industry & policy
The tyranny of choice
Being paralysed by seemingly
never-ending options
seems to be the plight of
many older Australians
who need home care.
By Stephen Judd
I
do the grocery shopping in our family. It’s not easy: sometimes
I can be found, all alone, in a supermarket aisle confronted
by the sheer choice in front of me. For example, take tofu
(for my daughter). Which tofu? Organic? Australian? Silky?
Chilli, teriyaki or plain? I am paralysed by choice, a situation
often resolved by taking home different varieties.
Being paralysed by choice isn’t just a situation confronting
fathers shopping for tofu. It also seems to be the plight of many
older Australians who are needing home care.
This February marks 12 months since the federal government
gave older Australians the choice of provider and complete
portability of their government-subsidised ‘package’ of care.
The philosophy is a great one: let older consumers choose what
services they need and from whom they receive these services.
Let them change providers if they are not happy. Let them control
how their allocated subsidy is spent.
The government has responded to the growing demand for
home care by releasing 6000 more “higher care” packages. And
yet, the queue of older Australians patiently waiting for home care is
growing (over 100,000 as at September 2017). However, ironically,
the number of Australians actually receiving home care packages
declined in the first months of the new My Aged Care system.
Hang on, more supply but longer queues and fewer people
receiving care! How can that happen?
The answer lies in the tyranny of choice. Older Australians are
being assessed for home care in record numbers but then being
left on their own to choose where and how to access that care.
That might be great for the savvy, the well-educated and those
who can self-advocate, but pity the older Australians living on their
own who have dementia. They receive a ‘snail mail’ letter telling
them they have 56 days to decide on a provider. Best of luck and
have a nice day.
12 agedcareinsite.com.au
Our market research shows that almost half of those who
had been allocated a home care package whom we contacted
had not yet decided on a provider. Why? Were they merely
carefully weighing up their options not realising that if they didn’t
choose within 56 days they would need to re-join the queue?
And remember, these are older Australians who are assessed as
needing home care support.
Barry Schwartz in The Paradox of Choice found that while we
think that more choice is going to produce greater wellbeing,
often the opposite occurs. Rather, confronted by an array of
options, consumers often decide not to decide. This resonates
with UK research on care in older age which found that ‘the
choice discourse’, while resonating with contemporary neo-liberal
thinking, often became decreasingly appropriate as people’s
agency and capacity declined. In fact, it was sometimes at odds
with compassionate care (Borgstrom and Walter, 2015).
So, what should we do for the ever-growing queue of older
Australians who have been allocated a home care package but,
for whatever reason, haven’t been able to decide on a provider?
Some consumer groups advocate that there should be
‘navigators’ to help older Australians get through the system. A good
idea, but with 100,000 older Australians in the queue, there is every
likelihood that these navigators will be quickly overwhelmed.
A simpler solution can be found in how our superannuation system
works: we are free to choose our superannuation provider, but if
we don’t choose, then we have a superannuation fund allocated by
our employer. Moreover, we can change super funds at any time.
The same can work for older Australians who have allocated a
home care package. Confident and capable consumers can make
their own choice. However, those who have failed to elect a provider
within eight weeks (and surely that should be shortened if they
really need home care) would have their need for service provision
referred to all accredited providers in the consumer’s location.
If consumers are unhappy with their initial pr