Consumer Directed Care versus Provider Directed Care

It is now nearly 12 months into the new age of Consumer Directed Care (CDC).

For many of those in remote areas it is still a challenge to meet the requirements of CDC in a meaningful way for their target client group.

As we have travelled around the past year, we have asked a number of organisations if they are now operating under CDC arrangements. Many have initially stated they are now doing so, but closer inspection reveals there is still a long way to go. Yes, some services are developing individual budgets for consumers, however that is the problem; they are created for the person – not developed with them.

In a remote setting, there is also a reluctance to develop and provide monthly consumer budgets, mainly due to the potential for misunderstanding over what the funds can be used for, let alone discussing budget surpluses. It is still very much a Provider Directed Care arrangement.

Key problems many remote services have identified are:

• How do they discuss CDC with the individual when consumers and their families generally have low literacy and a lack of informed understanding of what CDC is?
• Not just low written literacy, but low financial literacy?
• Compound that with the sometimes limited care and service options for individuals beyond what is already in the community they are living in – you can see where the frustration lies.

So what can be done to move forward?

The Budget

This is the most frustrating aspect of CDC for many remote services, however some organisations are starting to see a way forward. A number of services have commenced using cloud-based Client Management systems. These have assisted in improving the communication between management located in regional offices and coordinators out on the ground, many of them hundreds of kilometres away. While CDC is not dependent on using one of these systems, it supports electronic recording of statistical data that can be used to generate a monthly statement. This statement, while not great for explaining the financial situation to a consumer on a remote indigenous community, is a good start.

One common idea is emerging – the use of pictures and graphs to illustrate to a person how many services they have received and the balance of service hours available. This format is easier for clients to understand, whether a bar or a pie chart is the best option is still being trialled.

Consumer Options

Let’s address the other key part of CDC: what does the customer want?

The confusion is starting to clear around this, although in areas where there are few resources and those that are available are stretched thinly across a number of clients, it is still a struggle to offer any real change or options. There just aren’t many providers on the ground in a small community of 500 people living 350km from the nearest town (and that is a relatively accessible remote community).

Increased choice and options is still a work in progress. Service coordinators want to be able to offer additional activities to their customers, as they understand these are what enhance ‘quality of life’, however, the demands of providing direct care support along with staffing difficulties mean that the majority of time is taken up with dealing with the important and urgent tasks, such as meal delivery, laundry support and personal care.

Additionally, the higher cost of service operation in remote areas results in higher unit costs, leaving less funds for the client to access services outside their immediate needs.

Will it change? We believe it will.

The introduction of the National Disability Insurance Scheme in the Barkly area of the Northern Territory has attracted new service providers to the region. There are more activities and allied health support people visiting those communities, providing services to younger people with a disability. These are an untapped resource that aged care services could potentially partner with if a person had an expressed need for this type of support.

The other disrupter on the horizon is the “package follows the consumer” change that will be introduced in February 2017. Yes, there is the potential for services to lose packages as people on packages pass away or move out of the area, however there is a silver lining to the change. People from Aboriginal and Torres Strait Islander communities are considered a special needs group. This may lead to a higher priority on the wait list. Additionally, many current clients are only on a level 2 package when some have been assessed at a level 3 or 4. These people can be placed on the wait list for a level 4 package when February 2017 rolls around.

These changes have the potential to ease the client-focussed demand and financial pressures facing services that are trying to provide Consumer Directed Care in remote settings.