Choice under CDC not translating into practice, study finds

The rhetoric about “choice” in consumer directed care hasn’t translated into practice, new research into the provision of home care services suggests.

The rhetoric about “choice” in consumer directed care isn’t translating into practice, an ageing conference has heard.

Dr Tammy Aplin, from the school of health and rehabilitation sciences at the University of Queensland, on Thursday presented findings of an exploratory study into the experiences of a sample of the 1 million Australians who are receiving home care services.

Her research, involving 14 participants in 11 Queensland households, is some of the first  to emerge on the issue since the implementation of consumer directed care legislation in 2017.

Dr Tammy Aplin

Dr Aplin said surveys of her subjects, who were receiving domestic assistance, social support and shopping via a mixture of commonwealth home support and Home Support Packages, reflected a wide variety of experiences ranging from “very positive” to “very negative”.

However the study, presented at the Cepar International Conference of Long-term Care Directors and Administrators in Sydney, found while people were happy with being able to choose providers, there was a significant level of frustration about the lack of flexibility once services were delivered.

For example, some clients wanted companionship from people providing domestic services, while others just wanted the job done. Others were unhappy that they had to “fit in” with service providers, or that the services they required weren’t available.

“Choice about who provides a service, or what time of day, or the range of services you might have at your home is limited,” Dr Aplin told Community Care Review outside the conference.

“Providers seem to be offering the same stock standard services but if you want something a bit different, like gardening, or you need some equipment that they don’t provide, then it becomes complex.”

There was also dissatisfaction with lack of information, poor communication, staff inconsistency and the wait for services, as well confusion over the My Aged Care website.

The confusion and lack of information left people who had problems communicating and making informed decisions at risk of receiving poor quality or inappropriate services, she said.

“I think the rhetoric has been that you’ve got choice in not only who your provider is, but how it’s provided,” she said.

“Whereas what seems to be happening on the ground for the people I talk to is that yes you have choice over your provider, but that seems to be where it ends.”

There was also concern over the limited quality assurance and lack quality assurance mechanisms, she said.

Dr Aplin said the challenge for providers is to increase flexibility and become more responsive to  individuals so services can be tailored to their needs and preferences.

“Listen to your people, talk to your people about what they want,” she said. “The old structures, which are quite medically based, need to change.”

What clients were unhappy about:

  • Lack of information about what’s available
  • Confusion navigating My Aged Care
  • Inadequate services
  • Too long to wait

Recommendations from study participants:

  • More flexibility in service provision
  • Transparency about costs
  • Creation of an advisor role
  • Clear information about what is and isn’t provided

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Tags: aged-care, choice, community-care-review-slider, home-care, my-aged-care, Tammy-Aplin,

5 thoughts on “Choice under CDC not translating into practice, study finds

  1. 14 consumers is hardly representative of a robust interpretation consumer experience. More robust reporting through consumer experience reporting commencing July 2019 should provide a more reliable record of consumer experience.

  2. While it is a small study it is what people are experiencing and it is in keeping with criticisms in the UK where CDC is optional.

    The problems with CDC seem to be

    1) that CDC and choice is being sold to the public in order to get them to accept a competitive market as a universal way of providing services. It is opened to franchisees, banks and others who are there primarily for profit. They have a record for exploiting the vulnerable and will not provide services unless they are sufficiently profitable.

    2) that government is trying to manage something vulnerable, which is often intimate and personal, by itself. It is poorly equipped to do so.

    This is a sector dealing with vulnerable people. The relationships formed are important. It should be a community service which the community keeps control of. It should have the power to decide which sort of person (or company) it will support to help it provide those services. We should be developing the sort of community structures that enable us to do this. It is our responsibility to see that we do the best that we can.

    The government’s role should be to support and build community structures that allow the community to fulfil its important role of seeing that those in need are cared for and supporting them to do so. Instead they have created the sort of market and the sort of centrally controlled administration through Myagedcare that essentially excludes community and the sort of relationships that are needed.

  3. This is not an accurate or useful commentary. A big issue are Clients not assessed correctly often, and Clients accumulating large Unspent Amounts. The Government still has very weak Rules on what the Funding can be spent on so Clients push the Providers with request for items and works on Houses that are not in line with the original purpose of the Model. They refuse direct service hours while saving for these expenditures.

    Add to that Regional Assessment Team referring to themselves and not assessing in the interest of Clients and you have another Government Model that is more about Promoting a Government success that reality.

  4. The study does reflect the reality though. We told the Government way back in 2013/14 when we, the providers, were being told what was going to happen, that it simply would not work. The issue is that instead of providing a few of the service types well, big providers try to provide everything and big vast systems where people are just numbers do not work. Instead of delivering a few services well, they deliver a wide range badly.
    The other issue is that Government should decide what their actual role is. Are they funding bodies, are they regulators, are they providers? Once they do then their role will become clearer and the industry will be more certain.
    The other reality is the way its been presented as in the consumer is in charge and their choices and goals will be supported. It simply can’t happen as we do not have the resources to make it happen. If you have 50, 000 clients spread across a state you only have an infinite amount of resources. So if 100 want showers at the same time and you only have 20 workers in an area, only 20 people will get their choice.
    The choice is also about if you dont want housework every week and would rather go on a bus trip out somewhere every other week and the company does not provide that.
    I hope this is the first of many studies that will force the government to rethink this and then spend millions more in changing things again…..

  5. Providing services at times to suit clients is a constant workload and every effort is made to meet clients changing needs. Expectations often exceed capabilities of funding and flexibility and the shortage of qualified, skilled home care workers that suit organisational standards is also problematic.

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