industry & reform
A sense of self
A compelling case for self-management in home care packages .
By Peter Scutt
It was March 2019 when I read
about research commissioned by then Minister for Aged Care Ken Wyatt investigating the quality of Australia ’ s in-home support since the 2015 changes to the home care system . The research focused not on the views and perspectives of government , service providers , professional bodies or policy makers , but on the lived experiences of people receiving in-home support .
The findings of the qualitative study were not particularly positive .
A full reading of the research report , Older people living well with inhome support , undertaken by Dr Sarah Russell of Research Matters , revealed a catalogue of insufficiencies , inadequacies , complaints and disappointments .
Some of them were systemic . Extraordinary waiting times , frustrations with My Aged Care and the rush of sales pitches once a package had been allocated unsurprisingly featured prominently , as did poor access to information . Other complaints were more directed at the practices and approaches of service providers : high fees but poor financial transparency and patchy case management ; a focus on administration and efficiency , rather than the individual needs and desires of the client ; high staff turnover and a lack of continuity of support workers ; the inability to communicate directly with support workers ; limited interest or capacity for matching clients with particular support workers ; and a general lack of choice and flexibility .
It was no surprise to me . Indeed , this was the experience of my own parents and family with the in-home care system and it is what drove the development of Mable .
AN EVIDENCE-BASED COMPARISON I contacted Dr Russell about her research and briefly described Mable ’ s self-management model . These are precisely the problems that our model seeks to address , I told her . She proposed that an independent research project , using the same methodology as this national research but focusing on self-management using Mable , would provide an evidence-based comparison of the two models . It has .
As expected , most of the participants who elected to be part of the study [ Self Managed Home care packages – how Mable is improving the quality of life of older people ] had switched to Mable from a traditional provider-managed arrangement . While most could identify some room for improvement , participants overwhelmingly described their selfmanagement experience as ‘ much better ’, ‘ much easier ’ and ‘ less stressful ’ than their provider-managed experience .
They said they felt empowered because they had genuine choice and control about who worked in their home , when they worked , what they did and how much they were paid . They liked that they could engage a range of support workers with different qualifications , skills and qualities to meet their different needs – qualified healthcare and personal care professionals when needed , but also cleaners , gardeners , experienced cooks … sometimes teachers , musicians and engineers .
Importantly , they could hire people who had similar interests , spoke their language , lived locally and knew their neighbourhood . And when plans changed unexpectedly , they – or their family member – could phone or text their support workers directly .
Not only were they able to get more hours of support from their package with self-management , people really valued the relationships that could develop .
OUR RIGHT TO CHOICE These findings ( and the many others in this report ) shouldn ’ t be surprising . We live in different ways , with different priorities , in different homes and communities all around the country . Throughout our lives , most of our relationships and support networks come from within our communities . Strong community connections become even more important for both safety and quality of life as people grow older and may have less independence .
I would never suggest that selfmanagement is a panacea . No single approach to human services could ever hope to meet all the unique demands and preferences of all the humans that it ‘ services ’. These demands are complex .
However , a system designed to support us to live ‘ our best lives ’, even with impairment and incapacity , must enable us to have choice and control if we want it . It is our right . And many older people do have the capacity – built throughout their lives – and express the desire to make decisions about what is right for them .
Ours will never be the option of choice for every older person in need of services and support but it ( and any equally safeguarded , choice enabling model ) must be an option .
This research shows in clear , accessible , real-life examples , that selfmanagement does work well for the majority of people who choose it . ■
Peter Scutt is co-founder and CEO of Mable . agedcareinsite . com . au 17