Urban-centric home care program falls short in rural areas
Delivering services in rural area presents significant challenges for home care providers and doesn’t always meet the needs of clients.
The home care program is helping older people in rural areas live in their communities, but the system is creating challenges for rural service providers which mean their clients’ needs aren’t always met, a study has found.
The study by researchers from the University of Tasmania, published in the Journal of Hospital Administration, looked at the capacity of home care packages to deliver for older Tasmanians in rural areas based on surveys of home care staff and recipients.
The team conducted in-depth interviews with seven older people who were either receiving or waiting for a home care package and three providers across the local government areas of Central Highlands and Derwent Valley.
The study found that “factors of rurality”, including workforce issues, distance, and lack of services and choice are hampering the ability of home care packages to deliver their full benefits.
“We found that (the program) is helping to keep people at home and keep them independent and it’s doing a lot of the right things,” lead researcher Dr Pauline Marsh told Community Care Review.
“But there were some system constraints, alongside the rural context, that meant it was limiting the capacity of the package to really help people stay at home and live a rich and meaningful life.”
Lack of staff and infrastructure
The study found a lack of suitably trained local staff and regional service infrastructure, as well as a reluctance of services to travel out of major cities, was affecting the capacity to match consumer goals with outcomes.
“Staff shortages is one of the big issues, particularly staff who are trained to work in the home environment,” Dr Marsh said.
“The other is finding service providers or contractors that will go out and deliver the services to people. The added costs of transport, and the time it takes to drive out to people, is not provided for by the system at the moment.”
As a result, mismatches between need and available services were common.
“People felt that they were sometimes paying for services that they didn’t really need because the ones they wanted or thought would help them were either too expensive or there weren’t any contractors that were coming to the rural area,” Dr Marsh said.
Urban bias
Dr Marsh said the research made it apparent that the home care system was designed within an urban context and lacked the flexibility to accommodate individual needs, something that could be fixed by having more consumer input in system design.
“This result speaks to a need for future research that critically examines the design of the home care package program for bias toward urban populations, in order to provide guidance for funding and delivery changes that more adequately account for local and rural circumstances,” she writes.
The study notes the home care program faces new challenges arising from the Covid19 pandemic and says it’s unclear what future challenges might result from this for rural older people and the rural workforce.
Current service models may also face a shake-up arising from the recommendations of the aged care royal commission.
“We can be sure, however, that demand for home-based services will continue to increase, and add new pressures on the rural workforce,” Dr Marsh reports.
“Systemic changes are required and now is our chance to make meaningful improvements.”
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My Level 3 Package is supposed to be being managed by a large, not for profit organization.
They have no idea how to resource local contractors. I simply put a post up on my local community website and find them myself.
I find I do most of the work myself. I will be shifting to self-management once I recover the money owed to me as I have had to pay to have bad workmanship jobs re-done. The company’s idea of Quality Assurance is that a person has a licence.
Mad as hell and they won’t get away with it.
Emile, I hear you. One of the issues is the alledgedly “not for profit” providers are charging huge percentages of our package then gives jobs to people they make further profit from.
Self management is the only way to go in rural remote communities. Some people who have continence issues are only being showered 3 time a week in 45 degree heat. The providers won’t send staff unless they have enough work in the area on a given day.
Finding your own staff locally through self management is the only way to get true consumer directed care.