Older people and access to social care and SDS

For the International Day of Older Persons, we look at what people have said about accessing social care.

As part of the ALLIANCE and Self Directed Support Scotland’s national research project about people’s experiences of Self-directed Support (SDS), My Support My Choice: People’s Experiences of Self-directed Support and Social Care in Scotland (MSMC), we heard from 187 people who were 65 or older.

Amongst these older participants, several people offered input on how they would expect to find information about social care. Friends and family (including extended family living outwith Scotland) were many people’s first port of call, followed by medical professionals.

One older respondent, whose spouse accessed Self-directed Support (SDS) (which they described as “very, very good”), first engaged with social workers for their own care following a recommendation and referral from their doctor. One person summarised their experiences as, “you can also ask your GP, because there will be a social work team connected to them, your doctor.”

However, the same person reflected that following contact with a GP, accessing information to obtain support is not easy. They went on to explain that in their experience, “you speak to ten people and they all tell you, ‘it’s not me, it’s somebody else.’”

Another older person echoed the above comments about some people not having the capacity – or the responsibility – to carry out online research about SDS. They stated that they “don’t want a helpline”, and they preferred face-to-face communication. They went on to point out that “many people don’t have access for the computer. How then do you check online?”.

Older participants also spoke of their confusion regarding Free Personal Care and what was covered within social care support more broadly. One person summarised as follows: “Some people, like dressing and toileting, that’s free. But if you need somebody to cook a meal or clean, that you have to pay for, is that right?” Another participant summarised their perspective and questions:

“If they’re fit enough, they don’t get anything. When do you decide? […] Is it to be decided before it happens? […] Will it be changeable, or once I decide I have to stick to it?”

Many older people raised concerns about the level and quality of care and support they received. As well as reporting on the negative impacts of cuts to social care support, several older respondents described care arrangements that were not suitable – mostly centred around inflexible timings of personal and home care.

One older person from a Black and minority ethnic group spoke about their experience with unsuitable care arrangements, where after several months of service provision that did not suit their lifestyle they said “I don’t want this service, I will try to manage. Wrong timings, wrong people!” – and they stopped using SDS. A more culturally sensitive approach may have been more successful in providing the respondent with a sustainable pattern of support.

Several older Black and minority ethnic participants reported that social work staff often assumed that they would have access to unpaid care from within their family networks. One person stated that their family:

“Don’t have time, they live somewhere else, they have full time jobs, and then they are expected to start [caring]. Joint family looking after, it doesn’t happen as much. If it does happen it’s a lot of strain for families, and for relationships, to do all the work, look after their family, grandparents who do not live with them. So, there are many situations like this.”

It is essential that social work professionals do not assume that family members will be able to provide unpaid care – or that older people wish to be supported by friends and family. In particular, it should not be assumed that Black and minority ethnic people are able or content to move out of their own home and into the home of another family member so they can be supported via unpaid care.

We also asked people about independent advice and support services. While most people find access to independent advice and support makes SDS easier for them, we found that older people are less likely to know about these services and find them useful. Focused efforts are required to ensure older people are aware of – and can access – independent advocacy and support services.

Targeted work is needed to dismantle communication barriers faced by older people (especially older people from Black and minority ethnic communities) so they can find out about SDS and social care quickly and easily. This work includes widening the pool of professionals who are informed about SDS and can encourage people to access it, streamlining information processes and clear signposting, and ensuring people have access to information in a range of formats. People also need access to high-quality information about SDS/ social care at different points in their journey through the social care system – including explanations of the limitations of and overlaps between Free Personal Care and Self-directed Support.

To find out more about My Support, My Choice and to read the reports, visit: https://www.alliance-scotland.org.uk/health-and-social-care-integration/self-directed-support/msmc/.

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