Conclusions

<BODY BGCOLOR="black" BACKGROUND="back3.gif" TEXT="#1031AD" LINK=RED VLINK=BLUE> <CENTER> <TABLE WIDTH=580 BORDER=0> <TR><TD> <CENTER> <FONT SIZE=6> <FONT FACE="HELVETICA"> <B> Liverpool Home Care Prospecting Initiative <BR> LTU Prospects Project </B> </FONT> </FONT> </CENTER> <FONT COLOR=RED> <H3> Conclusions </H3> </FONT> <P> <B> The project centred on four main areas of activity: <UL> <LI> Research unmet care service provision <LI>Income Maximisation advice, with a view to purchasing care services<BR> <LI> Research into LTU and their views re: gaining employment<BR> <LI>Research potential new business activity/providing sustainable jobs for LTU. </UL> <BR> For each heading, this Report has broken down the main areas of activity (as above). <P> <I>However, they should not be considered in isolation.</I><BR> <P> <FONT COLOR=RED> Unmet Care Service Provision </FONT> <BR> The total Liverpool City Boundary population was 475,522. The extrapolated research findings show that of those aged 16 or over, 76,187 had one of the care needs measured by the survey. <P> Of those surveyed, (501 interviews), over half of those with a need were disabled (52%). The remainder were either older aged with a need (24%), a carer (19%), a single parent (11%) or recovering from an illness (5%). (These percentages add up to over 100% as some people had more than one need) <P> There was a high correlation between age, social class and having a care need. Four in ten (40%) of those with any or multiple needs were over 65 years of age and over half (55%) were of socio-economic class E. Women were also more likely to have a need (60%), with a large proportion falling into the older aged, single parent and carer needs groups. <P> However, the research has identified that many elderly people do not feel they have a personal care need. Researchers felt that many elderly people said, either through pride or because they did not want to "make a fuss", that they had no need for "care to the person" services. This challenges the perceived view that elderly are in greater need of care services. Whilst some providers may feel that many elderly people have a need for care services, it is wrong to try and impose services if the elderly themselves do not feel they have a need It is possible that as the elderly do become older this may change, however, this should be treated with a degree of caution because the older aged population is generally healthier than previous generations of elderly people. <P> A significant number of those with a need (excluding carers) lived in a terraced house (62%), rented accommodation (60%) and had one WC (74%). The most common housing complaints were draughty windows/doors, damp. Rotting wood/floors and inadequate heating. <P> Modifications to the home such as grab rails were low. Those in the lower socio-economic groups (C2, D, E) were least likely to have aids or adaptations. <P> 35,914 (62%) people were identified as having a mobility problem. To understand to what extent each was asked if they had difficulty or needed assistance with a number of everyday situations. A considerable number actually needed assistance (70%) and virtually all had some difficulty with one or more of the mobility circumstances. <P> Over half (52%) had difficulty carrying out domestic chores, with shopping and domestic tasks being the main problems. Nearly four in ten (37%) had problems with dressing and washing. <P> As regards peoples senses, nearly four in ten (37%) had problems with eyesight, hearing and speech. <P> Difficulties were also experienced in leisure activities (43%), performing a normal family role (26%) and depression (26%). These complaints were especially high for disabled people. <P> Both disabled people and older aged people had problems getting up from a fall and, in some instances, of being left on their own. Some 33,776 people over half (52%) of the sample, experienced some difficulties getting up from a fall or being left on their own. <P> Peoples care needs varied according to the type of problem they had. In particular, someone who was disabled was more likely to have mobility problems, whereas a single parent was more likely to have child care problems. <P> Disabled people were particularly sensitive to their ability to participate in social activities and would possibly benefit from any initiative to improve their social circumstances. <P> It was found that many people who were interviewed may not have a care need such as bathing or gardening but would benefit from increased social interaction. Many respondents have mobility problems and therefore have difficulties getting out of their homes. Indeed some people visited had not left their homes for weeks or even months and a visit from a CSA allowed them to chat and discuss their lives and for many this was of great benefit. Whilst LHCPI has no hard data to support this view, it is the belief of the whole team that loneliness and isolation is a problem for many people. <P> Usage of LA services was low. Only a quarter (26%) of those with a care need used these services. In addition, satisfaction amongst those able to give an opinion about their LA service was weak. Under two in ten (16%) gave the top rating "very satisfied". The most frequent comments regarding LA services was a "lack of control" over service delivery. The most common service received was Home Help/Care and respondents felt that the service did not undertake the tasks they actually wanted done. They also wanted more hours of service <P> It should be noted that it appears that those in greatest difficulty are likely to be receiving the care services they require. This may be both formally and informally. This is illustrated by the fact that there is very low demand for "care to the person" services e.g. bathing. In this respect the LA is meeting its commitment to these people. This is not to say that people do not have difficulty or do not require assistance. Approximately one third (31%) of those with a care need experienced problems with dressing and washing and, in particular, bathing proved to be the greatest problem. <P> When asked what assistance would make a considerable improvement to their lives, painting and decorating, home cleaning, lifeline alarms and property repairs were most frequently mentioned. For carers, transport assistance for the person they cared for would also be helpful. <P> Single parents did have noticeable differences to their care requirements and were more likely to mention holidays, outings, and home safety more than other groups. These are services not usually provided by the LA. <P> Many people with a care need were in the lowest socio-economic grouping (E), where funds were likely to be limited. For this reason, very few people were prepared to pay more than Ł2.00 an hour for the service. As they have very limited funds to purchase such services, their demand may, in part, stem from an inability to purchase services that are too expensive e.g. painting and decorating <P> Willingness to pay for a service was low. Only 11% of those with a need were very willing to pay with the figure for carers slightly higher (21%). <P> <FONT COLOR=RED> Income Maximisation </FONT> <BR> Contrary to many peoples beliefs, welfare benefits are grossly underclaimed. A large section of the community, who are elderly or who suffer from disabilities, are often unaware of the Benefits, or their own entitlement. The DSS figures for 1994-5 for IS alone show that about 1 million pensioners were classed as entitled to this benefit but had not claimed. The Labour Government estimates that this is a rise of 35% over 1993-94 underclaiming. The figures for unclaimed Benefits for pensioners alone lay somewhere within the range of Ł590M to Ł800M and the average unclaimed amount was Ł14.10 per person per week. (Source Community Care 5-12 Dec 1996) <P> When considering the low levels of IS and the high cost of living, it can safely be assumed that many people were living in poverty. In the experience of the CSAs, many elderly people sit in cold, dark rooms, reluctant to use their heating/lighting due to their low income and the cost of fuel. <P> Whether or not people have been able to access Disability benefits often depends on whether they have been able to seek advice from a specialist agency. Many people who completed the claim forms for AA/DLA, without assistance, were often unsuccessful in obtaining benefits. This is not due to the ineligibility of the claimant but rather their inability to cope with the lengthy and complicated claim forms. A review was not often requested, due to peoples lack of knowledge and/or reluctance to challenge official decisions. <P> The complexity and length of the forms often deters people from claiming. The inability to complete them through a physical of mental cause e.g. arthritis in hands, visual impairment, or mental health problems (Alzheimer’s) is also a deterrent. <P> Many people, especially those who are elderly or who have disabilities, are unable to leave their homes or travel far in order to seek advice. The provision of advice and assistance in the clients own home is often, therefore, the deciding factor in enabling them to access the Benefits to which they are entitled. <P> <FONT COLOR=RED> Long Term Unemployed People </FONT> <BR> LTU are, at present, prevented from taking up some offers of employment because of the Benefits Trap. Claims that LTU are better off working because of assistance provided i.e. Housing Benefit for the first four weeks of employment does not encourage LTU to return to work. What happens after four weeks when this assistance stops and their income is too low to meet their mortgage repayments? <P> Many LTU want to work. Employment would allow their return to independence and regain their self esteem. They want to do "an honest days work for an honest days pay". To those wanting to return to work the regaining of their self respect is as important, if not more important than a decent wage. <P> <FONT COLOR=RED> Potential Business Activity </FONT> <BR> It can be seen that there is a high level of unmet demand for "Add-on" care services such as painting and decorating. A business would stand the greatest chance of success if it provided a range of services that included painting and decorating, gardening, home cleaning, home maintenance and window cleaning. <P> Any community business established should focus upon the following factors: <UL> <LI>Quality <LI>Accountability <LI>Value for money <LI>Demand </UL> <BR> Whilst Ł6.00 per hour does initially seem expensive for the services when compared to the "informal" economy, emphasis should be placed upon the above factors. People are more willing to pay Ł6.00 per hour when they realise what the money is being used for, e.g. adequate wages, training and quality services. <P> Any business established should try to focus upon creating a friendly reassuring image to which people can relate. The provision of care is to traditionally vulnerable client groups, who, for their own safety, have become suspicious. There are a variety of ways this could be achieved: <UL> <LI>Put a "face to the name". People are reassured when they come to know who is providing the service. <BR> <LI>Liaise closely with other providers and support groups. This will provide a network of people who are able to vouch for the integrity of the company. <BR> <LI>Gain accreditation from the LA. This will ensure there is a recognised standard of service provision. </UL> <BR> Any business that provides services such as painting and decorating or gardening will face strong competition from the informal economy. Whilst the informal economy may not provide guarantees or quality assurance, it may have charges as low as Ł3.00 per hour as overhead costs are very low. <P> Based upon this research initial start-up costs may be prohibitive to a new community business trying to break into the market. <P> Business start-up is more likely to be successful and sustainable if service providers already in existence could expand or diversify, and who are likely to already have in place some of the infrastructure needed by a new business. <P> There are 76,187 people who have one or more care needs measured by the survey. However, only 11% of those in the care needs survey were willing to pay and the most likely price they would be prepared to pay is Ł2.00 or less. A sustainable "stand-alone" business is unlikely to be able to exist if the charge were Ł2.00 or less an hour. <P> The challenge therefore is to place the ability to purchase into the hands of the purchaser. </B> </TD></TR> </TABLE> </CENTER> <B> <H5> <A HREF="exec.html" TARGET=_top>[Executive Summary]</A> <A HREF="back.html" TARGET=_top>[Background of the LTU]</A> <A HREF="search.html" TARGET=_top>[Research Objectives]</A> <A HREF="concl.html" TARGET=_top>[Conclusions]</A> <A HREF="rec.html" TARGET=_top>[Recommendations]</A> <A HREF="gloss.html" TARGET=_top>[Glossary of Terms]</A> <A HREF="pool.html" TARGET=_top>[Liverpool Community Care Ltd]</A> </H5> </B> </BODY>