A systematic narrative review of consumer-directed care for older people: implications for model development

Abstract

What is known about this topic• Consumer-directed care approaches are becoming increasingly common in domiciliary and community-based aged care in countries such as the United States, United Kingdom, Australia and New Zealand.• Despite the increasing endorsement of consumer-directed care as a mainstream policy option, a systematically constructed evidence base that could guide policy-makers and practitioners in developing consumer-directed care approaches for older people has not been published to date.• Research comparing user preferences across countries or investigating how ecological factors shape user preferences has received limited attention. What this paper adds• Consumer-directed care has the potential to empower older people and their caregivers by offering them greater flexibility and by increasing their involvement in care-related decisions.• Consumer-directed care programmes need to be adapted to local conditions taking into account the varied needs and preferences of older people and caregivers. Programmes should offer a broad range of options that allow for personalisation, support and greater control over services. AbstractConsumer-directed care is increasingly becoming a mainstream option in community-based aged care. However, a systematic review describing how the current evaluation research translates into practise has not been published to date. This review aimed to systematically establish an evidence base of user preferences for and satisfaction with services associated with consumer-directed care programmes for older people. Twelve databases were searched, including MedLine, BioMed Central, Cinahl, Expanded Academic ASAP, PsychInfo, ProQuest, Age Line, Science Direct, Social Citation Index, Sociological Abstracts, Web of Science and the Cochrane Library. Google Scholar and Google were also searched. Eligible studies were those reporting on choice, user preferences and service satisfaction outcomes regarding a programme or model of homebased care in the United States or United Kingdom. This systematic narrative review retrieved literature published from January 1992 to August 2011. A total of 277 references were identified. Of these 17 met the selection criteria and were reviewed. Findings indicate that older people report varying preferences for consumer-directed care with some demonstrating limited interest. Clients and carers reported good service satisfaction. However, research comparing user preferences across countries or investigating how ecological factors shape user preferences has received limited attention. Policy-makers and practitioners need to carefully consider the diverse contexts, needs and preferences of older adults in adopting consumer-directed care approaches in community aged care. The review calls for the development of consumer-directed care programmes offering a broad range of options that allow for personalisation and greater control over services without necessarily transferring the responsibility for administrative responsibilities to service users. Review findin...

Investigating consumers' and informal carers' views and preferences for consumer directed care: A discrete choice experiment

“…Whilst there is no single definition of CDC, the distinguishing feature of CDC is that consumers or their representatives should be able to make choices about the types of care services they access and the delivery of those services (including who delivers the services and when) [5,6]. Consumer choice such as that which comes with CDC has been shown to be associated with service satisfaction [7]. In Australia, newly initiated, publicly subsidised community aged care services (CACSs) designed to assist consumers to continue living in their own homes must, from July 2015, be offered on a CDC basis by service providers.…”

“…In the United Kingdom (UK), 'personal (social care) budgets' and 'personal health budgets', targeted at individuals with a range of long-term conditions, will be available to support identified healthcare and wellbeing needs in the UK [2,7,[9][10][11][12]. Belgium's 'Personal assistance budgets' and the French 'Cash for care' programme both introduced in 1997 target older people with impairments and can be used to pay salaries for personal assistants and specific care services [8].…”

“…Similarly, the 'Home care service vouchers' programme in Finland initiated in the late 1990s focuses on people aged 65 and M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 over with assessed care needs and are used for purchasing care services from identified providers [8] while the 'Assistance allowances' introduced in Sweden in 1993 are targeted at individuals with major difficulties in daily life and do not have restrictions in terms of what can be purchased [15,16]. 'Cash and counselling' programmes in the United States (US) piloted between 1998 and 2002, targeted at people who are older and with impairments as well as individuals with serious mental health problems, pay for some elements of health care such as skilled nursing, long-term rehabilitative therapies and clinical recovery services for people with serious mental health conditions [2,7,13]. In Canada, 'individualised funding' rolled out from 2000 onwards pays for support for people with developmental impairments [18,19].…”

Self-Directed Care and Individual Budgets for Older People: Lessons from the UK

“…This article draws on the international literature (see Ottmann et al, 2013;Rummery, 2011;Alakeson, 2010) but particularly the current story of the transformation of adult social services in England and Scotland, to illustrate the potential for the social and behavioral sciences to make sense of this change. The aims of the transformation to personal budgets or selfdirected support (SDS) (the terms used in the UK to cover 'cash for care' schemes) are to broaden choice and control for people using social care services -generally assistance with activities of daily living (DH, 2008).…”

“…In Scotland, the term self-directed support (SDS) is more commonly employed (Scottish Government, 2013). Terms such as consumer-directed care are used to cover similar changes in other countries such as Australia and the United States (US) (Ottmann et al, 2013).…”