Disability and care needs in the older population: disability benefits, social care and well-being

Lead Research Organisation: University of East Anglia
Department Name: Norwich Medical School

Abstract

The project aims to deliver new evidence to sharpen policy judgements on promising directions of reform of publicly-funded support for older people with care needs. In the UK, such support consists of two main elements. Care services are available through Local Authorities and cash disability benefits are provided by the national social security system. Individuals may be entitled to one, both or neither source of help. Each element of the system operates its own assessments of an older person's care needs, and they differ in how account is taken of whether the person has a partner. People who receive care via a Local Authority pay means-tested charges for their care, except in Scotland where there is a non means-tested public subsidy towards the cost of care. Other than an element paid via the means-tested Pension Credit, entitlement to disability benefits is not affected by an older person's income or financial assets. Care provided via Local Authorities is in the form of services or a 'personal budget' which has to be spent in ways which address the recipient's care needs. Recipients of disability benefits are free to spend them as they wish. These differences mean that, irrespective of their financial value, the support from the two separate parts of the system may alleviate the adverse effects of disability on wellbeing in different ways and to different extents. Some have suggested that public funds channelled through disability benefits should be redirected to the care system. Debate on the funding of care and support for older people continues. We will contribute to this debate by providing objective and independent evidence on the likely impacts on the wellbeing of different groups of older people, of a change in the balance of funding of the two parts of the system.

We will provide evidence on:
- the extent to which the well-being of an older person is affected by the disability of his/her partner or other members of the household, and the likely consequences for their wellbeing of taking account of a partner's disability in determining entitlement to publicly-funded care services and disability benefits;
- whether equivalent-value care services and disability benefits mitigate the impact of disability on wellbeing to the same or differing extents;
- the responsiveness of the current systems of care and disability benefits to changes in older people's needs for care and whether any delays in the system affect their wellbeing;
- the likely effect on the wellbeing of different groups of disabled older people (older/younger, poor/rich, single people/couples etc.) of potential changes in the balance of public funding for care services and disability benefits, for example increasing the levels of one and decreasing those of the other, or extending the eligibility criteria for one and decreasing it for the other.

The study will involve advanced statistical analysis of four large-scale household surveys: Understanding Society, incorporating its predecessor the British Household Panel Survey; the English Longitudinal Study of Ageing; the Health and Social Care Survey of England; and the Family Resources Survey. Two of these have started to collect important new information on receipt of care services and payments for them, which we will use. Our analysis will be necessarily restricted to the household population and, because of data limitations, some of it will be restricted to England. However, policy differences between England and Scotland will be exploited in the analysis.

Evidence from the study will be useful to national and local policy makers, those representing older people and commercial enterprises providing care or insurance services. We do not aim to advocate specific policy reforms, but rather deliver evidence that will be taken into account in national policy and local implementation. That has the potential to benefit older people and tax payers, if it results in better use of public funds

Planned Impact

The ultimate potential beneficiaries from this research are older people with care needs in the UK and UK tax payers in general, if the research is used to identify policy reforms which provide better value for tax payers' money. The more immediate impact will be felt through better-informed policy making. We aim to deliver evidence that can be taken into account in national policy development and its local implementation. The principal users of this evidence will be national policy makers (Government Ministers and their officials, MPs in both Houses of Parliament), the devolved administrations of the constituent countries of the UK, local government, voluntary organisations (e.g. those representing older people) and commercial enterprises (e.g. insurance companies and care providers) who seek to influence debate in this area. Our findings will be relevant to the work of the Department of Health, the Department of Work and Pensions and HM Treasury. While the main geographical focus of our study is the UK, our research questions are relevant to policy makers in all countries undergoing population ageing.

Beneficial to these users will be evidence on:

- the extent to which the well-being of an older person is affected by the disability of his/her partner or other members of the household and the likely consequences for their wellbeing of taking account of a partner's disability in determining entitlement to publicly-funded care services and disability benefits;
- whether equivalent-value care services and disability benefits mitigate the impact of disability on wellbeing to the same or differing extents;
- the responsiveness of the current systems of care and disability benefits to changes in older people's needs for care and whether any delays in the system affect their wellbeing;
- the likely effect on the wellbeing of different groups of disabled older people (older/younger, poor/rich, single people/couples etc.) of potential changes in the balance of public funding for care services and disability benefits, for example increasing the levels of one and decreasing those of the other, or extending the eligibility criteria for one and decreasing it for the other.

Such evidence, if acted upon, has the potential to increase the effectiveness of public services and policy in this area and enhance the quality of life of older people. This is a live area of policy debate and evidence is likely to be immediately beneficial to policy makers with benefits to older disabled people and tax payers flowing as soon as any policy reforms are implemented.

We expect our experience of dealing with the survey measurement issues relating to disability and wellbeing to have impact among survey designers and managers, including those at ONS and Understanding Society and other organisations involved in primary survey research. This impact will ultimately take the form of improvements in the quality of future surveys.

Staff working on the project will enhance their analytical and communication skills in ways which could be applied in many employment sectors.
 
Description The project has generated important messages for the design of systems of public support for older people with disabilities. In the UK, this system has two parts: nationally-administered cash disability benefits, overseen by the central government through the Department for Work and Pensions; and social care which is administered by Local Authorities. Disability benefits (notably the Attendance Allowance (AA) and Disability Living Allowance (DLA) programmes) are largely non-means tested, while the Local Authority social care system is strongly means tested. We found that:

• Later life socio-economic inequalities in disability have increased among successive birth cohorts and this trend could increase the share of later life care costs borne by the state in the future (source: analysis of ten years of the UK Family Resources Survey).
• If anything, receipt of disability benefits by older people is more strongly (negatively) related to income than social care, despite public support for social care being subject to greater means testing (source: analysis of the 2012 English Longitudinal Study of Ageing). That many more older people receive these non means-tested cash benefits (around 13%) than receive means-tested social care (2.5%), does not, therefore, necessarily mean that cash benefits are less well-targeted than social care, contrary to what has been suggested by some.
• Receipt of both types of support is strongly (positively) related to disability, with the effect of disability level being somewhat larger for social care (source: analysis of the 2012 English Longitudinal Study of Ageing). That a much smaller proportion of older people receive social care than receive disability benefits thus appears to be due to Local Authorities concentrating their resources on those with the most severe disabilities rather than to means testing.
• Receipt of AA/DLA and receipt of Local Authority funded social care services overlap only partially (just 55% of those reporting receipt of social care report receiving disability benefits). Moreover, fewer than a half of the 20% of older people with the highest levels of disability, receive either disability benefits or Local Authority-funded social care (source: analysis of the 2012 English Longitudinal Study of Ageing)
• It is crucial to allow for the personal costs that disabilities bring, when comparing the disposable incomes of older people with and without disabilities and when analysing how their incomes would be affected by reforms to the public system of support for older disabled people. However, our work has shown that estimates of these personal costs are sensitive to technical issues involved in the choice of measurement technique (source: analysis of various Family Resources Surveys). Further work on these methodological issues is needed, and is continuing.
• Reforming disability benefits so they reach more of the most disabled people and are set at levels which are more closely related to disability costs, can reduce deep poverty. Similar effects can be achieved with or without more means testing, although results are sensitive to assumptions on take-up of benefits (source: analysis of various Family Resources Surveys). More research is needed on what determines the reach of non means-tested disability benefits.
Exploitation Route Our work could be used to reform cash disability benefits and/or refine the balance between cash disability benefits and social care for older people. We held an event in the House of Lords in June 2015 to publicise the findings and discuss the policy implications with MPs, policy makers etc.. We have had extensive contact with relevant officials in the Department of Work and Pensions and the Department of Health and are in touch with them about further ways to ensure the policy messages of our findings are widely understood. We have responded to relevant consultations e.g. Select Committee inquiries and will continue to do so. Some journal papers have already been published and other written outputs are in advanced stages of preparation to reach academic and policy audiences.
Sectors Communities and Social Services/Policy,Healthcare

URL http://www.uea.ac.uk/medicine/health-economics-group/projects/disability-and-care-needs-in-the-old-population
 
Description Key pathways to impact have included: oral presentation of findings to the Department of Work and Pensions (November 2014), to attendees from a wide range of sectors at a House of Lords seminar hosted by Baroness Campbell (June 2015), and at the Department of Health seminar (October 2015) which included also officials from the Department of Work and Pensions and from HM Treasury; submission of written evidence to the Health Select Committee (published November 2014) and an on-line contribution to 'Hard Evidence' (September 2015). Following the seminar at the Department of Health, officials asked us to scrutinise some related analysis they had undertaken. We produced a detailed note for them in which we demonstrated that their own analysis was potentially very misleading in terms of its policy implications. This analysis has also fed into discussions about reforming the questions on disability in the English Longitudinal Study of Ageing. Debate about the target efficiency of disability benefits for older people continues, with reform of these benefits remaining on the political agenda. As a result of our impact generating activities, officials in key Government Departments are now aware that any reform of disability benefits should recognise that the existing system, despite being largely non means-tested, is quite well targeted by both income and disability but leaves a substantial proportion of those facing the highest personal costs of disability in deep poverty. They are aware of our findings that tailoring rates of disability benefits more closely to levels of disability and hence to personal disability costs, combined with ensuring that more of the most disabled older people receive these benefits, could alleviate deep poverty amongst the most disabled older people. It is too soon to know whether the Government will pursue reforms along these lines. In addition to the impact generating activities described above (and in more detail elsewhere on Researchfish), the research team are nearing completion of a non-technical report for the Joseph Rowntree Foundation (JRF), drawing on the project's findings, which will be used by them as part of their anti-poverty strategy. We expect this to result in a high profile for our work in policy circles and hence to be a very important pathway to impact.
First Year Of Impact 2015
Sector Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice,Other
Impact Types Policy & public services

 
Description Written evidence to House of Commons Health & CLG inquiry into long-term funding of social care (submitted March 2018)
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
URL http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/housing-communities...
 
Description Directly commissioned report on disability and poverty in later life to feed into JRF's anti-poverty strategy
Amount £7,000 (GBP)
Organisation Joseph Rowntree Foundation (JRF) 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2015 
End 10/2015
 
Description ESRC Impact Accelerator Account at UEA
Amount £3,500 (GBP)
Funding ID ES/M500525/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 03/2016 
End 07/2017
 
Description Closed discussion with Department of Health, NatCen and English Longitudinal Study of Ageing academic team 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact To discuss improvements to ELSA questions on disability in the light of MiSoc funded research on the relationship between receipt of disability benefits and reported measures of disability in ELSA, as previously presented to and discussed with the Department of Health.
Year(s) Of Engagement Activity 2017
 
Description English Longitudinal Study of Ageing wave 6 launch: Publicly funded social care and disability benefits in ELSA wave 6 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The session in which the talk was presented was chaired by David Willets MP and it sparked policy discussion.

The Department of Work and Pensions asked for the slides and a member in the audience from the Department of Health subsequently invited us to give a presentation at the Department of Health.
Year(s) Of Engagement Activity 2014
 
Description Government Office for Science seminar on the use of advanced analytics 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Guided the GO-Science approach to analysis for their Foresight project: Analysing the Challenges and Opportunities of an Ageing Society

The GO-Science team requested further information on our research related to their Foresight project
Year(s) Of Engagement Activity 2014
 
Description House of Lords Seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Seminar sparked discussion on the reform of disability benefits for older people

Subsequently invited to give seminar at Department of Health
Year(s) Of Engagement Activity 2015
 
Description Presentation at ESRC Age UK Showcase event: Data analysis for effective policy for older people 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact The talk generated questions and discussion

No specific impacts occurred but we have remained in touch with Age UK as further findings are emerging
Year(s) Of Engagement Activity 2014
 
Description Scrutiny of Department of Health analysis of Attendance Allowance recipients in the English Longitudinal Study of Ageing 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact We wrote a short note for the Department of Health analysts which was subsequently discussed with them at a follow-up meeting. Request from DH to share note with ELSA funding group to inform improvements in ELSA questionnaire.

Not aware of any impacts yet.
Year(s) Of Engagement Activity 2015
 
Description Seminar at Department of Health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The seminar sparked questions and discussions.

Officials from the Department of Health requested our help with some analysis they were undertaking of the English Longitudinal Survey of Ageing. We scrutinised their analysis and wrote a report showing that more detailed analysis leads to a different conclusion on the target efficiency of Attendance Allowance.
Year(s) Of Engagement Activity 2015
 
Description Seminar at House of Commons 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact A seminar at the House of Commons organised in conjunction with the Strategic Society Centre to launch a report written by the SSC Director (James Lloyd) which drew very heavily on research arising from ESRC funded project(s). The event was primarily to inform debate over whether responsibility for Attendance Allowance should be devolved to Local Authorities. It was chaired by Lord Lipsey and attended by Neil Coyle MP. Lord Lipsey said after the event that the research had changed his view on subject. Neil Coyle asked a number of related parliamentary questions. In January 2017 the minister for Communities and Local Government announced that AA would not be devolved to Local Authorities, a decision consistent with our researcg. A House of Commons Library briefing paper providing background to the debate and ultimately the decision quoted extensively from our research and from the SSC report.
Year(s) Of Engagement Activity 2016
URL http://strategicsociety.org.uk/attendance-allowance-local-government-examining-evidence-options/#.WM...
 
Description Seminar for the Department for Work and Pensions: Target efficiency of public support for older disabled people in Great Britain 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The presentation generated questions and discussions on both methodological and policy aspects of the findings

We are not aware of impact directly or exclusively related to this single activity but see impact narrative for a discussion of emerging impact from the project as a whole.
Year(s) Of Engagement Activity 2014
 
Description Stratgic Society Centre Public Debate on the Future of Disability Benefits, Social Care and Welfare Reform 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact A presentation on patterns of receipt of disability benefits for older people and the likely distributional consequences of alternative forms of curtailment of these benefits.
Year(s) Of Engagement Activity 2011
 
Description Submission of written evidence on disability benefits and social care to House of Commons Health Committee Inquiry 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The evidence has been published on the Select Committee's web site but due to the election the committee did not produce a report of their Inquiry.

We are not aware of impacts directly attributable to this activity.
Year(s) Of Engagement Activity 2014
URL http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-committee/pu...
 
Description Written contribution to 'Hard Evidence' 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Comments from three people to date on the Hard Evidence web site

Replies to one comment appear to result in the commentator better understanding our analysis. Otherwise we are not aware of impact directly attributable to this activity.
Year(s) Of Engagement Activity 2015
URL http://theconversation.com/hard-evidence-do-elderly-disabled-people-get-the-state-support-they-need-...