Baxter K, Glendinning C
Very little is known about the many adults in England who purchase social care services and support using their own, private resources. However, rising eligibility thresholds for local authority-funded care combined with population ageing means the numbers of self- funders are likely to increase. The importance to local authorities of self-funders is also increasing with the implementation of the Care Act 2014.
This review sought evidence on: the size of the evidence base; characteristics of the self- funding population; information and advice sought by and available to self-funders; and providers’ experiences of self-funders. A self-funder was defined as someone who pays for all of their social care or support from their own private resources or ‘tops up’ their local authority residential or domiciliary care funding with additional private spending. Social care was defined as care homes (both with and without nursing), domiciliary care, day care and care received as part of extra-care housing.
185 potentially relevant pieces of work published since 2000 were identified. After applying inclusion and exclusion criteria, and removing duplicates, details were extracted from 71 publications. The majority focussed on residential care, domiciliary care or both. The studies used a wide range of research methods. Some were based on national or multi-regional samples; others were local studies.
The evidence suggests that the number and percentage of self-funders has increased in both residential and home care. There are differences between regions and across local authorities. There has been very little research about the socioeconomic or other characteristics of self-funders, but some evidence that dependency levels of self-funders in care homes appears to be lower than local authority-funded residents.
Self-funders often approached their local authorities as the first point of contact for advice but could feel disadvantaged by their perceived unwillingness to help. They are often signposted elsewhere and not followed up by local authorities. The main information issues for self-funders living in or considering residential care were fees and finances, particularly the long term financial implications of care.
There was very little evidence about the experiences of home care agencies or care homes in providing care to self-funders, although home care agencies were beginning to see the potential of the market for self-funders. There were some concerns by care home managers that self-funders and local authority-funded residents were not treated equitably in relation to assessments and reviews.
There are many gaps in the research evidence base, including: accurate figures on the number and characteristics of self-funders, and factors that influence the level of demand; the transparency of fees and contracts; dependency levels; how the tasks carried out for self-funders might differ from local authority-funded clients; experiences and outcomes for self-funders; and the experiences of providers. Almost no research was found on the self-funders experiences in housing with care schemes or day centres.