A reluctance among older consumers to change their care arrangements or ask for additional services, coupled with poor advocacy from providers, has hampered the impact of consumer directed care, a government evaluation shows.

The research, which was commissioned by the Department of Health and completed by consultancy firm TNS, found a “misalignment” between the notion of greater choice and the priorities of this group of older people.

“For the majority of the consumers in the study, there were question marks around the personal relevance of the reform, and a general disinclination to consider applying for additional services,” according to the evaluation which was based on in-depth interviews with 47 consumers.

CDC has been the mandated service approach across all home care packages since July 2015, having been first piloted in 2010. The model gives consumers greater choice and control over how and when home care services are delivered.

The evaluation found that carers of older people on higher-level packages were most engaged with CDC and they encouraged older people to consider their options.

The 15 carers interviewed for the study were typically younger, had higher service expectations and were used to being in control of their purchasing decisions, according to the report that was completed in September but released by the department last week.

Limited contact with case managers for those on lower level packages was also identified as a key barrier to consumers understanding their entitlements under a CDC model.

The research found encouragement and support of the provider was critical in driving engagement with CDC and some providers may have “insufficiently championed” the changes to their clients.

The most noticeable impact of CDC identified by consumers was increased flexibility in choosing services, which was reported by around one quarter of consumers.

While consumer experiences of the new model were largely positive, it was not always reflective of “the full CDC offering,” the report said.

Varied implementation

Private and larger providers were most advanced in embedding a CDC model and delivering a broader suite of services, while smaller providers had found the process more challenging, the research found.

A small number of ‘resistant’ providers, generally smaller not-for-profit organisations and remote organisations, were offering a limited menu of service options and had not introduced brokerage arrangements to increase the options available to clients.

However, the study found that provider commitment to a CDC approach strengthens over time and with experience.

CDC challenges

Coordinating a more flexible service, meeting consumer preferences and managing resistance from home care workers to the broadening of their roles were identified as some of the key challenges arising from CDC.

“For most providers, a more ongoing challenge was seen to arise in the need to upskill or multi-skill staff in order to ensure they were able to meet the new demands of flexibility,” said the report.

The impact of travel and language translation costs on home care budgets was also raised by some providers.

The TNS report follows an evaluation undertaken by KPMG on the home care packages program and CDC, which was released in 2015 and included a range of recommendations to improve the program.

Read the report in full here.

RELATED COVERAGE: Provider readiness for landmark home care change in focus as report finds some lag behind

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