The Effects of Direct Payments on Well-being of Older People in England

Self-directed care is a model that allows older adults with disabilities to arrange home- and community-based services flexibly. This study examines the impact of England’s self-directed care—Direct Payments—on older adults’ well-being and explores how the effects vary among individual characteristics. This study used data from the English Longitudinal Study of Ageing (ELSA, 2012–2023) on adults aged 65 and older who used Direct Payments and managed care (N = 568). We used propensity score matching methods to estimate the impact of Direct Payments on unmet needs, depressive symptoms, and quality of life. Direct Payments reduced unmet needs and had non-significant effects on depressive symptoms and quality of life. The beneficial effects of Direct Payments were more salient among older adults who were younger, had experienced less physical loss, and had reported met needs in the preceding survey. Our findings suggest that Direct Payments effectively improve older adults’ care outcomes by addressing their unmet needs, with individuals possessing greater health capital being more likely to benefit from using them. Policymakers and practitioners should support the disadvantaged and mitigate disparities in well-being.