Leaders discuss future of care management

A robust and holistic assessment tool, the aged care taskforce, technology, and provider innovation are key to quality care management in home care, an industry conference has heard.

At the Aged Care Week conference in Sydney last week, Therese Adami – Catholic Healthcare’s general manager of Home and Community – led a discussion with three provider executives about care management and its role in aged care.

Currently, providers must deliver care management to all home care package recipients including those who are self-manaing. It includes things like regularly assessing their needs, goals and preferences and reviewing care agreements and plans and ensuring services align with other supports. However, under the new in-home program – which the aged care taskforce is overseeing the final design of – not everyone is going to get care management.

Gaynor Squillacioti – chief operating officer at Southern Cross Care NSW & ACT – said assessment was key to getting care management right. The new assessment tool must be robust, dynamic, referenced, and consider the client, the support network around them and their emotional wellbeing, she said.

“It is also must recognise now that home care is the way that aged Australians wish to live, [that] if we fall over with regards to the care management, it can be detrimental and end the journey of being able to live at home,” Ms Squillacioti she told delegates last Thursday.

“Whatever assessment tool the government finally lands on, we need to make sure that those assessors are responsive, they are timely in their approach and they’re also realistic with the amount of support that our current service advisors or support workers are giving those clients in the community.”

Assessment also needs to be holistic and involve service providers, added Yvonne Timson – chief executive officer of Community Vision in Western Australia.

“The assessment can’t just be you walk in and do an hour and walk out,” she said. There needs to be some elements in the assessments where they also work with the provider because they’ve been involved with that individual or family for so long. And you may know that they’ll be presenting amazingly, but you’ve also seen the other side. The assessment process has to be a little bit more holistic, and be open.”

Providers should also form relationships with the assessors, said Ms Timson. “They’re not just going in and ticking boxes, they genuinely want the best as well. So form relationships and work hard at that because ultimately, it’s about that individual’s outcome – not about us.”

Advice for government and providers

In response to a question about what advice, criteria or framework policymakers and providers should adopt in the context of not everyone being entitled to care management under the new model, Ms Squillacioti said government must recognise that individuals care could differ despite their abilities.

“Even though [an individual] may have good mobility and they appear to be highly functioning, if they’ve got vascular dementia, we may well know that they are not showering and therefore in need of that personal care – but it’s not being recognised because the physical needs appear quite low. As long as we continually advise and support the government in making the right decisions as providers, we can aim to get an equitable and safe and stable service.”

In response to the same question Ms Timson said firstly “we’ve got to hope and pray that the taskforce” opts for something that works otherwise there will be a disconnect between how providers operate and what’s being pushed. “A picklist is not going to care for older Australians to live independently in their own homes.”

Secondly, providers need to be innovative and look at different ways to deliver care management that still puts the client at the centre. “Whether they want it virtual because they’re quite capable and just need to touch base or whether they need someone to hold their hand while they go through everything – it’s down to that individual,” Ms Timson said.

“You have to look at ways and areas you can automate or become more efficient to offset those which are obviously going to cost you more to deliver,” she said. “It’s a duty on us to look at that because then we’re working with the government, not against the government. We will do our part, but they’ve got to do their part.”

Faye Spitiri, chief executive officer of Fronditha Care – which specialises in assisting older Australians from a Greek cultural background – said it was also important to add a cultural lens. For Fronditha Care clients that usually involves a collective decision with family and sometimes other stakeholders rather than an individual one. “It’s understanding in that context, how to frame definition policy and the infrastructure to be able to deliver on that care in that context.”

Elsewhere during the discusison, Ms Spitiri called for the definition of care management across the sector including how it should be delivered and structured while allowing for flexibility to be addressed “with haste”.

“And that is a consistently explicit definition of what we all mean when we say that, so that we can benchmark and we understand it in order to create greater excellence, equity and consistency in care management,” she said.

Technology a valuable addition

Panellists agreed that technology was among tools that would be helpful in getting the most out of care management. Ms Squillacioti said technology, such as fridge, oven, and bathroom sensors, could assist in the assessment process to provide additional support and give a much fuller picture of what’s going on in a resident’s home.

“Speaking from a personal point of view, my mother had dementia and she had a homecare package, which involved domestic services such as meals. The carer used to regularly go in and my mother would say, ‘Oh, you’re alright love, I’ve already eaten.’ Now we knew she hadn’t, but there was no secondary support there.”

Sensors on the bin and fridge could provider that next layer, she said. “Having the IT there to support the assessment process, will give a lot more insight.” It also raises questions about who is going to fund the gathering of the data if clients and providers continue using them as part of care provision, said Ms Squillacioti.

“Is that going to be a recognised service of proactivity keeping these residents safe and secure in their homes?”

On this, Ms Spitiri said Fronditha Care’s approach was to self-fund technology and tools until they had built an evidence base and then use that to lobby for greater support from government.

“It’s incumbent on us as providers in the sector to invest in that if we can, because once you build an evidence base, and you share that with other colleagues in the sector, it benefits not only the individuals that are in a particular service’s care, but the broader community.”

Main image from left: Therese Adami, Yvonne Timson and Gaynor Squillacioti