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Caring relationships and their role in users’ choices: a study of users of Direct Payments in England

Published online by Cambridge University Press:  31 January 2019

Ricardo Rodrigues Open the ORCID record for Ricardo Rodrigues [Opens in a new window]
Ricardo Rodrigues*
Affiliation:
European Centre for Social Welfare Policy and Research, Vienna, Austria
*
Email: rodrigues@euro.centre.org
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Abstract

User choice in care for older people has assumed that care is like any other commodity; which is in contrast with the concept of care defined by the feminist and ethics of care literature, which includes a relational component beyond care tasks – caring relationships. This study aims to understand how caring relationships impact the decisions of older users of care and their perceived satisfaction. Semi-structured qualitative interviews were conducted with 24 Direct Payments (DPs) older users, including proxies, in three Local Authorities in the Greater London area. Users fell into three groups according to their use of DPs: those purchasing care from agencies, those employing acquaintances as Personal Assistants (PAs) and those employing strangers as PAs. Decisions on and perceived satisfaction with care were both influenced by caring relationships. All users recognised that caring relationships can have instrumental value in improving care delivery or allowing greater leeway in negotiating tasks. Many users placed intrinsic value on continuity of care and the development of close caring relationships and clearly favoured employing PAs. The latter involved higher levels of uncertainty, emotional investment and reciprocal gift exchanges. Agencies were often chosen due to users’ preference for more detached caring relationships. The findings confirm that caring relationships involving reciprocal emotional investment are an important outcome of care, with salient implications for user behaviour.

Keywords

qualitative research methodsuser choicehome carecaring relationshipsdirect paymentsolder peoplereciprocity
Type
Article
Information
Ageing & Society , Volume 40 , Issue 7 , July 2020 , pp. 1469 - 1489
Copyright
Copyright © Cambridge University Press 2019

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References

Baldock, J (1997) Social care in old age: more than a funding problem. Social Policy & Administration 31, 73–89.CrossRefGoogle Scholar
Barnes, M (2011) Abandoning care? A critical perspective on personalisation from an ethic of care. Ethics and Social Welfare 5, 153–167.CrossRefGoogle Scholar
Barnes, M, Henwood, F and Smith, N (2016) Information and care: a relational approach. Dementia 15, 510–525.CrossRefGoogle ScholarPubMed
Bartlett, W and Le Grand, J (1993) The theory of quasi-markets. In Le Grand, J and Bartlett, W (eds), Quasi-markets and Social Policy. Basingstoke, UK: Macmillan Press, pp. 13–34.CrossRefGoogle Scholar
Baxter, K and Glendinning, C (2013) The role of emotions in the process of making choices about welfare services: the experiences of disabled people in England. Social Policy and Society 12, 439–450.CrossRefGoogle Scholar
Baxter, K, Glendinning, C and Greener, I (2011) The implications of personal budgets for the home care market. Public Money & Management 31, 91–98.CrossRefGoogle Scholar
Boyle, G (2005) The role of autonomy in explaining mental ill-health and depression among older people in long-term care settings. Ageing & Society 25, 731–748.CrossRefGoogle Scholar
Bradley, EH, Curry, LA and Devers, KJ (2007) Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Services Research 42, 1758–1772.CrossRefGoogle ScholarPubMed
Canham, SL, Battersby, L, Fang, ML, Sixsmith, J, Woolrych, R and Sixsmith, A (2017) From familiar faces to family: staff and resident relationships in long-term care. Journal of Aging and Health 29, 842–857.CrossRefGoogle ScholarPubMed
Caplow, T (1982) Christmas gifts and kin networks. American Sociological Review 47, 383–392.CrossRefGoogle Scholar
Clarke, J (2006) Consumers, clients or citizens? Politics, policy and practice in the reform of social care. European Societies 8, 423–442.CrossRefGoogle Scholar
Collopy, BJ (1995) Power, paternalism, and the ambiguities of autonomy. In Enhancing Autonomy in Long-term Care. Concepts and Strategies. New York, NY: Springer, pp. 3–14.Google Scholar
Da Roit, B and Le Bihan, B (2010) Similar and yet so different: cash-for-care in six European countries’ long-term care policies. Milbank Quarterly 88, 286–309.CrossRefGoogle ScholarPubMed
Dowding, K and John, P (2009) The value of choice in public policy. Public Administration 87, 219–233.CrossRefGoogle Scholar
Eichler, M and Pfau-Effinger, B (2009) The ‘consumer principle’ in the care of elderly people: free choice and actual choice in the German welfare state. Social Policy & Administration 43, 617–633.CrossRefGoogle Scholar
England, P, Budig, M and Folbre, N (2002) Wages of virtue: the relative pay of care work. Social Problems 49, 455–473.CrossRefGoogle Scholar
Ettema, T, Dröes, R, de Lange, J, Mellenbergh, G and Ribbe, M (2005) A review of quality of life instruments used in dementia. Quality of Life Research 14, 675–686.CrossRefGoogle ScholarPubMed
Fernández, JL, Kendall, J, Davey, V and Knapp, M (2007) Direct payments in England: factors linked to variations in local provision. Journal of Social Policy 36, 97–121.CrossRefGoogle Scholar
Fine, M (2005) Individualization, risk and the body: sociology and care. Journal of Sociology 41, 247–266.CrossRefGoogle Scholar
Fine, MD (2007) A Caring Society? Care and the Dilemmas of Human Service in the 21st Century. Basingstoke, UK: Palgrave Macmillan.Google Scholar
Fine, M (2014) Nurturing longevity: sociological constructions of ageing, care and the body. Health Sociology Review 23, 33–42.CrossRefGoogle Scholar
Fineman, MA (1995) The Neutered Mother, the Sexual Family and Other Twentieth Century Tragedies. New York, NY: Routledge.Google Scholar
Folbre, N and Weisskopf, T (1998) Did father know best? Families, markets and the supply of caring labor. In Ben-Ner, A and Putterman, L (eds), Economics, Values, and Organization. Cambridge: Cambridge University Press, pp. 171–205.CrossRefGoogle Scholar
Gibson, DM (1985) The dormouse syndrome – restructuring the dependency of the elderly. Journal of Sociology 21, 44–63.CrossRefGoogle Scholar
Glendinning, C (2008) Increasing choice and control for older and disabled people: a critical review of new developments in England. Social Policy & Administration 42, 451–469.CrossRefGoogle Scholar
Graham, H (1983) Caring: a labor of love. In Finch, J and Groves, D (eds), A Labor of Love: Women, Work and Caring. London: Routledge and Kegan Paul, pp. 13–30.Google Scholar
Granovetter, M (1985) Economic-action and social-structure – the problem of embeddedness. American Journal of Sociology 91, 481–510.CrossRefGoogle Scholar
Greener, I (2007) Are the assumptions underlying patients choice realistic? A review of the evidence. British Medical Bulletin 83, 249–258.CrossRefGoogle Scholar
Greve, B (2009) Can choice in welfare states be equitable? Social Policy & Administration 43, 543–556.CrossRefGoogle Scholar
Himmelweit, S (1999) Caring labor. Annals of the American Academy of Political and Social Science 561, 27–38.CrossRefGoogle Scholar
HM Government (2007) Putting People First: A Shared Vision and Commitment to the Transformation of Adult Social Care. London: HM Government.Google Scholar
Hochschild, AR (1983) The Managed Heart: Commercialization of Human Feeling. Berkeley, CA: University of California Press.Google Scholar
In Control (2014) Third National Personal Budget Survey. London: In Control.Google Scholar
Kittay, EF (1999) Love's Labor. Essays on Women, Equality and Dependency. New York, NY: Routledge.Google Scholar
Kittay, EF (2011) The ethics of care, dependency, and disability. Ratio Juris 24, 49–58.CrossRefGoogle Scholar
Kröger, T (2009) Care research and disability studies: nothing in common? Critical Social Policy 29, 398–420.CrossRefGoogle Scholar
Lanoix, M (2013) Labor as embodied practice: the lessons of care work. Hypatia 28, 85–100.CrossRefGoogle Scholar
Le Grand, J (2007) The Other Invisible Hand: Delivering Public Services Through Choice and Competition. Princeton, NJ: Princeton University Press.Google Scholar
Lee, S, Mathiowetz, N and Tourangeau, R (2004) Perceptions of disability: the effect of self- and proxy response. Journal of Official Statistics 20, 671–686.Google Scholar
Leece, J (2010) Paying the piper and calling the tune: power and the direct payment relationship. British Journal of Social Work 40, 188–206.CrossRefGoogle Scholar
Lerner, JS and Keltner, D (2000) Beyond valence: toward a model of emotion-specific influences on judgement and choice. Cognition and Emotion 14, 473–493.CrossRefGoogle Scholar
Lloyd, L (2004) Mortality and morality: ageing and the ethics of care. Ageing & Society 24, 235–256.CrossRefGoogle Scholar
Lloyd, L (2010) The individual in social care: the ethics of care and the ‘personalisation agenda’ in services for older people in England. Ethics and Social Welfare 4, 188–200.CrossRefGoogle Scholar
Mauss, M (1954) The Gift: Forms and Functions of Exchanges in Archaic Societies. London: Cohen and West.Google Scholar
National Audit Office (2011) Oversight of User Choice and Provider Competition in Care Markets. London: The Stationery Office.Google Scholar
National Audit Office (2016) Personalised Commissioning in Adult Social Care. London: The Stationery Office.Google Scholar
Needham, C (2006) Customer care and the public service ethos. Public Administration 84, 845–860.CrossRefGoogle Scholar
Nelson, J (1999) Of markets and martyrs: is it OK to pay well for care? Feminist Economics 5, 43–59.CrossRefGoogle Scholar
Netten, A, Jones, K, Knapp, M, Fernández, JL, Challis, D, Glendinning, C, Jacobs, S, Manthorpe, J, Moran, N, Stevens, M and Wilberforce, M (2012) Personalisation through individual budgets: does it work and for whom? British Journal of Social Work 42, 1556–1573.CrossRefGoogle Scholar
O'Leary, P, Tsui, MS and Ruch, G (2013) The boundaries of the social work relationship revisited: towards a connected, inclusive and dynamic conceptualisation. British Journal of Social Work 43, 135–153.CrossRefGoogle Scholar
Pesonen, H-M, Remes, AM and Isola, A (2011) Ethical aspects of researching subjective experiences in early-stage dementia. Nursing Ethics 18, 651–661.CrossRefGoogle ScholarPubMed
Pickard, S (2009) Governing old age: the ‘case managed’ older person. Sociology 43, 67–84.CrossRefGoogle Scholar
Prime Minister's Strategy Unit (2005) Improving the Life Chances of Disabled People. London: Cabinet Office.Google Scholar
Ritchie, J and Lewis, J (2003) Qualitative Research Practice. A Guide for Social Science Students and Researchers. Thousand Oaks, CA: Sage.Google Scholar
Rodrigues, R and Glendinning, C (2015) Choice, competition and care – developments in English social care and the impacts on providers and older users of home care services. Social Policy & Administration 49, 649–664.CrossRefGoogle Scholar
Roth, AE (2007) Repugnance as a constraint on markets. Journal of Economic Perspectives 21, 37–58.CrossRefGoogle Scholar
Schmidt, AE, Winkelmann, J, Rodrigues, R and Leichsenring, K (2016) Lessons for regulating informal markets and implications for quality assurance – the case of migrant care workers in Austria. Ageing & Society 36, 741–763.CrossRefGoogle Scholar
Schwartz, B (2004) The Paradox of Choice: Why More is Less. New York, NY: Harper Books.Google Scholar
Scourfield, P (2007) Are there reasons to be worried about the ‘cartelization’ of residential care? Critical Social Policy 27, 155–180.CrossRefGoogle Scholar
Slasberg, C and Beresford, P (2016) The false narrative about personal budgets in England: smoke and mirrors? Disability & Society 31, 1132–1137.CrossRefGoogle Scholar
Slasberg, C, Beresford, P and Schofield, P (2012) How self directed support is failing to deliver personal budgets and personalisation. Research, Policy and Planning 29, 161–177.Google Scholar
Thaler, RH (1980) Toward a positive theory of consumer choice. Journal of Economic Behavior and Organization 1, 39–60.CrossRefGoogle Scholar
Tronto, JC (1993) Moral Boundaries: A Political Argument for an Ethic of Care. New York, NY: Routledge.Google Scholar
Twigg, J (2004) The body, gender, and age: feminist insights in social gerontology. Journal of Aging Studies 18, 59–73.CrossRefGoogle Scholar
Ungerson, C (2004) Whose empowerment and independence? A cross-national perspective on cash for care schemes. Ageing & Society 24, 189–212.CrossRefGoogle Scholar
Ungerson, C (2005) Care, work and feeling. The Sociological Review 53, supplement 2, 188–203.CrossRefGoogle Scholar
Watson, J (2016) Developing the Senses Framework to support relationship-centred care for people with advanced dementia until the end of life in care homes. Dementia.CrossRefGoogle Scholar
Wilson, CB, Davies, S and Nolan, M (2009) Developing personal relationships in care homes: realising the contributions of staff, residents and family members. Ageing & Society 29, 1041–1063.CrossRefGoogle Scholar
Woolham, J and Benton, C (2013) The costs and benefits of personal budgets for older people: evidence from a single local authority. British Journal of Social Work 43, 1472–1491.CrossRefGoogle Scholar
Woolham, J, Daly, G, Sparks, T, Ritters, K and Steils, N (2017) Do direct payments improve outcomes for older people who receive social care? Differences in outcome between people aged 75+ who have a managed personal budget or a direct payment. Ageing & Society 37, 961–984.CrossRefGoogle Scholar
Yeandle, S, Kröger, T and Cass, B (2012) Voice and choice for users and carers? Developments in patterns of care for older people in Australia, England and Finland. Journal of European Social Policy 22, 432–445.CrossRefGoogle Scholar