Working with Integrity in Consumer Directed Care (CDC)

New providers will be breaking into the government-subsidised home care market in February this year. How will their integrity fit in? That is, how will consumers and significant others know that their interactions with these new providers will be ethical, honest, trustworthy, transparent and professional?

Linda Belardi reports in the Community Care Review July 28, 2016, that industry consultants predict intense competition between providers including brokerage agencies and allied health services. They will be jostling for consumers who will now be able to choose their provider under the new Consumer Directed Care (CDC) arrangements. http://www.australianageingagenda.com.au/2016/07/28/new-providers-making-moves-into-home-care-market/

CDC, both a philosophy and an orientation to service delivery and planning of care, aims to offer consumers more choice and flexibility about the types of care and services they receive, how they are delivered, by whom and when.

https://agedcare.health.gov.au/increasing-choice-in-home-care

This is nothing new—MACS adopted this philosophy and has been delivering this kind of care for many years.

The upsurge of approved providers has already happened. Increased by fifteen per cent since the reforms were announced in the 2015 budget. And there were seventy-seven approvals by June 30 2017. http://www.australianageingagenda.com.au/2016/07/28/new-providers-making-moves-into-home-care-market/

Mark Sheldon-Stemm, principal of Research Analytics, points out that allied health businesses were also expressing an interest in becoming approved home care providers. This new wave increased focus on wellness and reablement that comes under the CDC banner.

http://www.australianageingagenda.com.au/2016/07/28/new-providers-making-moves-into-home-care-market/

He went on to identify strong competition coming from labour hire companies that currently supply staff to aged care, home care franchise groups and residential care providers not yet delivering community care. He suggests that there might be a certain level of disruption in the marketplace with the number of Victorian home care providers jumping ten-fold.

Sadly, though, unlike MACS, some emerging providers including CALD culturally and linguistically diverse providers, will have limited aged care experience. It’s debatable, then, that a niche service will ever override the basics of existing strong relationships between consumers and established, trusted providers. It’s also debatable that key personnel with the attendant professionalism will be obsolete. Over the years, building strong relationships with consumers and their families, along with a low turnover of staff, with the resultant consistency of service, have been two of MACS many strengths.

When we consider the CDC ongoing management obligations, we can see why the importance of relationships is key. From 1 July 2015, it became a legislated requirement for all home care package services to be delivered on a CDC basis. CDC means that there is a partnership between consumer and provider. It works in the understanding of what the consumer wants and hopes to achieve, and then delivers services that meet those needs. From February 2017, Home Care Packages will no longer be allocated to service providers, but directly to the consumer.

A consumer can choose any approved provider. Even change the provider, their package being transportable. https://www.agedcareguide.com.au/information/consumer-directed-care

All providers will need to work to this agenda. No excuses. CDC might have the feel of a monopoly game but there is no pass card for providers who are not prepared.

MACS Community care programs are well aware that providers need to:

  • Know their consumers and significant others well enough to have meaningful and skilled conversations with their home care consumers in the first place. Exploring care options must have a professional tag and such values like dignity, respect and independence come into it. All this would include building up a sufficient and appropriate medical and social history base. And compiling this doesn’t happen overnight. Goals may not always be shared with organisations “on trial” for their service delivery or who are not familiar with aged care, or have staff who are temporary;

 

  • The emphasis of CDC is around the consumer making informed choices about how he or she will spend their funding. But ability to make informed choices depends on the availability of sufficient, accurate information and the capacity of the consumer to assess the information and make those rational choices. Again, if the right system of health/aged care advisers, care managers, consumer advocates and family/ significant others is not there, where does that leave the consumer?
  • Along with explaining the monthly statement to a consumer, comes the transparent and trust sides of integrity. Having the ability to fully clarify funding spent under a package;
  • Working in partnership to update and co-produce care plans means that there needs to be reliable and effective communication to actually do this. Changing care plans is par for the course, not something that is put on the back burner because staff do not have the skills to actively listen to the consumer. Or to document or resource this efficiently. Inconsistency breeds lack of trust and diminishes the level of crucial information sharing. The Brother of St Laurence study Adjusting to Consumer- Directed Care, The experience of Brotherhood of St Laurence community aged care service users (see Resources below) identified the importance of communication in CDC—

“A lot of older people feel more comfortable speaking with someone that they have a relationship with even if it’s just for a few minutes on the phone because that few minutes, for some people it’s some contact, a bit of a welfare check, a bit of a chat, rather than just a clinical phone call to a Service Coordinator whom they’ve never met or seen and don’t have a relationship with.”

And so information sharing, and having the professional, seasoned skills to undertake this, effectively shelter under the integrity umbrella. When it comes to CDC service delivery, it’s not just the language of CDC, but the actual practice of integrity that counts. And all along, integrity is one of the entrenched values that MACS has achieved in its care delivery.

Resources

Bonnie Simons, Helen Kimberley & Nicky McColl Jones, Adjusting to Consumer- Directed Care, The experience of Brotherhood of St Laurence community aged care service users, 2016, BSL publication

Email agedcarereformenquiries@health.gov.au

Fact sheet – Introduction to Home Care Changes

https://agedcare.health.gov.au/programs/home-care/consumer-directed-care

http://www.myagedcare.gov.au/financial-and-legal/protecting-consumer-rights

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