You would now be well aware that on 20 April 2012, the Australian Government unveiled Living Longer Living Better, a comprehensive decade-long plan to reshape aged care.
As part of the reforms, the Australian Government committed to assisting people to remain living in their own homes for as long as possible, with the number of operational Home Care Packages to increase to around 100,000 packages across Australia. However, one of the most significant developments to come out of the reforms has been the introduction of Consumer Directed Care (CDC) across all new Home Care Packages.
The widely accepted definition for CDC is a way of delivering services that allows consumers to have greater control and flexibility over their own lives by allowing them to make choices about the types of care and services they access and the delivery of those services, including who will deliver the services and when.
Undoubtedly, CDC represents a progressive step forward in empowering the consumer however, the detail of exactly how it will operate in a practical sense also represents a fundamental change for home care providers.
The Department of Health’s Home Care Packages Program Guidelines, released earlier this year, outlined six guiding principles intended to underpin the operation and delivery of packages on a CDC basis. These include:
Consumer choice and control
The ultimate aim in aged care is to consistently provide high quality, compassionate care services that meet the expectations of the individual. For this aim to be achieved, it is essential that people are involved in shaping the direction of their care services right from the outset.
Under the CDC approach, consumers will have greater choice and control over the care and support they receive, enabling them to live as independently as possible. This will include access to a range of information about service options to help the consumer to develop a package that supports them to achieve the quality of life they want.
According to the guidelines, the premise of CDC is to acknowledge an older person’s right (based on their assessed needs and goals) to the individualised services and support that will assist them. As part of this process, consumers are encouraged to identify their own goals, as well as decide on the level of involvement they wish to have in managing their own package. This could range from complete involvement including decision-making and allocation of care and services, to a less active role in the management of the package whereby a consumer requires assistance.
Respectful and balanced partnerships
The development of respectful and balanced partnerships between the home care provider and consumer is essential because human interaction occupies the heart of aged care. When it comes to CDC, consumers will have an opportunity to work with the home care provider to develop the most appropriate Home Care Agreement, customised for individual needs. This should reflect the consumers’ rights and responsibilities, particularly when determining the level of control the consumer wants to use.
Getting out of the home and in to the community to develop networks, socialise and participate are all important aspects of general wellbeing for everyone. Therefore, one of the key principals of CDC is designed to facilitate community participation for older people, if it is something the individual values and wishes to be involved in.
Wellness and re-ablement
For people who may have been discharged from hospital or are otherwise entering the care system following a crisis, they may require the initial provision of re-ablement services to help with daily living activities and other practical tasks. But with CDC, there should always be an assumption that a re-ablement framework will enable the consumer to continue to be as independent as possible.
The guidelines also stipulate that in order to make informed decisions about their care, consumers need to have access to budgeting information, including the cost of services, the contents of their individualised budgets and how their package funding is spent. The introduction of individualised budgets provides greater transparency to the consumer about what funding is available and the flexibility to use those budgets to purchase the services they choose.
Key considerations for home care providers
With such unprecedented changes in the balance of power between the consumer and home care provider, the extent of the impact when CDC finally takes full effect in coming years remains unclear. From the perspective of the home care provider there are a number of important issues to consider. These include:
- The administrative tasks and overheads for home care providers in administering CDC and directly communicating with the consumer.
- Informing consumers about what brokered services are available to them and how to make choices that will correspond with better quality of care and life. Consumers will also require assistance in planning and contracting their choice of service support.
- Flexibility within the home care providers’ operational structures and systems with the capacity to respond to the expressed preferences and consumer choice.
- Management of budget allocation in a way that ensures transparency and clearly outlines the consumer’s preferences and where expenditure has been distributed via regular invoices and statements.
- The cost implications of CDC as a consequence of substitution effects for informal care or individualised care service needs.
- Recruiting and retaining staff that have the required training and qualifications to be able to delivering CDC.
- Ensure consumers have the resources available to take full advantage of the opportunities that CQC presents for them.
With these considerations in mind, it seems it is a powerful ambition that holds out significant challenges for home care providers as they prepare for complete implementation of CDC by July 2015.
Speaking at the recent Aged and Community Services Australia (ACSA) National Conference, the former Victorian Premier and Chairman of Beyond Blue, Jeff Kennett took the opportunity to warn against assuming CDC is an approach that can be “all things to all people.”
“While I think CDC in concept is a great idea, the opportunity of unlimited entitlement will actually choke the beast altogether,” Mr Kennett said. He said that an attempt by home care providers to offer unlimited choice would be unsustainable and would reduce the quality services and outcomes overall.
“Consumers can’t have 100 choices where we all pick and choose, and to the level of quality that we all expect,” Mr Kennett said. “If you make available huge ranges of options, it takes time and energy, and you upset the ones who don’t want what it is you’re offering them, therefore the fundamental reason for your existence is going to be reduced.”
“Don’t promise the world because people will reach for the world,” he advised. Mr Kennett likened this to what had happened to Australian municipal councils, many of which became financially unsustainable because they had attempted to provide a range of services that were simply too broad.
“Those in charge of them haven’t had the courage to say, look, we’re not here to provide everything; these are our priorities which we will provide well and ratepayers will either need to stand on their own two feet or find some other provision, because we don’t have resources to meet every demand,” he said.
So how do we, as a sector, effectively strike that balance between allowing consumers to exercise choice and be supported in exercising those choices, while limiting those choices in a way that ensures that consistently, high quality care can still delivered? Only time will tell.
Please share your thoughts with us below. What implications will the introduction of CDC have on Australia’s home care providers?