Self-directed community services for older Australians: a stepped capacity-building approach

Abstract

Consumer-directed care (CDC) is increasingly widespread among aged care service options in Organisation for Economic Co-operation and Development (OECD) countries. However, the evidence base regarding the programmatic and contextual factors that affect the outcome of CDC interventions is surprisingly small. This paper reports on a self-directed care approach for older Australians with complex care needs. A multi-methods longitudinal comparative cohort study was employed comprising 4 survey tools and 56 semi-structured interviews. Participation rates were around 20%. A total of 185 (98 in the intervention and 87 in the control group) older people and carers were recruited at baseline. Eleven months later, 109 participants (59 in the intervention and 50 in the control group) completed the repeat measure. Attrition rates were around 40%. Data collection occurred between July 2010 and April 2012. The data suggest that intervention group participants were likely to be more satisfied with the way they were treated (P = 0.013), their care options (P = 0.014), the 'say' they had in their care (P < 0.001), the information they received regarding their care (P = 0.012), what they were achieving in life (P = 0.031), that the services changed their view on what could be achieved in life (P = 0.020) and with their standard of living (P = 0.008). The evaluation suggests that while only a very small segment of older people is interested in a voucher or cash option, a substantially larger group would like to have greater say over and more direct access to their care, without, however, assuming administrative and financial responsibilities. The paper concludes that a stepped capacity-building approach to CDC may improve the acceptability of CDC to older people and generate synergies that improve older people's care outcomes.

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

“…This limited understanding left older people feeling confused, to the point where many simply continued to rely on traditional home‐care or day‐care services, as opposed to actively choosing their care arrangements (Norrie et al, , p. 182). Ottmann and Mohebbi () similarly note that in their multimethods longitudinal comparative cohort study of DF interventions in Australia, the most important barrier to uptake was “a lack of perceived knowledge, authority, and expertise” (p. 607). Thus, knowledge limitations appear to impact clients’ experience of DF at both early and later stages of DF use.…”

“…The literature indicates that a far larger number of clients are interested in self‐directing aspects of their care, like choosing their care‐givers and the care schedule. For instance, Ottmann and Mohebbi () report that “it appears that older Australian's preferences regarding self‐direction are only in a very limited sense motivated by a voucher/cash option and greater financial and administrative control and responsibility. [Instead] a far larger number of clients were interested in self‐directing aspects of their care, resulting in greater decisional authority and better and more direct access to services” (p. 609).…”

“…Indeed, there is some evidence that it is the ability to choose and schedule one's workers that has the greatest potential to improve experiences of care (cf. McCaffrey et al, ; O'Rourke, ; Ottmann & Mohebbi, ). Choosing and scheduling care workers allow for enhanced, individualised relationships, can enable culturally or otherwise identity‐sensitive care dyads, and addresses one of the major complaints of conventional home‐care arrangements, that is, inconvenient schedules.…”

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

“…Evidence from previous research has shown increased levels of uptake and satisfaction with CDC models of service delivery, especially among younger age groups . The availability of information/knowledge about CDC has been highlighted as a key facilitator to uptake of the model . It was hypothesized that individuals receiving CDC services were therefore more likely to be younger and have some prior knowledge of CDC.…”

“…14,16 The availability of information/knowledge about CDC has been highlighted as a key facilitator to uptake of the model. 21 It was hypothesized that individuals receiving CDC services were therefore more likely to be younger and have some prior knowledge of CDC. It was also hypothesized that individuals receiving CDC services would have a better quality of life (as measured by both the EQ-5D-5 L and ICECAP-O) compared with those receiving traditional PDC services.…”