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CHAPTER 2 THE RESEARCH

Introduction

2.1 Against this background of low use of DPAs, continued use of Charging Orders and reported local authority views on obstacles to the use of DPAs, RP&M Associates were commissioned by the Scottish Executive to undertake a piece of research that would augment the information already collected through the 2 surveys. In particular, the Scottish Executive wished to obtain information directly from care home residents and their families to help identify any barriers and facilitators for improving take up of DPAs. The overarching aim of the research was to explore with care home residents and their relatives, their knowledge of, attitudes towards, and experiences of DPAs, and identify potential for increasing uptake of DPAs.

2.2 More specifically, the research aimed to:

• Gain a greater understanding of the extent to which local authorities provide information on DPAs
• Explore with care home residents and relatives their understanding of DPAs, attitudes towards the principle of DPAs, and experience of the application process
• Identify barriers and deterrents to applying for and receiving deferred payments
• Identify ways in which uptake of deferred payments could be increased

Methodology

2.3 The research used qualitative methods to gather information from residents and their relatives, older people in the community and local authority officials.

Developing the research project

2.4 The initial methodology for the research drew heavily from the findings of the 2 surveys undertaken by the Scottish Executive, and focused on residents and their families who had set up DPAs in order to explore their views and experiences.

2.5 However, initial findings from the research indicated that the number of DPAs thought to have been set up since 2002 was overestimated substantially in the returns sent by local authorities in the 2004 and 2006 surveys; for example, one council, which had indicated in the 2006 survey that they had set up 75 DPAs, had in fact been using Charging Orders rather than DPAs.

2.6 In effect, the small number of actual DPAs that have been set up since 2002 necessitated a shift in the focus of the research. Initially, the intention had been to focus in the main on care home residents, however it became apparent that more investigation was required into the Charging Order regime that many local authorities offer residents as an alternative to DPAs. This has involved establishing the processes and rationale the local authorities follow when placing a Charging Order on a resident's property and why local authorities choose to operate this method of deferring a resident's fees rather than using a DPA.

2.7 In addition to this, a further piece of work was undertaken to establish the exact number of DPAs that have been established since 2002. The initial work highlighted that there was some confusion amongst local authorities in terms of the classification of a case as either a DPA or a Charging Order. As a result, it was decided to extend the research to include all local authorities who indicated that they had set up a DPA, in order to confirm the number of DPAs that have been set up across Scotland and provide a full opportunity to explore the research aims set out in paragraph 2 above.

2.8 Fieldwork was carried out as follows:

• One-to-one interviews with 4 individuals who have gone through the process of setting up a DPA, gathering views and experiences of the process
• One-to-one interviews with 6 individuals who have no DPA in place, including a mix of individuals who have sold their property prior to moving into care, or who have had a Charging Order placed on their property as an alternative to a DPA, gathering views and experiences of the processes they had been through
• Focus groups with 2 community-based groups of older people gathering information relating to knowledge of DPAs and attitudes towards relevant issues relating to payment of care home fees
• One-to-one interviews with 10 local authority representatives from social work finance.
• 2 one-to-one interviews with front-line social work staff responsible for advising residents about funding options and arrangements, to gather information on practices and views in relation to DPAs and Charging Orders
• Additional one-to-one interviews with a further four local authority representatives, which included staff from social work finance and legal services. The findings from this additional work are incorporated into the relevant sections of this report.

2.9 Although it had been hoped to gather the views of stakeholder organisations, neither Help the Aged nor Age Concern felt that they had sufficient knowledge and experience to contribute to the project.

2.10 Sensitive issues such as personal finances were addressed in one-to-one interviews and small focus groups of residents/relatives and community-based older people.

2.11 The majority of those who took part in the research representing the care home resident were sons or daughters. Uniformly, we found that it was a family member, rather than the actual prospective resident, who liaised with the local authority on the matter of funding the care home place. Local authority representatives confirmed that the success of more extensive community care packages has meant that residents entering care homes are now more frail and vulnerable than they once were. As a result, residents required a family member to represent them in discussions.

Reflecting the range of practices across local authorities

2.12 The research originally focused on a sample of local authorities selected with a view to representing the range of practices across Scotland. The 2 surveys undertaken by the Scottish Executive showed that local authorities largely fall into 3 categories:

• Those who routinely offer DPAs to residents
• Those who only offer DPAs when asked by the resident themselves about this option
• Those who never offer DPAs

2.13 A sample of local authorities was chosen to participate in the research to ensure that each of these categories was represented. Of those who reported that they routinely offer DPAs, both local authorities that have DPAs in place and those who do not were included in the original sample.

2.14 However, when interviews were carried out, it was discovered that 2 of the 3 local authorities originally selected which had indicated that they had DPAs in place (Aberdeen City and Moray) actually operate a Charging Order regime to allow residents to defer care home fees, although paperwork given to residents suggests that they are entering into a DPA. Thus, of the original sample of authorities, only one, City of Edinburgh, had any DPAs in place.

2.15 The original sample was subsequently supplemented by the inclusion of the 4 other local authorities who reported having DPAs in place in the Scottish Executive surveys (Borders, East Lothian, Falkirk, Highland; see Figure 2). Fieldwork confirmed that 3 of those authorities (Falkirk, Borders, Highland) had small numbers of DPAs in place, although their previous survey returns had overstated the numbers involved (eg, all but one of Falkirk's reported DPAs turned out to be Charging Orders). In the case of East Lothian, however, the research found the authority had no DPAs in place. Of the 2 DPAs East Lothian reported in the Scottish Executive survey returns, one turned out to be a Charging Order and, in the other case, although they had been in the process of setting up a DPA, the client had died before the agreement was completed. Thus, the final sample of 14 included all 4 local authorities confirmed as having experience of establishing DPAs, as well as a fifth authority (East Lothian) with partial experience of the process.

2.16 Figure 3 below provides a list of local authorities that took part in the study, and indicates, based on the Scottish Executive survey findings, the category into which each falls.

Figure 3: Classification of local authorities participating in research based on Scottish Executive survey findings (2004 and 2006)

Note: Local authorities shown in italics were shown by the research to have no DPAs in place.

Addressing the research objectives

2.17 In terms of the 4 main research objectives, each is examined from the resident and local authority perspective, with information provided on the use of Charging Orders where appropriate. The remainder of this report presents the findings of the project fieldwork. The final chapter presents conclusions and issues for consideration in responding to the findings of the project.

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