Self Directed Support
What is Self Directed Support?
Self Directed support is funding that you can get to help get the care you need.
You can get this in a variety of ways (called options).
Option 1 is when you take the money and directly manage it yourself
Option 2 is when the money is paid to a service provider who buys services on your behalf
Option 3 is where the money is spent for you by NHS Highland
Option 4 is a mix of any of the above
I know most about Option 1, so that's what I am going to talk about here.
How Do You Get Self Directed Support?
Well you need to be assessed. This is generally done by a social worker. Each area has a single point of contact to help you get started.
You will then be assessed for self directed support, either for you or for someone who you care for. If you care for someone don't forget to get a Carers Assessment too. There are new rights for carers coming into law shortly so this is even more valuable. Connecting Carers can help with the carers assessment.
What Can You Do with Self Directed Support?
The key thing to think about with self directed support is what you want to achieve. It's very flexible and could be used for;
Help to do activities that you can't manage on your own
Things that help keep you well
Social activities that you can't take part in
Starting your own business
Wellbeing activities such as arts and crafts
Why Use Self Directed Support?
We started using self directed support because we couldn't get care for our Mum when she needed it. This was because the homecare provider only had limited availability in our area. We decided to employ our own carers so we could get the care Mum needed it, when she needed it. We like the flexibility it gives us, although it's quite a lot of work.
We used self directed support to recruit 3 carers. We manage their rotas, payroll, training and supervision, holiday cover, sickness etc. We work with them to keep up to date with Mums care as her needs change.
There are a variety of agencies that provide care services. They can deal with a variety of support and the people working at the agency are trained and have their police checks done. The agency is also responsible for managing these carers. You can use your self directed support to buy care from an agency. You negotiate with them what days and times care is provided. Calls are generally 30 minutes long, but this varies depending on need.
We used this option initially but when Mum needed help at bedtime we were unable to get care at the time we needed it. Carers were also only visiting for 30 minutes and this wasn't giving Mum the help she needed. We decided to employ our own carers.
It my seem easier to employ carers on a "self employed" basis, as they are then responsible for their own tax and national insurance. However, there are things to consider about self employment. For us the main issue was that a self employed person can subcontract someone else in to do the work with no notice or prior agreement. For us this was too much of a risk. There is a helpful online guide which helps you establish whether someone should be self employed or not.
We decided to employ directly.
The first thing we did was to write a job description. As we had been caring for Mum we had a good idea of what needed to be done so we wrote a job description based around a typical morning shift and another for a typical evening shift. We felt this would give applicants a really good understanding of the role rather than just using general terms. We received lots of positive feedback from applicants that this was a really helpful approach.
We held informal interviews in a local cafe. My sister and I interviewed together. I was lucky that I had done quite a few interviews before. For us keeping it informal and more of a structured chat helped us to get a good sense of carers and what they were about.
There are people that can help with interviewing if this is something that you don't feel comfortable with. The costs of this should be covered by your self directed support money as you get money to help set up and get going. I would recommend Jo Adams to help with interviewing. You may also want to contact Self Directed Support Highlands.
You may want to take up references as part of your interview. We didn't bother because no one is ever likely to give a bad reference and these are the most valuable ones.
We recruited carers using an employment contract. We used a 1 month trial period to make sure that everything was working. We used an employment contract prepared by the Scottish Personal Assistants Network. Their membership fee is around £152 per year and this covers employment contracts, other documentation such as employee records, some HR support and employers and public liability insurance which are legal requirements.
This membership fee should be covered as part of your initial set up costs. We use Buchanan Shaw for legal advice relating to employment issues as we found the response from the Personal Assistants network above a bit slow.
When drawing up the job description we also wrote a detailed guide to what it was like looking after our Mum and included things like her attitude to swearing, whether shoes were allowed in the house, whether smoking was allowed. We included information on Mum's life and her experiences. We felt this helped the carers to see Mum as a person.
Self directed support is paid at £12.99 per hour. Out of that you need to make allowance for;
Holiday pay (minimum 28 days per year)
Pension costs (coming in late 2017 for small employers)
Employers national insurance contributions
Travel costs (if paid)
Any other cost incurred as the result of employing someone
As a rule of thumb these costs (sometimes to referred to as "on costs") are about a third more than the actual pay rate. Carers employed by agencies are entitled to the Living Wage of £8.25 per hour so you need to be paying this to attract anyone. However this means you can only pay around £8.70 an hour to ensure all your costs are covered by the £12.99 rate.
We decided to have one person dealing with the carers in our family. This was to make it easier for everyone. Carers have one point of contact if they are going to be ill or if they have any issues and there is also less confusion about who says what.
We did a 1 month trial period for our carers. We visited them during the first week to see if they needed help with anything and we visited them again during the month. At the end of the month we met up for a coffee and had a chat about how they had found things and to see if they wanted to carry on.
We got lots of great tips from our carers about things to help Mum. We continue to get good ideas which we incorporate. This is good all round - Mum gets better care and the carers are happy they have made a difference and we listen to their views.
We meet up with the carers every 3 months or so to have a chat about how things are going. We meet up with all 3 carers at the same time. This has been really helpful as what the carers do impacts on each of them also and they now know each other really well.
We have an A4 diary which sits in Mums kitchen. Every time a carer goes in they write a summary of what they did and what happened so the person following can see. This generally covers how Mum has been, what she had to eat and drink, any issues or any requests. We fill in the diary when we care for Mum too so the carers can see what we have done.
We have a carer that wants to be paid weekly and another monthly. As I am often out and about I decided to use an online payroll system to manage this. I use Kashflow Payroll. It's easy to use and costs £7 per month. It works out what the employers national insurance contribution is and submits information through online. (It's a legal requirement to report payroll in real time each time you pay someone). I download the payslips and keep a copy on file and email a copy to the carer. I email my sister who makes the transfer into the carers bank account.
You need to register as an employer with HMRC. They will send you an employer reference to use when paying your employer tax.
We use an online system for our rotas. We use this to manage holidays and absence and to allocate shifts. The system is called RotaCloud. It costs £9 per month. Carers can log in to check their shifts and there is also an app that they can have on their phones.
Dealing with Problems
There will always be problems to deal with. For us we try to prevent them happening in the first place. This starts by employing the right people, then by treating them right, listening and talking with them but also letting them get on with the job in their own way. We have 3 carers and they are all different and care in slightly different ways. This gives our Mum a much richer and better experience as a result.
By meeting with carers regularly we try and discuss things before they become an issue and carers know we are always at the end of a phone or email if they need anything.
We have had an issue with one carer and it became clear that she didn't fit anymore. She realised that herself and left. At the time it was tough but we have a great trio of carers now.
We have sometimes struggled with carers being off at very short notice. We try to cover their shifts ourselves but this isn't always possible. We have used Bridge Over Troubled Waters from Helmsdale to help us out. They have provided carers for holiday cover.
Get all the support you can - you are entitled to it
Keep a record of the hours you spend doing unpaid care. Despite having 3 paid carers as a family we provide twice as many hours of unpaid care each week.
There is a difference between being a carer and a family member. My relationship with my Mother suffered when I was doing lots of the caring. I was her carer and not her daughter.
I wanted to give a special mention to a monitoring system we use called Canary Care. It works through Mums phone line and has movement detectors in each room of the house. We are able to see what sort of night's sleep Mum has had for example. When Mum started losing weight Canary Care showed us that she wasn't in the kitchen long enough to get a meal. Canary alerts us if Mum is up in the night, if the temperature drops below a certain level. It also lets us know if Mum is not out of bed, that the carers are in and much more besides. We can see what is happening online and get alerts via text or email. You can buy or rent the system.