Exploring and improving access to direct payments by people with dementia living in rural communities

Direct payments are payments made to individuals eligible for social care services that allow them to manage and pay for their own care rather than receiving it directly from their Local Authority. Research suggests that people with dementia and those living in rural communities may particularly benefit from the additional flexibility afforded by direct payments. However uptake is currently low, particularly amongst older people. There is a lack of research to date in this area addressing the factors of dementia, ageing and rurality in unison. Therefore, the first aim of this study was to explore the experiences of people with dementia living in rural communities in relation to their access to direct payments, and specifically to develop a theory to explain direct payment uptake by this group. The second aim was to use findings to build and pilot an intervention aimed at ensuring that access to direct payments by people with dementia living in rural communities is maximised.

Grounded theory methodology was utilised, and research methods were predominantly qualitative due to the exploratory nature of the research. Focus groups were carried out with two community social work teams, and 26 semi-structured interviews were conducted with people with dementia in receipt of social care services in the community, and their carers and social workers. A theory was developed in order to explain access to direct payments by people with dementia living in rural communities. It was identified that while care managed by the Local Authority is set as the default route for service users, direct payments tend to be perceived as a second option. An intervention to address some of the identified barriers to direct payment uptake was developed and piloted in one community social work team for a period of six months. The intervention was evaluated using questionnaires, interviews with participating social work staff and statistical analysis of direct payment uptake data. Findings suggest that the piloted intervention may be effective in enhancing overall access to direct payments.

This study offers new insights into the previously under-researched area of direct payment access by service users with dementia in rural communities, and presents what is believed to be the first example of a theory to explain uptake of direct payments by this group. It is thought that this research provides the first empirical evaluation of an intervention aimed at increasing uptake of direct payments through changing the way this option is offered by social workers.