Care Confidence

Understanding and arranging social care is not easy. Older people who need to fund their own care (self-funders) say they do not always know where to start or what their options are. Some would like help to make decisions and plan their next steps.

At the University of York, we have developed a website with and for older self-funders which is evidence-based and contains useful information to help people make a plan. The website is called Care Confidence.

• Aims

  We want to ensure everyone who could benefit from Care Confidence has the opportunity to do so.

  In order to achieve this, the research team’s objectives are:

  • To support social care providers in four sites to implement a dedicated version of the Care Confidence care planning tool for older-self funders (tailored implementation)
  • To find ways of tailoring the use of the tool to improve its reach and inclusivity, meeting the needs of a more diverse population of older self-funders (diversity and inclusion)
  • To evaluate the implementation of Care Confidence against NPT principles (mixed methods, with staff) and qualitatively with older self-funders and their cares (robust evaluation)
  • To feed learning from the initial stages of evaluation into later stages of service improvement (continual improvement)
  • To share learning from the study, about implementing Care Confidence and the use of implementation thinking in social care settings, with a wider range of stakeholders to maximise impact (knowledge mobilisation)

• Methods

  We will work with local councils and charities to find the best ways of helping older self-funders to use Care Confidence. This might be simply letting people know how to access Care Confidence, or it might involve a face-to-face care-planning session, or something else. Services will put their plans into action, and we will collect data to help improve their approach. Specifically, we will:

  Hold workshops: For services to plan how to use Care Confidence and where it ‘fits’

  • When will they tell people about Care Confidence?
  • Will they offer some people additional help? (For example, people who are socially isolated, have English as a second language or who struggle with digital technology.)
  • What will this help look like?
  • Will they provide ongoing support?

  Assist services to put their plans into action

  This could involve some staff training, or a change in the way a service is delivered. Additional costs can be covered.

  Evaluate how things are going

  This will include:

  • Interviews, focus groups and a survey with front-line staff and managers
  • Interviews with people using Care Confidence
  • Information from the Care Confidence website

  Hold follow-up workshops and share the learning

  We will discuss what we are learning with stakeholders and agree further improvements. Services will adjust their approaches, more data will be collected by the research team and final workshops will then be held to hear findings and agree next steps.

  Working with older people and their supporters

  Care Confidence was co-designed with older self-funders and the people who support them. They tested the website as research participants and made design decisions through the project advisory group. This group will continue to contribute actively, ensuring that the proposed implementation study is guided by the expertise of people with lived experience.   
   

• Planned outputs

  The research will produce new knowledge about how best to support older self-funders. We will work with services, networks of professionals and people with lived experience to ensure key messages reach the right people and the research has maximum impact.

  Outputs will include:

  • Tailored Implementation Plans:
    Detailed reports on how local services can best implement the Care Confidence tool for self-funders, tailored to different settings and communities.

  • Workshops and Training Materials:
    A series of workshops and training materials for service providers, which will guide them on integrating Care Confidence into their existing workflows.

  • Process Evaluation Findings:
    A comprehensive evaluation report detailing how the interventions are implemented across different settings and their effectiveness, guided by Normalisation Process Theory (NPT).

  • Public and Stakeholder Engagement:
    A final report on the engagement efforts, including feedback from public advisors and stakeholders, detailing the impact of the study on policy and practice.

  • Guidance on Digital Exclusion:
    Resources and recommendations for overcoming barriers faced by digitally excluded individuals, ensuring equitable access to the tool.

  • Final Report:
    A comprehensive final report to be shared with stakeholders, summarizing the research, findings, and recommendations for wider dissemination.

  A final workshop in each study site will ensure learning is fully incorporated locally, and a national launch and visits to share findings with diverse groups will ensure wider reach, accompanied by a range of publicity and resources (including practical steps for implementation with costs, logic models and expected outcomes).
   

Many everyday activities such as getting dressed or washed, or making a meal, become more difficult as people get older. Help with these activities is called social care. Social care comes in many shapes and sizes, including getting help at home or living in a care home. Social care can be expensive. 

Some people receive help to pay for this care from their local council, but many people pay for some or all of it themselves. Thinking about what care is needed and how to pay for it, now or in the future, is complicated. There is so much information available that it can be hard to find the right information or know who to talk to. People who pay for their care often arrange all this by themselves, with little help or advice from professionals. 

• Aims

  Decision support tools aim to help people feel comfortable with the decisions they make as well as the way they make them. They are usually a list of questions to help people think about what is important to them. They also provide information about the risks and benefits of choosing different options. Decision support tools are often used in health care, for example in choosing between keyhole and open surgery.

  The decision support tool that this study has created – Care Confidence – aims to help older people make decisions about paying for social care, learn more about their options for paying for care and to think through what is important to them.  

• Methods

  This study aimed to produce a prototype decision support tool to help people feel more confident in seeking professional financial guidance or advice by removing the fear of the unknown, to facilitate people to think through their care options and personal preferences, and understand what different professionals can offer in terms of guidance or advice.

  Methods included re-analysis of existing interview data and consultations with a range of professionals alongside literature and website searches to identify content for the tool. This was followed by five sequential workshops, consultations with the project’s public and professional advisers, and work with a digital design team to create the tool. The alpha version of the tool was tested using ‘think aloud’ techniques to improve accuracy, usability and acceptability. The resulting beta version was tested with support from the MoneyHelper website and subject to a formative evaluation comprising interviews and an online survey to assess whether it had helped prepare people for making self-funded care decisions.  

• Findings

  Care Confidence project findings

  Navigating social care as a self-funder is stressful and time-consuming. It involves making sense of a complex system of financial requirements, legal questions of eligibility, a mixed economy of provider markets, and all in the highly emotional context that commonly includes ageing, frailty, dementia, hospital discharge and family dynamics. Previous research has demonstrated that families are poorly prepared to navigate this landscape, and do not even know how to start. Current offers from local authorities appear unsuited to the task.

  A new decision-support tool, Care Confidence, has been designed to assist in this journey. The study found that it seems to help with understanding care options, and to prepare people for asking further questions of other professionals. People particularly appreciated viewing videos of others talking about their experiences of navigating social care options. Further work on enhancing the Care Confidence interface, including a version tailored to mobile devices, and improving ‘digestibility’ of information, is now needed. There is also a deeper question as to where Care Confidence fits in the decision-making process. In contrast to existing medical decision-making tools, often relating to binary or limited treatment options, Care Confidence aims to support self-funders in more complex and dynamic choices. Rather than being a ‘decision support tool’, it may be better to regard Care Confidence as a preparatory guide to promote essential understanding and facilitate more targeted advice seeking.

  In the context of future social care funding reforms, local authorities would benefit from examining the information available to self-funders in their area, to consider how they could better-support decision-making. The Care Confidence toolkit is freely available and may be suitable alongside other support, though recognising that further enhancements and research is needed. 

• Resources and publications

  Decision support tool – Care Confidence

  Presentation to National Association of Finance Assessment Officers (NAFAO) 2023

  Presentation to International Long-term Care Policy Network (ILPN) Conference 2022

  Journal Article – Developing a Decision Aid for Older People Who Pay for Social Care