New model as self-managed care plummets

The number of home care service outlets offering self-managed care has dropped by 40 per cent since last year.

A new self-management model is available to home care providers following a dramatic fall in the percentage of service outlets offering self-management for clients.

The model, developed the older person’s advocacy organisation COTA, is based on several principles including information and support, capacity building and the use of a debit card to spend allocated funds.

Anna Millicer, project manager for the two-year Increasing Self Management in Home Care research project which wrapped up last month, outlined some of the insights in a presentation titled Self-management: Friend or Foe? at the ACSA summit in Melbourne on Tuesday.

Anna Millicer

The model was developed in response to poor uptake of self-management by Australia’s 900 home care providers, Ms Millicer said.

“We knew that the implementation of self-management in the home care packages space was telling us that there was not a lot of uptake and the widespread implementation of self management, despite a lot of rhetoric in the sector, was that it’s far from the norm,” she said.

“Our task was to co-design, investigate, trial and evaluate a high-level self-management model acknowledging the needs of the consumer and the provider.”

Forty per cent drop in self-management

Government figures show a 40 per cent drop in organisations providing self management since last year.

In 2017 46 per cent of service outlets provided self-management. This increased to 52 per cent in June 2018 but plummeted to just 12 per cent in 2019.

“This is an exponential change, and to COTA this is a distressing statistic,” Ms Millicer told the conference.

Trialling a new model

The research involved about 100 care recipients, 70 per cent of whom were represented by family carers, and seven providers who implemented the model as well as collaborators around finance and staff management.

A statistically significant number of home care recipients in the trial reported improvements in health and wellbeing, as well as increased knowledge about package finances, approved spending and hiring support workers.

“These are astonishing results,” Ms Millicer said. “At the end of this project trial it really paid off.”

 Sixty-two per cent of clients in the trial used a home care debit card and the remainder used their own card. This enabled them to tap and go for services and goods, and present receipts to their provider.

In most cases spending was responsibly and correctly managed, although one client had to repay money spent on services they were not eligible for.

Challenges and benefits for providers

Ms Millicer told the conference early stages of the research project showed providers had reservations, including fears around loss of revenue. Some initial “teething problems” also became apparent during the establishment phase.

Among them were an initial administrative burden, problems aligning debit cards and “mixed financial outcomes”.

Providers also had to juggle requirements around quality standards, as they remained responsible for services even if they were managed by the client.

One provider was the subject of a complaint to the Quality and Safety Commission and four consumers switched providers because they weren’t happy with services being received.

However, there were also benefits for providers who approached self-management as a partnership and saw their role as supporting and advocating for self-managed care, Ms Millicer said.

Self-management was also a way of ensuring a more engaged clientele and helped providers meet quality standards, she said.

Self-management isn’t for everyone and one size doesn’t fit all, Ms Millicer says. But the  research showed the benefits were the same regardless of the extent of self-management.

Providers need to embrace self-management it if they want to survive in the future, especially as the enabled and tech-savvy cohort of baby boomers move into the aged care sector, Ms Millicer says.

“The providers stand to gain a heap from having an engaged consumer cohort,” she told Community Care Review after her presentation.

“If we as sector don’t really embrace self-management, or at least autonomous shared management, it’s going to be a problem for the future, because it’s going to happen eventually. So start now.”

A full report on the research project is currently with the government and will soon become available on COTA’s website.

In the meantime COTA has developed a suite of self-management guides and tool kits which can be downloaded from its website.

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