If you haven’t started delivering consumer-directed home care packages, get practicing because from July 2015 it is CDC or bust. In the concluding part of AAA’s series on CDC, we hear the lessons learned from two providers who were early adopters.
Case study 1: Home Nursing Group
Since CEO Gorm Kirsch bought the company in May 2010, Home Nursing Group (HNG) has transformed from a local DVA provider based in Armidale to a regional community aged care provider serving the New England and mid-north coast regions of NSW. It now also has offices in Coffs Harbour and Tamworth. The provider’s core business is Home Care Packages, but as of January 2014 it also provides 60,000 HACC hours and some DVA services.
Getting CDC ready
HNG secured its first community aged care packages in 2011 with the second round of funding under the pilot consumer directed care program. As they never had traditional packages, Kirsch says they were able to start with a “clean sheet of paper” when designing their CDC packages.
Even so, HNG still had to learn the CDC way, which Kirsch says involved extensive research into consumer directed care, restorative and enabling care approaches and market demand among local aged care consumers. The research highlighted community concerns about administrative costs and a perceived lack of transparency among some providers, he says.
“Our CDC approach is premised on the idea that our primary job is to support consumers as they make decisions about their own goals and care options by providing as much information as required, in a relevant and timely manner.
“We never present consumers with a limited menu of options, rather we work with them to develop flexible, responsive service packages enabling them to meet their own goals.”
Kirsch highlights the following as key organisational issues that HNG spent time on during implementation:
- intake and budgeting systems to manage expectations and explain CDC
- staff training, such as in restorative and enabling approaches and open-ended language for goal exploration and storytelling
- reviewing technology including both internal systems and assistive technology for consumers
- aligning the quality framework with the CDC approach, such as accounting for the “dignity of risk
Transparency rules
It is necessary to know your operating costs and also how to explain those costs to customers, Kirsch says.
“This is the essential first step to ensure transparency and long-term viability. Most consumers accept costs, including administrative overheads, as long as they are justified, reasonable and well-explained. We have a team who prepare and check budgets and also report monthly to management and consumers about over- and under-spends.”
Great expectations
Kirsch says it is important that clients, as well as family members, understand fully and from the outset what can and cannot be delivered within a certain budget.
“Too often, consumers and their informal carers have unrealistic ideas about how many hours of care can be delivered per day. We therefore ensure the package funds are being used very efficiently, for example, paying private housekeeping services rather than using AINs to do domestic services.”
Clearing up case management
Case management is essential for effective service coordination but it is not well understood by clients and their informal carers, Kirsch says. “We therefore break down the components of case management during our early discussions with consumers to explain what it is and why it is an essential component of the package.”
Consumer views
Input from consumers, in addition to other stakeholders, plays an important role at HNG, says Kirsch. HNG consults in the local health community and with other community care organisations and it holds regular meetings with an advisory committee.
That committee includes consumer organisation representatives, GPs and community nurses, researchers from University of New England School of Health, and health system representatives. Discussions cover business strategy, policies and procedures, future planning and quality assurance including customer feedback surveys.
According to Kirsch, clients say they greatly value the control, choice and individual budget offered by CDC.
“Traditionally, in New England, community aged care packages were held by care brokers and delivery outsourced to private nursing services. This resulted in a separation between consumer-facing service delivery and funding bodies.
In bringing these elements together we have improved the experience for consumers by increasing budget transparency, reducing administrative charges and clarifying lines of responsibility.”
Hot topic
However, Kirsch says an emerging area of concern for some consumers is over-spending, and from the provider’s perspective the question of what happens when a consumer exceeds their budget, given it is not possible to subsidise from under-spent budgets.
“We recognise this as industry-wide issue, and look forward to discussing possible solutions with our peers.”
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Case study 2: Care Connect
Care Connect’s primary service offering is case management, which accounts for at least 80 per cent of its business although it does have some support workers following last year’s merger with Diverse Care, explains CEO Paul Ostrowski.
“However, we don’t like the term case management, we prefer advice or facilitation because people are not cases and it is no longer our role to manage them. It is our role to empower them or facilitate them to be able to manage their own lives,” Ostrowski says.
Getting CDC ready
Care Connect began providing CDC packages following the inaugural CDC funding round. Prior to that the organisation had spent three years preparing for consumer directed aged care and individualised funding for disability services, Ostrowski says.
They engaged an international consultant to re-engineer their service approach resulting in their My Life, My Choice, My Way model. They also involved their consumer advisory committee throughout service design and implementation and continue to include them for ongoing re-evaluation.
“I think many people innately believe that they do person-centred practice, they behave in a CDC fashion, but when the rubber hits the road and you have somebody from the outside assess how you are doing you often find in fact that it is not exactly what you thought it was going to be.”
Act now
For providers which are not yet delivering CDC, Ostrowski strongly recommends they begin testing a CDC approach immediately.
“You should not underestimate the amount of work required to do CDC properly. I’m talking about understanding your costs, making sure your model of service is appropriately adapted, making sure your technology can support things appropriately.
“Do not presume your systems can produce an accurate statement. It took us some months of work, which we did outside of our standard system, to be able to produce what we consider to be very clear statements.
“A budget tool for your clients that clearly explains how the process will work and how much each step will cost in the package makes an enormous difference,” he advises.
Working out costs
Right across the sector organisations are asking themselves how much they spend on administration and case management and how much of the funding should go to direct services, Ostrowksi says. “We did a great deal of internal work on that and believe that for the majority of clients, combined administration and case management of around about 30 per cent works for most people.”
Presenting it clearly
Care Connect is using a “very sophisticated budgeting tool” that instantly helps people better understand the steps taken to get them the best possible support and how much those steps and services will cost, Ostrowski says. “If you can represent that very graphically for people it allows them to make informed decisions about which way they would like their services moved.”
Unders, overs and contingencies
While blowing out the budget happens, it is only in small numbers and the regularity of CDC statements keeps on top of that, Ostrowski says. However, clients are more inclined to want to conserve funds, he adds.
While the guidelines say contingency funds should not exceed 10 per cent, he admits there are some who would like to set aside more. “One of the things our budget tool does is very quickly creates an alert than says you’re striving for a contingency that is larger than the guidelines allow.”
Technology is king
Technology will play a very significant part in implementation of CDC but most of the systems today are not designed primarily around managing personal budgets, says Ostrowski.
“Having looked at all of the options in the market we are now in the middle of a major process where we are looking to replace our IT systems. We did that because we think that there is enormous potential for technology to really improve people’s experience of the aged care system.”
Vacancies
“There is no point in pretending otherwise, vacancies are most complex with level ones,” Ostrowski says, adding that this is because it currently competes with a strongly supportive HACC program. “Many are making the choice that they are in fact better off under HACC. That of course will change after 1 July next year.”
READ NEXT: Part 1 of AAA’s series, ‘CDC: What you need to know’
