We could rightly say that our Aged Care experience in Australia is mainly around Residential Aged Care – plenty of media coverage when things go wrong, highly regulated, compliance focused and concentrated on dependence rather than independence.
The provider holds the license to provide care and receive funding. We could call this Agency Directed Care. The Agency (provider) is directed by the funder (government) about the location, price and quality standards for the delivery of care.
Enter the concept of Consumer Directed Care (CDC). Currently operating in Home Care and being considered for Residential Aged Care. What does it mean?
In the Australian context (and in the Governments own words), it means:
- you can have more say in the care and services you access, how they are delivered and who delivers them to you
- you can have conversations about your needs and goals
- you can work with your service provider to develop your individual care plan
- you can agree how much involvement you want in managing your care package
- you will know how your package is funded and how your individual budget is spent through monthly income and expense statements
- your service provider will ensure that your package continues to meet your needs with ongoing monitoring and formal reviews.
Note the words ‘can’ in the above list – in practice most people want less to do with their own care rather than more. They want an experienced provider to care for them, deliver value and ensure their needs are met.
In all likelihood, there might only be a small number of people who want to take full responsibility for their individual care budget but it will be a case of not having to do everything that will be important to consumers. It will be more about being able to choose what you want to do and what you don’t want to do. Some consumers may want nothing to change, but there will be some who want some measures of choice and control. Historically in our aged care service systems, service providers have had all of the control.
The blunt thinking from some in Government sees the compliance and funding problems associated with Aged Care being solved by placing the package of care in the consumer’s hands thus creating competition between operators to attract those consumers to their organisation and by association the funding that attaches to their package. Government believes they are creating a market where market forces will dictate quality, price and value and there will be universal availability of services as a result of competition and innovation – consumers will simply vote with their (virtual) cheque-book.
While the movement in power from the provider to consumer is just beginning in Australia, care schemes where consumers hold the funds to purchase their own care, have been operating in countries such as the UK, US, Germany, Sweden and France since the 90s.
These overseas programs have ranged from unrestricted cash payments with little accountability or government oversight to more managed programs with tighter controls on how the funding can be spent.
In Australia, the consumer holds the package of care but not the funding. They can direct the funding from government to whomever they choose.
Despite obvious variations in programs around the world, the overriding goal for all of them is to empower the consumer so they can direct and control their own care. Understanding consumer decisions on the level of control that they want to exercise over their care is probably the core factor for CDC success in Australia.
If the UK experience is anything to go by, their equivalent of our Aged Care Assessment Teams, have moved from being care (and budget) facilitators to being budget controllers whose main function is keeping people out of the system to preserve ever diminishing levels of government funding.
An unrecognised and wider risk from increased consumer direction comes from an inevitable shift in responsibility for outcomes of home care programs from government and providers to clients and carers – and when that happens we risk undermining the potentially effective service infrastructure currently in place that may not be replaced with a care ‘market’ in which consumers with low means could effectively access care.
Experience in the UK shows that universal availability does not necessarily mean a high level of take up. The restrictions placed on the UK scheme by way of excluding payments to relatives and purchase of statutory services, and a relatively weaker consumer voice among older people, have no doubt contributed to low take-up.
Older Australians need advocates and the consumer movement in Australia has gathered strength in recent years. Consumer groups championed CDC in Australia. While the consumer lobby is not as embedded or as strong as in the US, the relationship between government and consumer bodies is far less adversarial in Australia, where such organisations are given respectful standing in a wide range of forums and receive significant public funding. In the US, such close relationships would be seen to compromise the independence of consumer representatives.
Based on overseas experience we can safely say from the outset that CDC is not a panacea that will solve all the problems across the aged care system; it certainly does not mean an increase in funding or levels of support and indeed the concept of CDC carries some elemental risks. Its effectiveness will depend on design and the readiness of governments, providers and consumers to engage equally and effectively.
Contact Linkage Care aged care advisory service for more information on aged care on 1800 016 222 or visit www.linkagecare.com.au