Glenn Rees, CEO Alzheimer’s Australia
By Linda Belardi.
The policy shift to consumer directed care will be an illusion for many disadvantaged groups in society unless governments dedicate more resources to promote the decision-making capacity of all older Australians, said Alzheimer’s Australia CEO Glenn Rees.
Speaking at the Navigating Complexities of Consumer Directed Care conference last week, Mr Rees said the government’s CDC guidelines failed to adequately recognise the resources required to support the capabilities of people with dementia, those experiencing homelessness, LGBTI people and older people from CALD and indigenous backgrounds to exercise greater choice and control.
For many of these groups, stigma, social isolation and a lack of trust contribute to their alienation from mainstream services and therefore their ability to take advantage of opportunities to direct the provision of care, he said.
For example, it was far from clear how the new aged care gateway, assessment and referral services would cater for those experiencing homelessness and how information would be disseminated and understood by this group.
“The logic of CDC is a process of decision-making aligned with a person’s choices and needs. It assumes the person has made good life choices throughout their life in respect of health and lifestyle, which is unlikely to be the case,” said Mr Rees.
“Many homeless people will need greater support and direction to ensure they make choices that will lead them to achieve positive goals.”
This will require an increased amount of case management and support from appropriately trained staff, he said.
Mr Rees also quoted general manager operations at Wintringham in Victoria who said decision-making is so much harder when an individual has a lifelong experience of being disappointed with services or a past history of incarceration or institutionalisation.
People with these experiences need to learn to trust before they will be able to make decisions about home care services for themselves, she says.
Mr Rees called for an investment in outreach, skilled key workers who will liaise and negotiate with older people experiencing homelessness as well as more flexibility in mainstream service delivery.
Mr Rees said the Aged Care Gateway had to be further developed to support the diverse needs of older people, education and training should be expanded for care workers and research undertaken to better understand how CDC works in respect of disadvantaged groups and how the decision-making process can be made more sensitive to their needs.
He said when working with LGBTI clients it was important that a broad definition of family be supported by providers in adopting the CDC model.
“Without confidence, certainty and safety, LGBTI consumers and carers may be reluctant to fully participate and benefit from CDC initiatives,” he said.
Mr Rees said people with dementia want to feel central to the decision-making process and should be enabled to achieve their goals while managing risks.
Lack of trust, supportive networks and the experience of stigma and discrimination greatly complicate decision-making and access to services for many vulnerable groups, therefore the funding strategies and mechanisms within LLLB need to be fine tuned to empower all older Australians in a CDC environment, he said.