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CHAPTER 3 PROVISION OF INFORMATION ON DEFERRED PAYMENT AGREEMENTS.
Introduction
3.1 The 2006 Scottish Executive survey indicated that local authorities varied in the extent to which they routinely offered DPAs to residents. The research explored this in more depth, and interviews with local authority representatives as well as residents were used to assess the extent to which local authorities were routinely providing information on DPAs and the extent to which eligible residents were being offered DPAs to defer their payments. This section presents the findings of these interviews.
Information provided by local authorities on DPAs
3.2 The research aimed to establish the extent to which local authorities provided information to residents about DPAs. It is clear that not all local authorities are providing information on the option to enter into a DPA to any resident who may be eligible. The research found:
- Not all local authorities provide information to residents about DPAs nor about the ability to defer payments long-term using a Charging Order
- There is no uniformity amongst local authorities in terms of the type of information provided to residents about DPAs, Charging Orders or interim funding options
- There is no uniformity amongst local authorities in terms of how this information is presented to residents
- There is no uniformity amongst local authorities in terms of who is responsible for providing the information to residents
3.3 Only the councils who reported that they routinely offered DPAs provided any substantial information to eligible care home residents. At best this information took the format of a specific booklet about DPAs and other deferring options, which was passed on to residents. At worst, a simple one-liner was inserted into existing booklets about choices available to residents entering care. The research found that there was more uniformity amongst local authorities in terms of the provision of information about the option of interim funding. The majority of local authorities provided written information about this to clients. Unsurprisingly, the 2 councils who said they never offered DPAs did not provide any information to residents about DPAs.
3.4 Some local authorities we interviewed had no standard literature at all about DPAs, and relied solely on front-line care managers informing residents and their representatives verbally. One of the difficulties with this approach is that it relies on all care managers being equally informed about DPAs and our interviews with residents revealed that very little, if any, information about DPAs was provided in such interviews. Even within the same local authority area, interview evidence from the representatives of residents revealed that levels of understanding of DPAs amongst front-line staff varied markedly. Further, one front-line staff member stated that they would be incapable of providing a detailed account of a DPA to a prospective care home resident, and in other local authority areas prospective residents were directed to a member of the Finance section within the social work department who provided clients with more detailed verbal information about DPAs.
Resident perspective on information provided by local authorities
3.5 Interviews on the resident side revealed:
- Prospective care home residents rely heavily on a family member or friend to represent them in any discussion with local authorities about care home places
- These family members or friends often find the period leading up to their relative requiring a care home place to be extremely stressful
- Prior knowledge about DPAs amongst the residents' representatives we interviewed was very low
- The provision of clear and comprehensive information about funding options was understandably a key priority for residents' representatives
3.6 Those who took part in the research revealed that the period leading up to their relative requiring a care home place, and the act of finding a suitable one, were both extremely stressful. Many of the relatives had had to cope with a period in which their relative's health had rapidly deteriorated and they had to arrange home care support for their relative, as well as experience a period where their relative had been hospitalised. Several of the participants described the process of choosing a care home for their relative as traumatic with many care homes being visited before they found a suitable one.
3.7 In all but 2 cases, those interviewed had no prior knowledge of the possibility of deferring payments for care home fees prior to their relative being assessed as needing a place and undergoing a financial assessment. Indeed, until the time of needing a place, few families had given any thought as to how they would finance it or the options available to them. Several participants had been confused with the introduction in Scotland of free personal care for the elderly 7, wrongly assuming that this would mean that their relative would not have to contribute anything towards the cost of the care home place. Others thought that their relative would have to contribute, and that their house would have to be sold prior to them moving into the care home, or as soon as possible after this.
3.8 The 2 participants with prior knowledge of DPAs both knew about this option primarily because work colleagues had informed them.
3.9 While a few of the residents we spoke to were very pleased with the information that they were given about the options that were available to them in terms of funding the care home place, around half were very dissatisfied. Most participants, therefore, said that it was of paramount importance that they should be provided with clear and comprehensive information about funding options.
3.10 The sources of dissatisfaction noted by participants included:
- No information provided about alternatives available for deferring payments for care home fees
One participant heard of DPAs for the first time during the process of the research. During the interview with her, she told us that the local authority had not mentioned any possibility of deferring care home payments either through a DPA or a Charging Order.
- Obtuse language used in the literature provided by local authorities
Several of the participants indicated that the language used in letters and leaflets they had received from the local authority about the choices available to them was quite difficult to understand, and that frail older people may struggle to comprehend them.
- Lack of knowledge of DPAs amongst front-line social work staff
One participant, who had been aware of DPAs prior to contacting the council, informed us that the social worker she contacted about deferring payments did not know what a DPA was, and was unable to provide any information to the resident and her family at that point.
- Negative presentation used by local authority staff in their description of DPAs
Some participants felt that the description of the DPA they were given by the local authority was extremely negative. One participant stated that she felt that the officer she spoke to was trying to put her off applying for one. She was advised that "she would have a fight on her hands (to uptake a DPA) and would have to wait for months to see the agreement concluded". Another participant stated that they had been informed that there would be "high" interest charged on payments, in addition to the other obligations involved in entering a DPA. In fact, no interest is charged until 56 days after the death of a resident and this advice suggests a lack of understanding of the detail of the procedure amongst front-line staff. However, in this case, the issue of interest being added to payments ended the participant's desire to pursue the DPA. Furthermore, another participant stated that the local authority had been keen to point out the more onerous aspects of setting up a DPA, such as being responsible for insuring and maintaining the property for the length of the agreement, without at the same time describing any perceived benefits from entering into such an agreement.
Summary
3.11 Whilst guidance issued by the Scottish Executive has requested all local authorities to provide information to eligible home care residents about DPAs, only a few of the local authorities included within the research have done so in any meaningful way. Several had no written material to offer residents, and relied on front-line staff, with varying levels of knowledge about the process, verbally communicating options to residents and/or their relatives.
3.12 Interviews with relatives of care home residents revealed that the period around the organisation of a placement is typically very stressful, and that the provision of readily available, detailed, easy to understand information about the options available to them would be of great assistance at this time.
3.13 Several of the residents we spoke to had not, as far as they were aware, been informed about any options to defer payments for care home fees by the council with whom they liased.
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