Government-commissioned report backs the rollout of consumer directed care to residential aged care, but identifies need for a common model to be developed followed by provider-led trials
The Federal Government should progressively transition residential aged care towards a consumer directed care model, a government-commissioned report has concluded.
The report into the applicability of CDC in Australian residential aged care, conducted by KPMG, found that moving to such a model was in line with international practice and supported by stakeholders such as providers and consumers, but it acknowledged a number of challenges.
One of the barriers identified was the lack of a single “CDC model” for residential care, which the report proposed could be overcome by a staged transition to CDC, to be informed by a series of provider-led trials.
Significantly, the report identified the need to develop a common definition of CDC in residential aged care, as well as a “research and knowledge sharing agenda” to identify and promote emerging practice.
Yet the report, which was completed in July 2014, was only publicly released by the Department of Social Services last Wednesday – some 14 months after it received the recommendations.
Australian Ageing Agenda asked DSS to explain the delay in releasing the report. A response, which came from the Department of Health, did not answer the question.
However, it confirmed that the analysis was conducted as part of KPMG’s broader report into home care packages, which included examining the implementation of CDC in community care. The reports were published at the same time by DSS on its website last week.
Regulatory, funding barriers
Based on a literature review and consultations with 15 stakeholders including provider peaks ACSA and LASA and consumer group COTA, the Applicability of consumer directed care principles in residential aged care homes report acknowledged that the regulatory and funding environment was perceived as a barrier to providing more flexible care.
This echoed a recent Australian Ageing Agenda article on CDC in residential aged care in which some stakeholders said that fundamental structural change to the system would likely be required to facilitate greater consumer choice and flexibility.
The KPMG report said: “Overcoming this contention that regulations and funding are a barrier to CDC is a challenge that will need to be considered as the sector reorients to CDC.”
It also noted “concerns about how to balance provider duty of care with enhanced consumer choice and control principles” among the stakeholders.
Critically, it concluded there was “no consensus” around the role of an individualised budget, which is a key component of CDC in home care, in a CDC approach in residential aged care, or how this would “operate in practice.”
While the report noted that countries such as the United States have had CDC in residential aged care for more than 20 years, it found there was no single CDC model for Australian residential aged care that could be implemented.
It recommended that a “staged reorientation to CDC should be considered” which would involve key stages including:
- the development of a shared definition of CDC in residential
- a phase of research and knowledge sharing to promote CDC practice locally
- provider-led trials to examine key elements such as goals-based planning and some form of individual budget.
Following these phases, a “general CDC model of care” could then be implemented across the sector, the report found.
In 2012 the Living Longer Living Better reforms announced by the then Labor Federal Government included for the first time a commitment to pilot CDC in residential care. However, despite this initial interest from government, the trial ultimately never eventuated.
The Coalition Government has said it wants to see residential aged care move towards providing greater consumer choice, while recognising there were considerations before this could become a reality.
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