Glendinning Caroline, Halliwell Shirley, Jacobs Sally, Rummery Kirstein, Tyrer Jane
National Primary Care Research and Development Centre,Fellow, Health Services Management Unit, University of Manchester, Manchester, UK.
Health Soc Care Community. 2000 May;8(3):201-211. doi: 10.1046/j.1365-2524.2000.00242.x.
This paper draws on interviews with users of direct payments and focus group discussions with the personal assistants (PAs) who assist them with personal and daily living activities. It discusses the benefits and the drawbacks of directly employing such assistance, from the perspectives of both the purchasers and the providers of these services. The paper shows that direct payments can enable disabled people to purchase a much wider range of flexible help, better continuity, greater control and an enhanced quality of life, compared with conventional services. PAs also valued the trust and close relationships they developed with their employers. However, these benefits were much less marked when direct payment users recruited and employed personal assistants through care agencies. On the other hand, both direct payment users and PAs also sometimes experienced difficulties in managing the relationships between them. Some of these problems could be alleviated by changes in the support provided by direct payment schemes themselves; other difficulties were more intractable and arose from the nature of the work and the close relationships which it entailed. The paper recommends a number of measures which could reduce the risks and vulnerability of both disabled direct payment users and personal assistants, without reducing the enhanced quality of life which direct payments can confer.
本文借鉴了对直接付款用户的访谈以及与协助他们进行个人和日常生活活动的私人助理（PAs）的焦点小组讨论。它从这些服务的购买者和提供者的角度，讨论了直接雇佣这种协助的好处和弊端。本文表明，与传统服务相比，直接付款可以使残疾人购买范围更广、更灵活的帮助，获得更好的连贯性、更大的控制权以及更高的生活质量。私人助理也重视他们与雇主建立的信任和密切关系。然而，当直接付款用户通过护理机构招聘和雇佣私人助理时，这些好处就不那么明显了。另一方面，直接付款用户和私人助理有时在管理他们之间的关系时也会遇到困难。直接付款计划本身提供的支持的改变可以缓解其中一些问题；其他困难则更难解决，是由工作性质及其带来的密切关系引起的。本文推荐了一些措施，这些措施可以降低残疾直接付款用户和私人助理的风险和脆弱性，同时又不降低直接付款所能带来的更高生活质量。
