industry & policy
Working out the kinks
The incoming model for consumer-directed care will undoubtedly face difficulties; solving those problems requires a monitoring system focused on producing better outcomes.
By Michael Fine
The holiday season is upon us! Hope you have a good break planned over summer. It seems like many of us are going to need it. Just a few weeks into the new year, more radical changes to aged care are scheduled.
From February 27, 2017, government funding for home care services will no longer be paid to providers but will be attached to the consumer. Under the consumer directed care( CDC) model, instead of the planned allocation of places in each region, consumers or their family carers will be able choose their provider, changing from one to another if and when they wish.
Rather than relying on centrally planned or rationed places, a new regime of increased competition between providers is expected, as they will be required to compete for customers. The CDC principle of consumer payments and choice is hardly likely to remain confined to what we used to call community-care packages. The date has already been set, just over a year later, for the end of existing funding for Commonwealth Home Support Programme services. Here, too, once they have been assessed, consumers will be able to choose who helps them.
If government is serious about providing choice in this way, the approach will soon be applied to residential care as well. Many clients, to choose how they use their funds and perhaps reduce what they pay, will probably want to remain at home. Indeed, there is already an indication that, faced with increased charges for residential care, many are already making that choice.
Can we be sure all choices will be informed and wise? When consumers don’ t understand what they need or what they are choosing, choice resembles a lucky dip. How can we be sure about what we are purchasing if we don’ t understand it?
In these circumstances, a strong quality support and complaints system is essential. The CDC approach is not the solution to problems of quality and standards. Indeed, rather than solving all problems by providing choice, CDC opens up many new areas of concern. Experience in both North America and Europe suggests that despite the system’ s appeal, issues of access, quality management and fairness for both consumers and staff will inevitably emerge.
We have extensive experience in Australia with approaches that are flexible, person-centred, local as well as national, direct and effective in lifting standards in aged care. Along with strong advocacy and consumer complaints services, outcomes monitoring and reporting must become central to how we ensure the care standards will improve and not deteriorate the way standards in many areas of VET education, for example, have suffered once it was opened to increased competition.
Developed initially for residential care, outcomes monitoring can also be readily applied to community and home-based care. Important seminal work on the approach was undertaken in Australia by professor John Braithwaite and colleagues at the Australian National University, as well as a number of others.
In residential care, outcomes monitoring – involving inspections and community visitors, as well as family inputs, advocacy services and staff and consumer education – is economic and powerful, shifting the emphasis away from a punitive and narrow focus on adherence to rigid rules, and towards a more results-based improvement model. This fosters a quality-improvement culture in which staff, family members, consumers and community advocates can all contribute and work together.
In home and community care, new, practical tools for monitoring outcomes are being developed. A number of the most progressive services in both fields are already working with such approaches and report increasing morale amongst staff and service culture change. The approaches are also economically effective and efficient and can help providers identify affordable pathways to improvements in the wellbeing of care recipients.
The new aged-care system is not rocket science – it is far less predictable and more precarious than that. There will undoubtedly be a great many elements that require development and change but to deal with that we must ensure we don’ t cover up problems or hide ineffective services or systems of delivery.
As aged-care changes, we need to do more than point to the problems of the existing system and believe blindly that the new approach will solve all these issues. To help services become genuinely more responsive to human needs, to foster creativity, social connections and human potential for those who need to rely on care as well as for those who provide it, it is time to learn from our recent history.
Despite the claims of advocates of the new system, problems will occur. A good framework for complaints and improvement is essential. Quality support focused on outcomes will do much to foster innovative approaches for working towards better care. ■
Michael Fine is an adjunct professor at Macquarie University.
Declaration of Interest: Fine is principal investigator of an ARCfunded study of the development of the Australian Community Care Outcomes Measure. See,“ Care and Compare”, p16.
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