carers managing DPs for older people. Overstretched and overburdened, these carers still found multiple benefits from DPs, not least the ability to coordinate care with their employment, ensuring the quality of services and with it their peace of mind. The work contributes to understanding how directing care through DPs fits in a continuum in which unpaid carers interact with formal care in any caregiving scenario. Directing care represents an additional phase in adaptation to dependence. Resilience is viewed as a confluence of individual, social, physical and environmental factors. For those with the most complex or precarious caregiving role, increased control may have the greatest benefits.

Item Type: Thesis (PhD)
Additional Information: © 2018 Vanessa Davey
Library of Congress subject classification: H Social Sciences > HN Social history and conditions. Social problems. Social reform
Sets: Departments > Social Policy
Supervisor: Knapp, Martin
URI: http://etheses.lse.ac.uk/id/eprint/3867

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