Description of the programme

Previous research has found that a significant minority (5-10%) of elderly people (e.g. 85 years and older) living in the community would benefit from some form of money management assistance. Daily Money Management (DMM) is a collective term for the full range of services offering such assistance, either through supportive assistance or in surrogate decision-making in which the service provider becomes the money manager (such as budgeting, bill paying and public benefits advocacy). Previous research estimates 360 such programmes nationwide, delivered by non-profit, for-profit and government agencies. They are available from several agencies across New York City and State often offered as part of their clients as part of broader community-based care management packages. They support and enable elderly people to remain living in their community safely with support for their finances, with the potential to prevent financial elder abuse.

What are the outcomes?

Key variables were constructed from the data to identify the relevant, presenting crises experienced by the clients. Improvement in outcomes was measured in relation to these. They included:

• Housing
• Benefits
• Financial
• Health
• Mental Health
• Social Isolation

The evaluation also measured:

• Take up and continuation of services
• Economic assessment of cost of DMM services, based on hours of DMM service use; and days of home care provided, against (for comparison) a hypothetical group of people living in care homes.

Key findings

• Women made up 70% of clients referred to DMM services; two-thirds were aged 80 and over; and 90% had annual incomes of less than $20,000.
• Of 115 referrals, 94 took up the service and 20 declined.
• One third of all referrals continued to use the services until death and further third until going into residential care.
• Compared with those who left the programme early or were lost to follow up, those remaining in the programme were more likely to be single or widowed clients.
• 99% of DMM users had experienced a financial crisis, 85% a health crisis, and 29% were socially isolated. 26% of clients had experienced all three of these.

• A wide range of services were delivered in relation to basic DMM and crisis-specific services.
• Bill paying was the most common basic DMM service (86 people)
• Balancing a checkbook was the most common crisis-specific service (51 people), reflecting the large proportion experiencing a financial crisis.

• Lower rates of social isolation
• Improvement in social security benefits received
• Higher rates of grants and stipends.
• In a small number of cases the DMM service provider was able to stop or lessen the impact of financial abuse

The authors recommend DMM be included as a core component of community based services.

What are the costs?

• DMM/case management programs were found to provide a significant cost saving of $60,000 per client when compared with the costs of nursing home placement.
• They are also highly cost-effective, costing only $240 per client per month to deliver.

Points to consider

• • As the authors note, the study was without a control group and instead makes comparisons for the purposes of the economic model based on a hypothetical comparison group (of people living in residential care).
  • Without a control group, or pre- and post- intervention measurement to control the differences between groups, it is difficult to attribute the improvements to the programme, although the findings are indicative of a positive benefits.
  • The sample size was also relatively small and an indication of the statistical significance of differences between groups is not given.
• • The findings have high relevance for the financial wellbeing and concomitant quality of life for elderly people living at home and for the cost-effectiveness of the provision of community-based money-related support assistance and advocacy for elderly people.
• • The findings are particular to older people living in community settings and will be influenced significantly by the US social welfare, services provision and regulatory context and well as wider cultural factors in the care for elderly people.
  • However, there are some general findings which should be of interest and relevance to policy makers and practitioners internationally working the financial advice and money guidance field.