Disability and care needs in the older population: disability benefits, social care and well-being

该项目旨在提供新的证据，以加强对有护理需求的老年人的公共资助支持改革的有希望的方向的政策判断。在英国，这种支持包括两个主要要素。护理服务通过地方当局提供，现金残疾津贴由国家社会保障制度提供。个人可能有权获得一种、两种或两种不同的帮助来源。该系统的每个组成部分都对老年人的护理需求进行自己的评估，它们在如何考虑老年人是否有伴侣方面有所不同。通过地方当局接受护理的人为他们的护理支付经经济状况调查的费用，但在苏格兰除外，那里对护理费用有一种无需经济状况调查的公共补贴。除通过经经济状况调查的养恤金抵免支付的部分外，领取残疾津贴的权利不受老年人的收入或金融资产的影响。通过地方当局提供的护理是以服务或“个人预算”的形式提供的，其支出方式必须满足受助者的护理需求。领取伤残救济金的人可以随心所欲地使用这些钱。这些差异意味着，无论其经济价值如何，来自系统两个不同部分的支持可能会以不同的方式和不同的程度减轻残疾对福祉的不利影响。一些人建议，通过残疾津贴提供的公共资金应重新用于护理系统。关于为老年人提供护理和支助的资金问题的辩论仍在继续。我们将为这场辩论提供客观和独立的证据，说明改变这两个部分的资金平衡对不同老年人群体的福祉可能产生的影响。我们将就以下问题提供证据：--老年人的福利在多大程度上受到其配偶或其他家庭成员残疾的影响，以及在确定是否有权享受公共资助的护理服务和残疾津贴时，考虑到配偶的残疾对其福祉可能产生的后果；--等值护理服务和残疾津贴是否在相同或不同程度上减轻了残疾对福祉的影响；--现行护理制度和残疾津贴制度对老年人护理需求变化的反应，以及该制度的任何延误是否会影响他们的福祉；-对不同类别的残疾老年人(老年人/年轻人、穷人/富人、单身人士/夫妇等)的福祉可能产生的影响。这项研究将涉及对四项大型家庭调查的高级统计分析：纳入其前身英国家庭小组调查；英国老龄问题纵向研究；英格兰健康和社会护理调查；以及家庭资源调查。其中两个已经开始收集有关接受护理服务和为其支付费用的重要新信息，我们将使用这些信息。我们的分析将必然限于家庭人口，而且由于数据的限制，其中一些将仅限于英格兰。然而，英格兰和苏格兰之间的政策差异将在分析中得到利用。这项研究的证据将对国家和地方政策制定者、那些代表老年人的人以及提供护理或保险服务的商业企业有用。我们的目的不是倡导具体的政策改革，而是提供证据，在国家政策和地方执行中加以考虑。这有可能使老年人和纳税人受益，如果它能更好地利用公共资金的话

The project aims to deliver new evidence to sharpen policy judgements on promising directions of reform of publicly-funded support for older people with care needs. In the UK, such support consists of two main elements. Care services are available through Local Authorities and cash disability benefits are provided by the national social security system. Individuals may be entitled to one, both or neither source of help. Each element of the system operates its own assessments of an older person's care needs, and they differ in how account is taken of whether the person has a partner. People who receive care via a Local Authority pay means-tested charges for their care, except in Scotland where there is a non means-tested public subsidy towards the cost of care. Other than an element paid via the means-tested Pension Credit, entitlement to disability benefits is not affected by an older person's income or financial assets. Care provided via Local Authorities is in the form of services or a 'personal budget' which has to be spent in ways which address the recipient's care needs. Recipients of disability benefits are free to spend them as they wish. These differences mean that, irrespective of their financial value, the support from the two separate parts of the system may alleviate the adverse effects of disability on wellbeing in different ways and to different extents. Some have suggested that public funds channelled through disability benefits should be redirected to the care system. Debate on the funding of care and support for older people continues. We will contribute to this debate by providing objective and independent evidence on the likely impacts on the wellbeing of different groups of older people, of a change in the balance of funding of the two parts of the system. We will provide evidence on:- the extent to which the well-being of an older person is affected by the disability of his/her partner or other members of the household, and the likely consequences for their wellbeing of taking account of a partner's disability in determining entitlement to publicly-funded care services and disability benefits;- whether equivalent-value care services and disability benefits mitigate the impact of disability on wellbeing to the same or differing extents; - the responsiveness of the current systems of care and disability benefits to changes in older people's needs for care and whether any delays in the system affect their wellbeing;- the likely effect on the wellbeing of different groups of disabled older people (older/younger, poor/rich, single people/couples etc.) of potential changes in the balance of public funding for care services and disability benefits, for example increasing the levels of one and decreasing those of the other, or extending the eligibility criteria for one and decreasing it for the other.The study will involve advanced statistical analysis of four large-scale household surveys: Understanding Society, incorporating its predecessor the British Household Panel Survey; the English Longitudinal Study of Ageing; the Health and Social Care Survey of England; and the Family Resources Survey. Two of these have started to collect important new information on receipt of care services and payments for them, which we will use. Our analysis will be necessarily restricted to the household population and, because of data limitations, some of it will be restricted to England. However, policy differences between England and Scotland will be exploited in the analysis.Evidence from the study will be useful to national and local policy makers, those representing older people and commercial enterprises providing care or insurance services. We do not aim to advocate specific policy reforms, but rather deliver evidence that will be taken into account in national policy and local implementation. That has the potential to benefit older people and tax payers, if it results in better use of public funds