CDC: what you need to know

With less than a year until all home care packages need to be delivered on a consumer directed care (CDC) basis, those in the know give Natasha Egan some timely advice for organisations not yet prepared.

Goal-based planning. Service coordination. Financial management.

These are the skills workers and managers need to have in a consumer directed aged care environment, the Community Services and Health industry highlighted in its 2013 environmental scan A time for action.

CDC is already here for many consumers and providers and the 2014 ACAR sees more than 6,600 additional home care places in the market. But the real story is that, from July 2015, all home care packages need to be delivered on a CDC basis.

How prepared is your organisation?

Next week, AAA features two providers readily embracing the CDC way

According to Ronda Held, manager of the CDC capacity building project Home Care Today, (see ‘Resources’ at the bottom), there are three stages of readiness among Australia’s community aged care providers.

Those leading organisations which have enthusiastically embraced the rollout of CDC packages since the pilot program, worked hard on the systems and processes to get it up and running while also championing the cause, she says.

“There’s another group who are doing it but some of the feedback we get from consumers and some of those frontline organisations, [is] the rhetoric doesn’t quite match the reality,” says Held.

Consumers not getting to use or being discouraged from using a provider of their choice has been one complaint, she says. While sometimes the reason seems legitimate, other times it does not, Held adds.

“Then of course you have the ones who are not ready to transition. They have not put a toe in the water yet and basically now have 12 months to get ready for the transition and that is where we are focusing the Home Care Today project on,” she says of the third group of providers.

The project, which is being run by COTA Australia in partnership with Aged and Community Services Australia and Leading Age Services Australia, is a multi-faceted CDC capacity building initiative targeting both consumers and providers.

Held says an area of feedback they are getting via aged care conferences and Home Care Today consultations is that many providers are putting more focus on the technicalities of CDC, such as the legalities or how to subcontract other service providers, rather than on the shift in culture required from a consumer perspective.

Engagement

This leads into some key advice from Held. If you haven’t already started on the culture change process, you need to do so straight away because it takes time to implement, she says. Everyone, in all roles in the organisation, needs to understand the implications and be supportive of CDC, Held says.

Secondly, involve consumers in more than just their individual package. Held recommends forming a consumer advisory commitee and involving members throughout the design and transition process.

“Don’t design CDC and then deliver it to consumers. You will have consumers who can give you advice along the way as to how you should set the whole thing up and what your financial statement should look like and so on. Test it on them before you finalise it. Get their advice on implementation and ultimately on evaluation on how it is going as well.”

Planning and coordination

In terms of developing the best package for an individual, Held says she knows from managing community services over many years that staff can struggle with individualised goal-based planning, sometimes because they don’t think in terms of goals for themselves.

However, she says it is all about knowing the right questions to ask and points to the work by UK consultant Helen Sanderson. “What does a good day look like? What do you enjoy doing? What really makes you excited? They’re the sort of questions that people need to learn to ask,” she says.

Similarly, when coordinating the package, it is important for workers to realise they are facilitating rather than managing, says Held. While case management and capacity building are phrases commonly used in the sector when talking about CDC, the terminology can be confusing.

“We are really trying to shift that language to more an advisory and facilitation role. Consumers don’t like the term case management at all,” says Held.

“We need to get the mind shift from that traditional case management approach to one of an advisory role where the consumers are making the decisions and persons in the agencies are supporting that.”

Similarly, Held says they prefer to use “capability” rather than “capacity” because saying you’re building people’s capacity implies they don’t have the capacity in the first place.

“They probably have the capacity but they don’t have the information or the understanding of how the system works to be able to use their capacity. It is really about people understanding the complexities of the system and what their options are and being able to make choices based on that.”

Financials

Equally important when explaining options and providing choices are the initial and ongoing conversations with clients to determine and deliver the amount of control and information the client wants, says Held.

For example, in dealing with the budget, she is getting feedback that some consumers are confused by the monthly statement and think it is a bill they have to pay.
“If someone says I can’t cope with any of this. I want you to take my budget and talk to me about what I want and deliver it; that is consumer directed as well,” she says.

Overall, the shift to individualised budgets and a client-driven environment means that frontline workers now need advanced skills in managing budgets and helping clients understand their monthly statements.

Lorraine Poulos, an industry consultant who offers training in a range of aged care areas including budgeting for CDC, says the first thing everyone needs to remember is that the budget is not the actual. Rather, it is a plan, and each month the budget statement shows whether you have gone under or over, she says.

Poulos agrees that everyone in the organisation needs to be behind the transition to CDC. She says one of the richest parts in budget training sessions is when the finance people and the care coordinators are in the same room.

“When that happens, the finance people actually get to understand what the community care service is about and why they need to have flexibility around the way they manage the service,” she says.

Looking at the interface between the case manager and the organisation’s database, Poulos says it is important to make the budget available in real time. She gives the example of a home care package recipient in hospital who is allowed to return home on the weekend if they have some support.

“The systems have to be responsive enough for the case manager to be able to approve sending in some additional care on the weekend, knowing that the client in general has enough money in their budget,” Poulos says.

Bringing care planning, service coordination and financial skills together, Poulos recommends that care coordinators find out from their Medicare Local what existing services are available for clients to access, as well as any private health entitlements for allied health services, and then build the budget around that.

“If the case manager was able to help clients navigate that so they could access those services, that’s where the richness of the work and their skills come into play,” she says.

Help available and coming soon

Looking forward one year and whether the sector will be ready, Held says July 2015 is essentially just the starting point of an ongoing cultural change project.

While it is true that, early on, organisations were not learning from each other as well as they could have, as many organisations were protective of their models, the situation is now improving, she says.

“We are hoping through the Home Care Today medium we can start doing more of that – things that are shared; that we are learning along the way.”

Resources for consumers include a printed and downloadable CDC information booklet and 45-minute face-to-face peer-education sessions, which are being rolled out by COTA over the coming year. Providers can also book these peer education sessions for their existing clients prior to transitioning to CDC.

Specifically for providers, Home Care Today is developing a range of sharable content, some of which will be delivered by the peak bodies. Trainer and student materials will also be available on the website for organisations to run their own internal training.

Projects completed or underway include the development of tools to: determine internal costs and build budgets; help workers have person-centred, consumer directed and restorative care conversations; and design a co-production CDC approach. There is also a longer term project looking at legal issues and risk in a consumer directed environment.