Consumer Directed Care in A ustralia: early perceptions and experiences of staff, clients and carers

Abstract

The study aimed to identify the shared issues and challenges being experienced by staff, their clients and informal carers, with the introduction of Consumer Directed Care (CDC). Secondary analysis was undertaken of data that had been initially collected, via semi-structured in-depth interviews, to inform the development of a discrete choice experiment. The raw staff and client/carer data were re-examined using an iterative inductive process. The analysis focused on locating the shared themes and differences between the participant groups based on their CDC experience. The data were also assessed for difficulties or barriers that impacted on the service. Four broad shared themes were derived: culture, role change, operational systems and resourcing, but with a range of diverse and sometimes conflicting sub-themes between the different participant groups. Differences can be linked to participant role in the service chain, with discordance emerging between what has been traditionally offered and what might be possible. This investigation occurred during the period in which services were transitioning from a traditional aged care service model to a new model of service provision requiring considerable industry change. We conclude that existing industry regulation, culture and practice supports an established service model in Australia that arguably makes translation of the objectives of CDC difficult.

Impact of consumer‐directed care on quality of life in the community aged care sector

“…These findings might also be at least partly attributable to the relatively short time for which clients in the present study had been receiving CDC services (less than 12 months), which might not have been a long enough time period to allow for a comprehensive adjustment and realization of the full benefit of the new model. Difficulties associated with changing existing industry regulations, culture and practices that support already established service models in Australia (which, for instance, emphasize “care and caring” determined by the service provider as opposed to “risk‐taking, dynamism and creativity” in a co‐designed approach between the client and provider needed to realize consumer‐centric objectives of CDC) make the translation of CDC objectives within a short time even more of a challenge . Furthermore, the full effect of the CDC model might not have been captured in the present study, as the model currently covers only a limited number of aged care services.…”

Questioning “choice”: A multinational metasynthesis of research on directly funded home‐care programs for older people

“…Specifically, detailed notes were made on the findings and conclusions presented in each article, study, or report; these notes were then examined to ascertain perennial themes or topics of interest. As Table demonstrates, a variety of themes emerged; for instance, several articles discussed how DF might exacerbate or reduce risks for older people (Carr & Robbins, ; Ismail et al, ; Mitchell, Baxter, & Glendinning, ), explored the cost‐effectiveness of DF programs (Jones & Netten, ; Rummery, Bell, Bowes, Dawson, & Roberts, ; Woolham & Benton, ), and highlighted some of the organisational challenges associated with the implementation of DF programs by various health authorities (Doty, Mahoney, & Sciegaj, ; Duffy, ; Gill et al, ; Velzke, ).…”

“…These factors include the availability of workers, the quality, and availability of pre‐existing services, whether the client lives in a rural or urban setting, whether the client has access to other supports, like family and friends, and so forth (cf. Carr & Robbins, ; Gill & Cameron, ; Gill et al, ; Moore & Jones, ; Ottmann et al, ; Putnam et al, ; Ridley et al, ; Velzke, ). As Ottmann et al () point out in their systematic narrative review of DF in aged care, older people's support needs and ecological contexts vary greatly and are shaped by numerous factors including “the social, institutional, socio‐historical, cultural and family contexts of people's lives” (p. 579); these factors likewise come to shape older peoples’ choices in practice.…”

“…Finally, the few studies that directly investigate the positive outcomes of increased choice find that choice is the most beneficial when it enables enhanced care relations (O'Rourke, ; Rodrigues & Glendinning, ; San Antonio et al, ). Gill et al (), for example, found that clients emphasised the importance of individualised services that encouraged front‐line service providers to develop personalised relationships with them. In this example, “choice” becomes a mechanism for enhancing care relations, and the significance extends beyond simply choosing how to spend the money.…”

“…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). Norrie et al () present a similar finding in their study of DF in England, noting that “most [users] did not feel that [DF] had made a significant difference because their support plan had remained much the same” (p. 181).…”