Consumer Directed Care (CDC) is an approach to the planning and management of care which allows consumers and carers more power to influence the design and delivery of their services, and allows them to exercise a greater degree of choice in what services are delivered, when and where. Principles which underpin CDC include those of:

• greater choice and flexibility
• better access to the information needed to make informed care choices
• a partnership approach to care between provider and consumer
• wellness and reablement, and
• greater transparency.

In order to deliver CDC in aged care, providers are required to:

• have conversations about consumer needs and goals
• co-produce care plans
• provide greater transparency about funding packages
• allow consumers to determine their level of involvement in package management, and
• engage in ongoing monitoring and reassessment to ensure needs are being met.

Following the introduction of consumer-directed care into all community-based aged care services in mid-2015, the residential aged care sector in Australia has begun to progressively reorient itself towards the future introduction of the same model.

How can we reorient towards greater consumer choice and control in residential care?

Conceptualising CDC in residential settings however is underpinned by the same, empowering goals as seen in home care services: CDC aims for greater choice and control for consumers, driven by individual needs and goals. This empowerment inverts the formal decision-making chain and returns control and choice-making to residents, with the ultimate goal of increasing independence and a greater quality of life.

Other outcomes may include:

• A more ‘home-like’ environment when more residents are directly involved in decision-making in day to day activities
• Respecting consumer rights to exercise greater control irrespective of capacity to make those choices
• A recognition of the difference between consumer-directed services and consumer-directed care. (This means having the freedom to choose how and when services are implemented, rather than the type of services provided.)

Challenges remain

There is yet to be a universal approach or agreement on appropriate consumer-directed care models in Australian residential settings nor evidence of their efficacy.^[1] Residential settings have been cautious to embrace the change, concerned that there remain are a number of unanswered questions and assumptions.

While the sector needs to reorient towards great flexibility and consumer choice, anxieties remain about the operationalisation of the balance of duty of care with enhanced consumer choice and control. The challenges currently faced by Australian residential aged care providers who are early adopters include:

• Understanding consumer-directed care as process rather than model
• The practical applications of increasing resident choice and control
• Remaining sensitive to more vulnerable population cohorts while embedding consumer-directed care into mainstream aged care
• Ensuring the focus remains on enabling the right to exercise choice rather than enforced decision-making, and
• Responding to the various impacts on business culture imperatives including accountability and transparency.

It is essential to keep residents as the central focus of change, particularly as we move towards greater innovation and flexibility and use of technology. Lessons from international experiences of introducing consumer-directed care into aged care remind us:

• Current system capacities should be reviewed prior to investing in new systems
• Outcome measures need to be clearly articulated to monitoring and manage the benefits/risks
• Focus on continuous quality and improvement needs to remain during times of change.

The importance of consumer feedback in driving transformation: Arcare responds

This shift towards an increasingly market-driven and consumer-centric model of aged care requires providers to embark on organisational change. Part of this is an increased attention to consumer engagement. In a residential aged care setting, the consumer is often both the resident and their family members.

The principles of CDC align with the values and frameworks which underpin Arcare’s service delivery in its residential aged care communities and which reflect what residents, clients, families and employees care about most. Arcare’s residential aged care is driven by a values system that was developed by the Arcare community to reflect an approach to supporting the most vulnerable citizens, and the interdependence of community members and the emotional, physical and financial investment associated with joining a new community.

Arcare operationalises these values through its Dedicated Staff Assignment model which has transformed the way that care and support are provided by offering residents wraparound care from the same core team of care professionals. The power and value of these consistent and committed relationships between residents, employees and family transforms the physical and emotional wellbeing of residents. In addition, care staff are encouraged to continually reflect on how their own day-to-day practice contributes to a strengths-based approach to supporting ageing in a residential setting.

In 2016, Arcare developed ways to systematically embed processes to collect information from both residents and staff to assess the quality of their care and quality of life. An interview tool was developed to assess consumer experience of quality residential care and services with a set of structured survey questions. Data from family members was also collected to complete the 360 degree engagement of stakeholders.

Larter supported Arcare in its implementation research and delivery of the consumer and staff engagement tools. Larter brings expert knowledge, technical skills and experience to support health organisations to designing and evaluating health programs and services. We work with clients see pathways towards a solution. With them, we see opportunities – often when no-one else can. The relationships we hold with client representatives and organisations are partnerships in the true sense: sharing knowledge, experience and vision.

Contact us to discuss your transformational needs.

[1] ‘Applicability of Consumer Directed Care Principles in Residential Aged Care to the Department of Social Services’, KPMG 2014 [https://agedcare.health.gov.au/ageing-and-aged-care-aged-care-reform-home-care-packages-reform/applicability-of-consumer-directed-care-principles-in-residential-aged-care-homes-final-report]

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