Abstract:Consumer directed care (CDC) is increasing in community aged care. However, limited information is available to successfully transition social workers and other case managers to their new role. This paper reports on a case study of six senior case managers who supervised staff in three Australian community-aged care agencies as they transitioned from agency directed care to consumer directed care. A change management framework was used to analyse the qualitative data collected in 12 semistructured interviews. … Show more
“…For instance, Carr and Robbins () write that “frontline workers are either not aware of the [DF] policy, [or] do not have sufficient information to confidently offer direct payments” (p. 6). Laragy and Allen () find that in the Australian context, many senior case managers found DF program implementation confusing and felt that “they did not have sufficient information regarding the changing procedures to support and supervise their teams adequately” (p. 219). McGuigan et al () report that the informal care‐givers they interviewed in Northern Ireland (serving as proxies for DF users) expressed a need for enhanced information exchange around DF schemes:A lack of clear, concise information available for users was a complaint among the sample, with many suggesting they would like to receive current and timely information on changes in rates of pay, details on what exactly the [DF money] can be used for and information relating to employment and employment legislation.…”
Section: Analysis and Resultsmentioning
confidence: 99%
“…In certain contexts, some staff report difficulty distinguishing between DF and traditional services because they feel that clients already have choice under traditional models of care provision, or, conversely, that under DF, client choices do not change. For example, Laragy and Allen () report that some of the senior case managers they interviewed in Australia felt that the DF model is the same as the “client‐centered care” model already in place, as this model focuses on client empowerment, including choice over their service provision (p. 221). Gill et al () report that in their secondary analysis of interviews with DF clients, staff, and informal caregivers in Australia, “most of the clients and carers expressed views that the range of services offered under [DF] were unchanged and that the services offered were limited to what has been traditionally offered” (p. 482).…”
Section: Analysis and Resultsmentioning
confidence: 99%
“…At the same time, however, the literature also identifies barriers to the flow of information and support for new and continuing DF users. In Carr's (2011) Laragy and Allen (2015) find that in the Australian context, many senior case managers found DF program implementation confusing and felt that "they did not have sufficient information regarding the changing procedures to support and supervise their teams adequately" (p. 219). this type of support is not consistently available to DF users across programs and contexts.…”
Section: Choice Studiesmentioning
confidence: 99%
“…There are a variety of terms used to describe this wave of changes, including consumer‐directed care, self‐managed care, self‐directed care, direct payments, individualised funding, and personalisation (cf. Laragy & Allen, , p. 213). Our research team uses the term “direct funding” or “directly‐funded” (DF) home care to emphasise the cash transfer element of this mechanism and to offer a critical hesitation around positioning those who require health and social services as “consumers” in an age of government austerity and hyperneoliberalism.…”
In many developed contexts, home-care services have been overhauled with the intent of increasing control and flexibility for those using social and health services. This change is associated with providing funds directly to individuals, and sometimes their families and supports, to arrange at home-care assistance with the activities of daily living. Directly funded home-care programs, or "direct funding" (DF), are not value-neutral policy interventions, but complex and politicised tools for the enactment of care in contemporary times. In this qualitative metasynthesis, we consider 47 research articles published between 2009 and 2017 that explore various DF programs for older persons in the United Kingdom, Australia, and the United States to identify core concepts in the literature. We find that choice emerges as a central concern. We then assess the literature to explore the questions: How does the existing literature conceptualise choice, and the mechanisms through which choice is enhanced, in DF programs for older persons? How is choice, and the benefit of choice to older service users, understood in relevant studies? We argue that the concept of "choice" manifests as a normative goal with presumed benefits among the studies reviewed. Particularly when discussing DF for older people, however, it is essential to consider which mechanisms improve care outcomes, rather than focusing on which mechanisms increase choice writ large. In the case of DF, increased choice comes with increased legal responsibilities and often administrative tasks that many older people and their supports find burdensome. Furthermore, there is no evidence that choice over all elements of one's services is the mechanism that improves care experiences. We conclude by presenting alternative models of understanding care emerging from feminist and other critical scholarship to consider if we are, perhaps, asking the wrong questions about why DF is so often preferred over conventional home-care delivery.
“…For instance, Carr and Robbins () write that “frontline workers are either not aware of the [DF] policy, [or] do not have sufficient information to confidently offer direct payments” (p. 6). Laragy and Allen () find that in the Australian context, many senior case managers found DF program implementation confusing and felt that “they did not have sufficient information regarding the changing procedures to support and supervise their teams adequately” (p. 219). McGuigan et al () report that the informal care‐givers they interviewed in Northern Ireland (serving as proxies for DF users) expressed a need for enhanced information exchange around DF schemes:A lack of clear, concise information available for users was a complaint among the sample, with many suggesting they would like to receive current and timely information on changes in rates of pay, details on what exactly the [DF money] can be used for and information relating to employment and employment legislation.…”
Section: Analysis and Resultsmentioning
confidence: 99%
“…In certain contexts, some staff report difficulty distinguishing between DF and traditional services because they feel that clients already have choice under traditional models of care provision, or, conversely, that under DF, client choices do not change. For example, Laragy and Allen () report that some of the senior case managers they interviewed in Australia felt that the DF model is the same as the “client‐centered care” model already in place, as this model focuses on client empowerment, including choice over their service provision (p. 221). Gill et al () report that in their secondary analysis of interviews with DF clients, staff, and informal caregivers in Australia, “most of the clients and carers expressed views that the range of services offered under [DF] were unchanged and that the services offered were limited to what has been traditionally offered” (p. 482).…”
Section: Analysis and Resultsmentioning
confidence: 99%
“…At the same time, however, the literature also identifies barriers to the flow of information and support for new and continuing DF users. In Carr's (2011) Laragy and Allen (2015) find that in the Australian context, many senior case managers found DF program implementation confusing and felt that "they did not have sufficient information regarding the changing procedures to support and supervise their teams adequately" (p. 219). this type of support is not consistently available to DF users across programs and contexts.…”
Section: Choice Studiesmentioning
confidence: 99%
“…There are a variety of terms used to describe this wave of changes, including consumer‐directed care, self‐managed care, self‐directed care, direct payments, individualised funding, and personalisation (cf. Laragy & Allen, , p. 213). Our research team uses the term “direct funding” or “directly‐funded” (DF) home care to emphasise the cash transfer element of this mechanism and to offer a critical hesitation around positioning those who require health and social services as “consumers” in an age of government austerity and hyperneoliberalism.…”
In many developed contexts, home-care services have been overhauled with the intent of increasing control and flexibility for those using social and health services. This change is associated with providing funds directly to individuals, and sometimes their families and supports, to arrange at home-care assistance with the activities of daily living. Directly funded home-care programs, or "direct funding" (DF), are not value-neutral policy interventions, but complex and politicised tools for the enactment of care in contemporary times. In this qualitative metasynthesis, we consider 47 research articles published between 2009 and 2017 that explore various DF programs for older persons in the United Kingdom, Australia, and the United States to identify core concepts in the literature. We find that choice emerges as a central concern. We then assess the literature to explore the questions: How does the existing literature conceptualise choice, and the mechanisms through which choice is enhanced, in DF programs for older persons? How is choice, and the benefit of choice to older service users, understood in relevant studies? We argue that the concept of "choice" manifests as a normative goal with presumed benefits among the studies reviewed. Particularly when discussing DF for older people, however, it is essential to consider which mechanisms improve care outcomes, rather than focusing on which mechanisms increase choice writ large. In the case of DF, increased choice comes with increased legal responsibilities and often administrative tasks that many older people and their supports find burdensome. Furthermore, there is no evidence that choice over all elements of one's services is the mechanism that improves care experiences. We conclude by presenting alternative models of understanding care emerging from feminist and other critical scholarship to consider if we are, perhaps, asking the wrong questions about why DF is so often preferred over conventional home-care delivery.
“…Other states have progressively introduced relatively small scale individualised funding programmes in the disability sector and more recently in aged care (Laragy and Allen, 2015;Purcal et al, 2014).…”
Section: Individualised Funding and The Ndismentioning
The need for all people with disability to have access to reliable information before they can make informed choices in individualised funding programmes is well documented. However, little guidance exists on how information can be provided to ensure it reaches its target audience. While information provision is important everywhere, there is a pressing need in the Australian context to ensure all people have access to information as the National Disability Insurance Scheme is designed and introduced. The authors identified key principles of information provision documented in the literature and used these to analyse their data from Australian studies of individualised funding programmes. The data came from 143 transcripts and records of interview in five studies conducted from 2011 to 2013. The analysis confirmed the importance of the principles previously documented and identified two additional principles, these being related to gender and 'hard to reach' groups. This analysis informs a new framework to increase equity and improve people's access to information in individualised funding programmes. Information needs to be: (i) accessible and diverse in format, mode, source and location; (ii) personalised and targeted; (iii) accurate, consistent and timely; (iv) from a trusted source; (v) independent; (vi) culturally appropriate; (vii) actively promoted to 'hard to reach' groups and (viii) gender appropriate. This paper provides a new framework to guide information in individualised funding programmes for professionals in roles ranging from policy makers to service delivery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
