Challenges of CDC in residential emerge in UK pilots
The experiment to introduce consumer directed care to residential aged care homes in the UK has “largely failed at this point”, after pilots showed poor uptake among seniors, says an Australian aged care leader who has just returned from a study trip.
The experiment to introduce consumer directed care to residential aged care homes in the UK has “largely failed at this point”, after pilots showed poor uptake among seniors, says an Australian aged care leader who has just returned from a study trip.
While the UK government planned to introduce the program from this year, it has now pushed back implementation until 2020, Ian Hardy, CEO of Helping Hand, told the Strategic Thinking for Choice and Control conference yesterday.
The outlook toward CDC among providers and local councils in the UK was “perhaps not as rosy” as it was among Australian providers, Mr Hardy told the conference hosted by Council on the Ageing Australia and Criterion.
Mr Hardy had just returned from a study tour of the UK where he met providers, peak bodies and councils, as well as the researchers at the London School of Economics who were undertaking the formal review of the trial.
About 18 months ago the British government offered 20 local authorities the option to participate in the pilots, whereby funding that would normally go to the care home went instead to the resident as a direct payment, Mr Hardy said.
The pilots initially saw direct payments being offered to existing residents, who may have been living in the facilities for years, he said. “Unsurprisingly the majority declined to take it up; they felt it would change their relationship with their provider,” he said.
Although it later became more common for incoming residents to be given the opportunity of availing of a direct payment, he added.
“It would appear that the experiment has largely failed in the UK at this point. A significant proportion of people who were already residents in facilities declined, and a relatively significant proportion of incoming residents have also declined.”
Among the residents who did take up the direct payments there was fairly widespread disappointment with the providers’ inability to offer any significant flexibility, said Mr Hardy.
“Some residents reported tensions with their provider, so the notion of the resident as a customer who has rights was, for a variety of reasons, making that resident feel quite uncomfortable.”
However, some residents did feel empowered even though the home was not able to offer them a great deal of improved options.
“Providers themselves are reporting concerns about viability. And worryingly there was skepticism about whether it would achieve anything for the resident,” he said.
Australian experience
In Australia, some politicians and sector leaders were keen to transplant the increased flexibility of home care into residential care, but the trouble was that “nobody actually knows what it means when we talk about CDC in residential,” Mr Hardy said.
“It is undefined and from a business point of view it’s quite difficult to get our collective heads around,” he said.
Nonetheless many Australian providers were already working within the current policy and funding framework to try and facilitate greater choice in daily routines and other important aspects of life for residents. “We’re seeing co-design in the design of routines of homes and the buildings themselves,” he said.
Some providers were considering ways of disaggregating costs and returning a proportion of the total available funding to the resident in the forms of debit cards or accounts.
As a natural extension of that approach, residential operators should be ready for residents to want to spend some of those funds with outside providers as well, said Mr Hardy.
“Just as we’ve seen in the home care environment, many independent businesses are starting up to meet the needs of people who are staying at home and have the resources to buy services to help them stay there. I see no reason why under a discretionary spending component in residential care we wouldn’t see the same thing happening.”
The lessons currently being learned by home care providers about unit costing, accurate billing and reporting, and organisational efficiencies, would translate directly to the residential sector, Mr Hardy said.
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Thank you for your insights Ian and I would have to strongly disagree with your comment ““It is undefined and from a business point of view it’s quite difficult to get our collective heads around,” he said.
It currently works in a number of places and serves the residents and providers very well. Therefore, I think you need to realign your thinking on this.
In regard to residents reaction to being offered the funds and the flexibility I agree with you that this requires a lot more work and we have found that this is probably the hardest part of CDC in Residential Care. However, it is not insurmountable and we now know it takes time and a certain technique to open the door to the resident and their families. Once opened then there is significant change.
Early days yet but definitely not a failure.
Like all one size fits all models it has its successes and its failures. What is needed is a variety of models of service delivery that are tailored to the specific needs of the individual. That is often anathema to bureaucrats and politicians as it tends to overcomplicate their sometimes unrealistically simple views about how reality and life work. We will eventually develop that multi model system, but a lot of people will not have their needs met in the meantime.