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Find services to help elderly relative stay in their own home - 2017-18

Why important

Visits for social care have not historically been in the top tier of reasons why people come to council websites. Numbers receiving social care services from the council are relatively small (and getting smaller as a consequence of austerity) and until recently enquiries will have been handled mostly through referral and phone and face-to-face channels. However, under the Care Act 2014, councils in England gained new responsibilities to ensure that all people in their area have access to suitable information and advice about care options. Although they are not obliged to provide all this themselves, social care departments have made significant investments over the last three years in their online provision, not least in pursuit of efficiencies in enquiry handling.

Date of assessment

December 2017

Coverage

County councils, English unitaries, Metropolitan districts, London boroughs

Overview

This year’s survey focused, like last year’s ‘Find local care support for older person’, on how well councils are serving the large number of people that need to provide care arrangements for elderly friends and relatives without council funding. Results, with 41% providing a good or very good service, are less good than last year (52% of the same cohort achieved this level) and the reason is clear. As part of their response to the Care Act, most English and Welsh councils have invested in directories of services and providers for ‘self-funders’. But it has proved difficult to make this work well, and this year’s test, focused on finding information about specific services has made this clear. For example, just 24% of sites make it easy to find providers of personal care services like dressing and washing, 32% to find gardening or shopping services, and only 44% information about community based social support services. The good news is that there are some councils doing this very well, providing examples for others to follow.

Find your council report

Check ‘coverage’ to see if your council has been surveyed. Go to councils page and select your council. Look for link to task report under 2016-17 results

Headline results

41%

Provide a good or very good online service based on this survey

Better connected rankings

9%
32%
51%
7%
0%

*Discrepancies in the figures are due to rounding off

Key
  • 4 stars (Very Good)
  • 3 stars (Good)
  • 2 stars (Unsatisfactory)
  • 1 star (Poor)

 

Questions

Log in to view question set or View sample question set from 2016-17 (pdf)

Task report

All Better Connected service tasks start with a Google search, replicating what the vast majority of Internet users do when setting out find something new.

We remarked in last year’s report on the social care task Find local care support for an older person that services ‘not found in Google’ were high for social care tasks. It is disappointing that this year there are still seven sites in our cohort of 152 (5%) where our search term ‘XYZ Council care at home services for elderly person’ did not lead to the information we were seeking.

This may be because too little attention has been paid to search engine optimisation by those responsible for this content. However, sometimes it appears to be because of a deliberate separation of a care services directory from the main council.gov.uk adults social care pages – more on this below.

In developing the questions set for Find services to help elderly relative stay in own home, we anticipated that someone, probably a family member seeking care for an older person, would want to start by understanding a bit about the social care ‘system’ operated by councils and in particular, whether their relative would be eligible for support.

Hence our questions: Can I find information about council-arranged support for care (including care at home) and Is it clear that people may need to pay for care packages/services AND that a financial assessment will be carried out for this purpose?

The highest scoring sites make it really easy to find this information by providing a simple introduction to options for ALL older people struggling to live independently. This includes information about who is eligible for council support, both in terms of needs and financial circumstances; the processes involved in accessing such support; and options for people who are ineligible for council services.

Adult social care teams are transitioning from a time when they needed only to be concerned with those who qualified for council financial support, to the current time where the Care Act has given them responsibility also for providing information, advice and guidance about care options for the whole population.

On some sites it is evident that the transition is still in progress, with content mostly addressed to traditional users of adult social care, those who are in receipt - or can expect to be - of council arranged support and the funding to go with it. Visitors are encouraged to apply for an assessment (sometimes with scant information and the phone as the only contact option), before doing anything else.

Others, perhaps understandably anxious to preserve resources for those most in need, hardly mention support available (ie that anyone is entitled to a paid-for assessment) and divert site visitors immediately to ‘self-serve’ from directories of services provided by private and third sector organisations.

Providing the right information with enough but not too much detail is hugely important at the early stage of people’s enquiries, saving time, energy and resources, including those of council teams. Anecdotal evidence suggests that councils experience high rejection rates for council-arranged packages of care where their potential recipients do not realise that, depending on their income and savings, they may need to make a contribution to costs.

Balance is important. One county council emphasises the financial implications upfront, starting the page with:

If you have more than £23,250 in savings and assets you’ll have to pay the full cost of the long-term help you get at home. You'll also have to pay £236 per year for the council to arrange your care.

Further down the site states: Ask for an assessment to see if you can get help from us. At this point most people might regard an assessment as pointless. There’s no mention that the council can assess your needs, provide professional advice and point you towards variety of sources of help, all for free and not means tested.

It is sometimes not clear that assessment of need (as opposed to financial circumstances) is a key determinant of getting support – other times there is far too much detail provided about how these needs are determined.

Some councils are now providing online self-assessments of need, which are presumably used (this is rarely made explicit) to triage incoming enquiries and reduce numbers self-referring for a full (and costly) assessment.

Our survey shows that on 85% of sites reviewers were able to say ‘yes’ to Can I find information about council-arranged support for care (including care at home) and on 70% to Is it clear that people may need to pay for care packages/services AND that a financial assessment will be carried out for this purpose?.

These are better scores than the 65% scored for two similarly introductory questions last year. Last year’s slightly easier question about paying for care scored slightly higher, at 74%.

Generally low scores for each site overall in this survey are partly accounted for by the fact that although introductory information could be found, this was often more difficult than it should have been.

Headings can be vague and sometimes make distinctions that might be clear to the professionals, but not necessarily to the site user. The heading or category ‘carers’ almost always leads to information for carers, and never information for someone looking for a carer.

‘Help at home’ might lead to personal care, or be much broader and lead to gardening, meals on wheels, and handy man services. Headings should be carefully crafted to be as descriptive as possible eg ‘Support for carers’ or ‘Find a carer’. Council should also avoid being mealy mouthed. Why the coy ‘Money matters’ when ‘Do I have to pay for care?’ is so much clearer?

‘Day services’ is a vague term for the uninitiated and appears to refer to a whole range of services provided at a day centre, though this is rarely if ever explained. One site reviewed site does not explain what ‘Day Service’ means even at the point of inviting people to apply for an assessment to join a specific centre.

If a succinct heading can’t be found describe something, then a presentation format that allows a few words of description under a heading is really helpful – look no further than the home page of https://www.gov.uk/ for what we mean, although there are some good examples of this practice in a social care context by councils in our recommended section.

There are also some regularly used headings that lead to different content on different sites, which means people using more than one council website can easily be caught out making assumptions on previous experience. For example 'Getting out and about' might cover just transport, but may also include social aspects associated with the wider topic of wellbeing – things like lunch clubs and befriending. ‘Staying Safe’ might be about falls or living aids, but could also be about crime, burglar alarms or even abuse. And who would think to look for residential care providers under ‘housing options’.

Some sites present completely separately topics that clearly overlap from the user perspective, but with no cross-linking. This presumably reflects council demarcation between the silos of public health and social care. So promoting health and healthy lifestyles may not be linked in any way with mobility or mobility equipment, or healthy eating with advice about and meals services.

At the core of our question set, there were five that tested how easy it was to find, on or linked from council web pages, information about key services enable older people to maintain independence and stay in their own home. This, of course, is an important objective of government policy for addressing the escalating cost of caring for an ageing population. From an individual and family perspective, the benefits are equally significant.

Of the key services we asked about, finding providers of personal care services like dressing or washing proved the most difficult – just 24% of sites led our reviewers to a satisfactory answer.

Many councils did not break down a broad category such as 'homecare' into subcategories in their directories. Users therefore have to read descriptions of all the home care agencies listed to see which offered these services, and this was regarded as unsatisfactory by reviewers.

Only 32% were able to find either a gardening or a shopping service and 44% information about community-based support services. The latter is a poor result for those pushing the value of ‘asset based’ social care provision as well as ‘social prescribing’.

Results were better for services associated with traditional social care provision including telecare and monitoring (81%) and products to support older people living independently with disabilities and impairments (74%).

One of the most important factors in the findability of information about services to support older people, including those ineligible or disinclined to use council arranged services, is the way councils have implemented directories of services and/or emarketplaces.

In the wake of the Care Act (effective in March 2015) most councils have added directories of services and providers in the private, charity and voluntary sector, alongside information about services they deliver themselves. Some councils also enable visitors to buy services (emarketplaces).

Most of these directories are built on third party platforms provided by social care IT suppliers like OpenObjects, OLM, Public Consulting Group and others, with a small minority of councils providing in-house built and maintained directories.

It is fair to say that councils are still finding their way with these directories, not just in terms of their functionality (search, filtering, categories) and the quality, completeness and currency of their contents, but also in the way directories are integrated with the adult social care pages on the main council.gov.uk website.

As a result of last year’s survey, it emerged that some councils had intentionally kept separate their social directory from the council website, for two main reasons. First, because they were working with partners, often including the local voluntary sector or local NHS, and did not want the site to be seen as a council initiative for political reasons. Second, rather worryingly, it was sometimes felt that the council had a poor reputation around social care, and that more people would therefore use the facility if it was disassociated from the council.

Separating the directory has, however, unfortunate consequences, particularly for findability. Council sites come very high in Google rankings, because of their ‘official’ standing but also because they generate very high volumes of traffic. NOT to link closely a new site to a well established one is a major mistake, and some sites that took this approach have since been discontinued because of lack of visitor numbers.

Councils that have moved a significant amount of content from their adult social care pages to directories need to make this findable by making sure that content is frequently deep-linked from the council.gov.uk site, using clear headings and descriptions. Editors need to take care that links ‘land’ visitors in the right places: too often a user is dumped into a listing of services with no warning or introduction, and this can be disorientating, even for experienced web users.

Good user experiences may also be compromised by:

  • Duplication of content on two sites (creating user anxiety around whether content is the same, or whether one version is better or more up to date)
  • failure to ‘deep link’ between something discussed on the council site (eg residential care) and the relevant pages with listing of care homes on the third party site
  • jarring differences in the presentation and style of content between the main council site and the third party site
  • poor content categorisation on third party sites dependent on pre-determined, off-the-shelf modules and titles
  • over-engineering of some third party sites resulting in long and/or circular user journey
  • reliance on a basic keyword search which on its own may not be enough for users to be confident that they have found all providers of that service
  • No acknowledgement of the council’s involvement as owner/partner in provision of the directory
  • No means to return from the directory to the council adult social care pages which may contain key information about eg assessment or eligibility for funding
  • Reliance on some interactive online document formats used by third directory publishers that can be hard to use

Some councils have implemented directories that cover information for children and families as well as for older adults. Landing on these from specialist adult social care pages can be jarring if the visitor is not prepared. If you arrive at a directory from the adult social care pages and are presented with age ranges choices Early Years, Primary, Secondary or Young Adults – as happened to one of our reviewers - its easy to assume that you have arrived at the wrong place. In another case, following a link to ‘activities’ from adult social care pages led a reviewer directly into detail of the local Boys Brigade.

Clearly, there are ecomomies to be had by using a directory platform for more than one purpose, but this can only be done successfully with considerable thought and planning. Thorough testing is also advisable to reveal shortcomings of the sort described above.

When it comes to commissioning and maintaining online directories of services for adult social care, it is clear from our survey that best practice is still emerging.

A further complication is the developing role of other important players in the social care information and advice field including NHS Digital, voluntary sector organisations like Disability Living Foundation, and commercial players like Which?

Sites that we recommend

Staffordshire

I liked the structuring of content and the simplicity of the writing. The question and answer format worked well. The Directory was easy to use and the home page provided a good introduction to topics and linked back where relevant to pages on the main council site. Well done!

https://www.staffordshire.gov.uk/health/care/Adult-Social-Care.aspx

Cheshire East

This site had one of the best integrated directories I've seen. Livewell content is seamlessly integrated with the main site. The directory allows easy filtering to find relevant services. The links into it from main content pages directly link into relevant results. Very impressive!

http://www.cheshireeast.gov.uk/livewell/care-and-support-for-adults/care-and-support-for-adults.aspx

Herefordshire

A generally excellent experience here, with well judged, nicely written clear content that gets straight to the point. The directory has logical headings that break down into the areas we were looking for. I felt that possible the filters brought back too wide a range of entries at times, but this is a minor quibble.

https://www.herefordshire.gov.uk/info/200147/social_care_and_support

Croydon

Excellent. The main "Care at home" page is very nicely written, a clear simple introduction and useful links to more info and the service directory, marked as being a separate website. The main categories offered allow me to jump into the directory according to the specific services or support I need, which was very helpful.

https://www.croydon.gov.uk/healthsocial/adult-care/asc-assessing/ascreferral

Barnsley

Fantastic - excellent supporting information, logically presented, with clear links through to the all-important assessment and eligibility information throughout. The directory of services has a good range of helpful categories which allowed me to narrow down my searches quickly. One small niggle is when the site offers me an online guide to home care - without warning, this opens a new window and a new website - the National Institute for Health and Care Excellence. It would be good to warn users that these things are going to happen, to avoid confusion.

https://www.barnsley.gov.uk/services/adult-health-and-social-care/

Sandwell

Excellent throughout - clear, easy to find info - links to all the relevant info .Slight grumble that I couldn't always find specific services on the Information Point directory due to lack of choices. For example, if I choose "Support in your home", I just get a huge A-Z list of providers with no way to narrow it down by exact service. There is a search box, although I'm not sure how accurate the results are. Still, very good.

http://www.sandwell.gov.uk/info/200216/adults_and_older_people/988/contact_adult_social_care

Wigan

Very clear info about assessments and eligibility - it's really good to see this crucial information put front and centre, whilst also providing clear and quick links to other related information. Site search returns Q&As from 2014 and 2015, and nothing more useful in the first five results (the correct link is seventh). One small issue with the links from the "Help for living at home" page into the "Community Book" care directory. This page offers extremely helpful links to broad categories of support which shows a good amount of thought into users' needs, however the results aren't perfect. If I click on the personal care link, for example, some of the results are for care homes. I think this is because it's a basic keyword search rather than any clever categorisation and filtering. Still, it's a good effort, and overall this is one of the best implementations of this task that I've seen.

https://www.wigan.gov.uk/Resident/Health-Social-Care/Adults/Adults-health-social-care.aspx

 

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