The demand for personal budgets and direct payments is high within the disability sector, where many people want control over the lives they live. However, despite this demand, their roll out has been relatively slow due to various reasons we addressed in a previous blog ( https://blog.homecaredirect.ie/whats-holding-back-the-roll-out-of-personal-budgets/)
Here I want to concentrate on one of those reasons, namely the unbundling of funds from traditional providers.
Where people with disabilities are receiving services from a traditional provider and they want to move to a personal budget or direct payment, their funding has to be transferred over to them. When that provider is a normal for-profit provider, the transfer of funding is relatively straight forward as that provider sends in monthly invoices for the service, they are providing to the person concerned and so the amount is easily identified.
The only issue here is if your provider is a low-cost provider to the HSE you will get less funds than if they were charging a higher price. So, you could be discriminated against depending on whether your provider before the move over to a personal budget, is cheap or expensive for the HSE.
However, when the provider is a Section 39 funded organisation it is more complicated. Their funding is bundled up into block grants that these organisations receive from the HSE. So, when people want to move down the personal budget route or a direct payment route, these funds have to be unbundled and this is where the problems start.
In many cases especially where Section 39 providers are concerned, there is initial resistance to funds being unbundled as this means the organisation are losing a client and funding. In some cases, the organisation refuses to unbundle funds unless the HSE replace the person leaving with another case or unless the HSE pays compensation for loss of a client. These compensation payments can be of the order of €6-€10,000.
If this barrier is overcome, the next issue the person has to face is at what rate his hours are unbundled. When someone is receiving a service from a traditional provider, they get a specific number of hours of support. Now to unbundle those hours, an hourly rate has to be applied to get an overall annual monetary budget.
This is where it gets tricky, as the interests of the Section 39 organisation that were providing those hours is to apply the lowest possible rate so they retain the maximum amount of funds, while the objective of the person needing support, is to have the highest possible rate applied so they are allocated the largest budget possible.
To date this process has been extremely opaque with the person involved having no input and getting no information with regard how the hourly rate is calculated and what costs are included. What happens in reality is that Section 39 organisations when applying for funding include every cost possible but when unbundling funds, they are much more selective with regard what costs are included.
We have seen a situation where one particular organisation unbundles funds at a specific rate but when you look at the figures in their Annual Report with regard the funding they received and the hours they delivered, the unbundling rate should be significantly higher.
In another situation we are aware of, a person was offered funding of €37,000 for their 56 hours but unbeknownst to the organisation involved, the person had previously received a detailed calculation showing the cost of their service was actually €86,000!
This creative accounting on the part of section 39 organisations can have a huge effect on the successful take up by people of personal budgets and direct payments. These organisations have all the cards in their hands while the person needing support finds themselves being denied information on what after all are their personal funds and with very little ability to negotiate or push back.
It must be remembered that these are not just abstract economic calculations but rather there is a human being behind these numbers, whose ability to live the life they want and deserve, could be severely affected by this number crunching.
So, what is the solution to bring these calculations and discussions out into the open, in a way that is fair and practical to all involved?
In the absence of a tender process for disability services, I would suggest that the Older Persons home care tender is used to set prices. The fact is that many of the organisations that are involved in the Older Persons tender are the same organisations that provide disability services and the reality is that the prices received for older persons services do act as a baseline for what these same organisations charge for disability work. If they have a set price for older persons work and we accept the fact that there are waiting lists for older persons work, it stands to reasons that companies will not allocate their scarce resources to take on disability work at lesser rates.
There will be a new Older Persons tender in place from July of this year and the expectation is that there will be a standard price set of €31/hr for all providers. Why not use this standard price for personal budgets and direct payments in the disability sector as well. This removes the opaque nature of what we have at the moment and brings much needed clarity and transparency to people who are looking to go down the personal budget or direct payment route while at the same time ensuring the HSE aren’t paying over the odds.