Older people with complex needs, low literacy and few social networks and financial resources are more likely to experience difficulty in adjusting to consumer directed care, according to a new report.
The Brotherhood of St Laurence evaluated the experience of its community aged care clients in the move to CDC over 15 months and found that while it was a positive experience for many consumers, the new system was also confusing and overwhelming for some.
Consumers who did not have the capacity to self-manage their package because of cognitive impairment, the absence of a carer or lack of skills had to allocate a larger portion of their subsidy to case management fees, therefore reducing the amount available for direct care services and activities.
Some clients with low levels of literacy and numeracy, especially financial literary, also said they struggled to understand the main elements of the CDC model and interpret their monthly financial statements.
The complexity of managing a CDC package and budget, negotiating choices and accepting new responsibilities will always be problematic for many service users who experience social and economic disadvantage, said the report produced by BSL’s research and policy centre.
Some key findings identified in the research included:
- Half of the 45 consumer interviewees found the term ‘consumer directed care’ confusing.
- Most consumers and carers liked receiving a monthly statement and felt more ‘secure’ knowing their budget position. However, just under a quarter of consumers found the statements difficult to understand, “with one consumer unable to read the statement at all and another still ‘bewildered’ even after several explanations.”
- Time spent with a case manager was highly valued overall but particularly by those who were isolated or disadvantaged by poverty.
- To manage their needs within a restricted budget, some consumers sought additional informal support from family and friends to help their budgets stretch further.
A significant finding from the evaluation was the impact on social participation under CDC.
Only half of BSL clients who had attended activities as part of a social inclusion program said they intended to continue to access the program using their individual budgets. Under a block funding model, participation in social programs had been subsidised.
BSL said the consequences of a reduction in social support services may be “serious”, especially for those with mobility limitations and those who are socially isolated from family and friends.
“The previous community aged care model had allowed some flexibility to providers to vary the level of support to individuals in line with actual needs and to underwrite programs such as the social inclusion program for the common good,” said the report released in May.
Concern over ‘hoarding’ of funds
The BSL report also echoed industry concern regarding the reluctance from some clients and carers to spend their packaged funds, despite having an unmet need.
“Building a surplus may be prudent if judiciously managed, but not at the risk of poor health and wellbeing which may lead to more complex conditions,” wrote the authors.
The report’s authors said consumer-directed policies in aged care must be accompanied by practical support for consumers and appropriate regulation.
The paper also highlighted the risks of further increasing individual responsibility such as through a fully “cashed out” model of care, which it said could impose “an unmanageable burden on some older people who are already struggling.”
Positive experiences of CDC
According to the findings, many consumers appreciated the flexibility to coordinate their own services and to use their personal budgets to further individual pursuits rather than standardised care options. Many consumers also reported that having a say in their care gave them a sense of independence and confidence in their own ability.
Some consumers also used their accumulated funds to purchase new aids and equipment.
The evaluation, which was conducted from May 2014 to July 2015 and gathered information from consumer interviews, consumer forums and two focus groups, is available to read in full here.
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