Section 11: DIRECT PAYMENTS FOR MINORITY ETHNIC COMMUNITIES
235. Take up of community care services generally is proportionally low among minority ethnic communities in Scotland, including minority ethnic disabled people and older people aged 65 and over. This is similarly reflected in direct payments take-up. This can lead to difficulties for minority ethnic individuals and families, particularly those for whom English is not their first language, as decreasing independence can lead to feelings of social isolation.
236. It is starting to be recognised by some local authorities that the assumption that minority ethnic families have continued a tradition of looking after their own members may not be the case. Direct payments could be a key way of ensuring minority ethnic individuals and families have better access to community care services generally.
Eligibility, assessment and support
237. Direct payments may provide the individually tailored care that best meets minority ethnic users' assessed needs, including language and other specific cultural needs. However, this can only happen if appropriate services are available such as translators, and trained care managers, targeted local support, trained service providers and PAs. It is therefore important that these services are available and are fully accessible to minority ethnic direct payment users. Local authorities and other public bodies must bear in mind their legal duty to eliminate unlawful race discrimination and to promote race equality (which will shortly also apply to disability and gender), including when they have contracted out the delivery of a service to another party.
238. The single shared assessment ( SSA) process is a gateway to direct payments for all users. Translators, where needed, are a minimum requirement to equalise access to the care services for minority ethnic elders and disabled people. As with other users, minority ethnic individuals may be experiencing difficulties or have needs that are not obvious. Language barriers or difficulties with hearing or speech, might make it difficult for users to explain or describe. In the same way, the recommended direct payments pre-assessment work (see para xx) should be available to minority ethnic users with appropriate language and peer support (see para xx), as should support for care planning (see para xx) and care management (see para xx).
What minority ethnic users can expect
239. Minority ethnic service users who are eligible for direct payments can expect:
- to be given choice and control over how their assessed needs are met
- to be offered pre-assessment work so that they can work out their needs and make informed choices about use of direct payment for some or all of their support
- to be given details of local support services for information, training and practical help
- direct payments to be offered at every assessment and review
- to be given direct payments training that is personalised to their needs
Local Support
240. Some local authorities have allowed external support organisations to access their in-house translator services. If this is not possible, local authorities need to ensure that the external support organisations that they fund are sufficiently resourced to provide the necessary translators.
241. Local support needs to be able to offer minority ethnic individuals the services direct payments organisations offer to other older or disabled people. For example in the care planning and management stage help setting up stages of a package, general confidence building as people gain from the experiences of their peers, help setting up a separate bank account to track payments and expenditure, help setting up employer's liability insurance, providing rooms for interviewing PAs, providing an address for responses to adverts, and help in resolving any difficulties that may arise.
242. Once funded to do so by local authorities, local direct payments organisations in partnership with minority ethnic organisations should be aiming to expand their current support service to better accommodate minority ethnic users' support needs. They need to expand their outreach so that the places where potential users routinely meet (for example, GPs, social networks) have the information they might need. Dialogue and partnership work with local minority ethnic representatives and groups will be important, particularly in building trust, capacity, and confidence within those communities. These relationships may take time to establish as formal groups/networks may not existing in all areas, or some communities may have little experience of getting involved with organisations with whom they may feel they have little in common: current disabilities and/or older people's support organisations may have little or no minority ethnic representation. This may be particularly so if local minority ethnic people are not accessing mainstream community care services in the first place, or are not in contact with their council for other services.
243. Local support organisations have had some success in targeting minority ethnic trainees for PA training courses. For example, older people may wish to spend their final years in the company of people with whom they most identify: their own faith communities, eating traditional food and watching their own language television, whether their own language television, whether they are of Polish or Chinese origin.
Using care agencies and other service providers
244. Section 4 looks at service provision using direct payments. Where recipients pay an organisation a fee for a service, for example, for a sitter from a private or voluntary agency, they do not have the responsibilities of an employer, such as tax, National Insurance, insurance, etc. Using service providers has many advantages, including providing emergency back-up and illness/holiday cover but the individual does not have as much say in who will come to their house and what they can or cannot do.
Employing PAs
245. Employing PAs may offer the targeted support that many minority ethnic users seek. General guidance is offered at section 1 and advice on employing family members at section 5. The proposed Adult Support and Protection Bill to be enacted in 2007 will make it possible for local authorities to allow employment of family members in exceptional circumstances where this is necessary to deliver the required care.
Example : Imaginative approach taken by one service user by employing PAs
Mrs Aslam was diagnosed with dementia and her physical well-being was deteriorating rapidly, so she required support with all aspects of personal care, and supervision throughout the day as she frequently becomes disorientated and anxious. She does not speak or understand English, and only reads in her native local language. Her family felt that current social services such as day centres and home helps were not appropriate for her as she would not be able to communicate her needs and wishes and the services could not provide culturally appropriate resources. It was feared that this would make her even more anxious, so her daughter took on all of the support she required.
Mrs Aslam talked to her family about direct payments and her daughter translated and explained direct payments to her. Direct payments now allow her to pay for a personal assistant to work with her 25 hours a week and in addition her daughter continues to provide additional support to her mother. This arrangement means that Mrs Aslam has been able to build up a relationship with her PA and there is consistency in her daily life. Her PA knows her needs and can help her to go walks with her new baby granddaughter, go swimming at her local pool and to go shopping for the food that she prefers to eat.
How to mainstream direct payments for local minority ethnic users
246. Ensuring that there is adequate funding of targeted local support services is one of the key ways for local authorities to ensure that direct payments are routinely available for minority ethnic people. This support will help local authorities
- Promote direct payments for minority ethnic users. There is a very low knowledge base within some communities. Awareness of locally funded direct payments support needs to reach the whole community through, for example, outreach programmes, since many people may only hear of direct payments through word of mouth, may not be sure if they are eligible, or may not be aware of it at all, particularly if English is not their first language.
- Provide specialist support targeted to minority ethnic users' needs if needed, for example, a translator, advocate or support worker with specialist skills.
- Ensure minority ethnic users and potential users have access to information targeted to their needs.
- Train minority ethnic users on pre-assessment, care planning and care management via local support organisations.
- Train local authority care managements on race equality issues, and encourage a culture of open and honest dialogue to enable more minority ethnic people to take up direct payments if it best meets their needs.
Further Information
247. The Department of Health in England had produced 'Breaking Barriers', a video or DVD on direct payments aimed at people from minority ethnic communities available by following the link below 32.