SECTION 14: SELF-DIRECTED SUPPORT FOR OLDER PEOPLE
247. This section should be read in conjunction with the general sections.
248. All older people aged 65 and over are eligible for self-directed support to meet their assessed personal care needs if they are living at home. This is their entitlement as part of the free personal and nursing care ( FPNC) available to people aged over 65 years in Scotland 66.
249. Older people may choose to have some services delivered by their local authority, and others via self-directed support. Some may wish to introduce self-directed support to their package gradually to enable them to gain confidence in their ability to manage them. Currently, very few people accessing FPNC do so via self-directed support, but as local experience and support builds, numbers are expected to significantly increase. Self-directed support can help equalise access to the local community so that individuals can be more meaningfully integrated into Scottish society. Local authorities need to ensure that self-directed support options are routinely available for older people, as with any other eligible client group. Information and training is an essential part of this process, see section 6, and older people can expect to be given details of local people who can support them to consider and use self-directed support. Local authorities should also fund self-assessment work so that people can work out what their needs are and how best to meet them.
'…I am so very grateful for self-directed support. I don't know what I would do without it now, it's such a great help'…. (Older person with physical disabilities, also caring for husband with dementia)
Eligibility, assessment and care
250. The services older people may be assessed as needing are anything from podiatry to equipment, to home support services or community psychiatric nursing. For example, older people or those with disabilities may experience mental health problems such as depression. The causes may range from declining health, mobility and general activity to financial problems or feelings of social isolation. Lack of friendships and support or mourning the death of partners is not uncommon, nor is the uncertainty about the future created by periods of hospital care and even delayed discharge from hospital. Older people with learning disabilities or dementia may have more complex needs but should not be seen as different from older people generally, and they should have the same access to mainstream health and social care support.
251. Flexibility, choice and control over how their assessed care needs are met is a right of older people as much as any other eligible care groups. Older people can expect to be given the maximum possible informed choice and control over how their assessed needs are met including using self-directed support to meet some or all of their needs. Self-directed support is one option to enable people to maintain their independence and individual quality of life and should be offered to older people who are eligible at every assessment and review.
252. Once self-directed support packages are being properly managed with the necessary support, they may also bring increased security for some individuals wishing to avoid going into a care home.
253. The nursing care element of Free Personal and Nursing Care is not available as part of a self-directed support package unless it is for continuing health care needs. This means those primary care tasks carried out at the person's home that do not require to be carried out by a qualified health professional, for example routine aspects of diabetes and epilepsy care (see section 4). Arrangements need to be put in place across Scotland to encourage self-directed health care at home as part of a wider package to support independent living. Integrating care and health through joint management and funding should lead to more responsive relationships between users and service providers.
'When I became ill, at first I needed care and companionship for most of the day. The self-directed support system allowed me to choose a personal assistant from my own village community. This gave me a lot of confidence. As a result, my husband was able to continue work for two years, until his recent retirement.' (Older lady with physical disabilities).
254. Whilst use of service providers may best suit many older people, others may prefer to employ their own staff. This may be because some people already pay people for support on a casual basis by using their own money. If they decide to accept FPNC funding using self-directed support, they will have to adopt transparent book-keeping systems and take on the responsibilities of being a PA employer.
Mr Scott lives in a rural area and went onto self-directed support 2 years ago because this better met his assessed needs. He has a care package of 30 hours per week, 17 hours of which is free personal care. He has contracts with five self employed personal assistants and is delighted with the care he receives, emphasising the importance of relationship building between himself and his PAs in order to achieve this. Mr Scott's PAs also offer additional basic health care support.
Meeting local needs
255. Local support organisations will need to work collaboratively with older people's organisations to better accommodate older people's support needs. For example, older people take pride in retaining their independence and may be reluctant to accept help. Services will need to train staff to respond sensitively to individual's concerns.
Consent and capacity issues
256. Older people, as with other eligible groups, need to consent to self-directed support if the local authority assesses them capable of managing them with the necessary support. Section 3 offers guidance on consent and capacity issues. For those lacking capacity, consent may be given by guardians and attorneys authorised to do so under the Adults with Incapacity (Scotland) Act 2000 ('The 2000 Act').
257. Whilst it is clear that local authorities must operate within budget, the total amount of funding received within the support package needs to be sufficient to meet the older person's assessed needs. The aim is to tailor a package that allows users flexibility, choice and control over how their assessed needs are met.
How to mainstream self-directed support for older people
258. Local authorities need to ensure that funding of local support services is sufficient to deliver the level and type of support that older people need to self-directed support. This support will help local authorities to:
- promote self-directed support for older service users aged 65 and over
- ensure older users and potential users have access to information targeted to their needs
- offer older users self-assessment and other support to help prepare for the assessment process
- provide specialist support targeted to older people's needs, for example an advocate or support worker may be needed with specialist skills, and
- train local authority care managers, and encourage a culture of positive risk taking to enable older people to benefit from self-directed support if it meets their needs.
259. For further information contact the Scottish Helpline for Older People ( SHOP), see AnnexC.