Consumer-directed expectations challenge providers

In an aged care system ruled by consumers, choice will still be limited by resources, writes Mark Sheldon-Stemm.

The aged care quality standards that came into full effect on 1 July 2019 focus on the aged care provider being able to meet the choices and expectations of consumers.

But is there a limit to what choices can be made and do the resources match what is being asked for?

This is a significant issue to be addressed in residential care when applying the new standards and ensuring the consumer is provided with choice and support to live the life they wish.

In home care, the ability to provide choice and to live the life the consumer wishes is governed by a different set of conditions to residential care. Consumers in home care own their package and have a defined amount of funds available to them to choose the services they require.

When the situation arises where funds available under a package are less than the consumer’s requirements, as per their goals and wishes, the ability to meet choice is made up by additional funding from the consumer, or in many cases by their family members.

The ability of the home care provider to give choice is very clear, well defined and understood by all parties before the commencement of services. The home care provider then supplies monthly statements showing funds available and charges against these funds, as agreed by the consumer.

However, the same situation does not apply to residential care. The licenses are still owned by the aged care provider and while the funding is calculated on an individual basis through the funding tool, the use of these funds is not accounted for or disclosed to the consumer.

Effectively, the new standards are being applied to two separate environments, which have significant differences and accountabilities.

The concern raised in applying the new standards to residential care is with how aged care providers can know when a consumer’s choices are outside the available funds to meet their wishes.

As there is no requirement, and in many cases no ability, to supply an individual budget to consumers, providers will be placed in a one-sided choice model. Without any limitations on funding what can be used to give direction on choice?

As a result of this dual system of standards, two situations are likely to arise.

The first is for those providers who do not have a system of allocating individual funding and costs. How will they communicate that the choices being made by a consumer are outside of the funding and resources available?

In this case funding is likely to be diverted away from other consumers to those who have the largest set of wishes and goals. Unlike home care, there are no financial boundaries set or agreed.

The second is, where a provider has a system in place that allocates individual funding and the residential care provider advises the consumer how their funds have been spent. In this case if the consumer wishes to have more services then they will be required to pay for these. This mirrors what occurs in home care.

This second situation has been raised by several of the organisations that have implemented or are implementing a consumer-directed model into their residential service.

This is where the application of the new standards across both home care and residential service models prove problematic. Any consumer dissatisfaction with a limit on choices and wishes in home care is dealt with based on an individual budget.

This is not the case in residential care and requires some clarification from those who will be assessing under the new standards.

The questions being raised by a number of residential providers relate to how assessments will take place based on:

• providers without individual budgets for consumers and their dealings with the consumer on why all their choices can’t be met;
• providers with individual budgets for consumers and the limited choices due to the funds available.

How will the Aged Care Quality and Safety Commission assess under these two different circumstances in an environment where the rules of choice are not clear and there is consumer dissatisfaction as a result of this?

Is this an unintended consequence of the introduction of the new standards? If it is then steps need to be taken to rectify the situation for both residential care and the consumer so there is common ground for understanding.

Mark Sheldon-Stemm is principal at aged care sector consultancy Research Analytics, which has been researching and testing models of CDC in residential aged care.

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