Sharing our Learning and Experiences of our CDC Trial in Home Care

Multicultural Aged Care Services (MACS) has been operating in the community service since 2003. It is focused on the needs of elderly individuals from CALD (Culturally and Linguistically Diverse) backgrounds in the Greater Geelong area who need support to live at home.

Our personal carers are the soul of the community program and are totally committed to improving the quality of life of consumers and their families. They are a special team with a wealth of specialist experience.

Developing a Planned Approach to CDC

Karin was one of the first managers who applied to trial the concept of Consumer Directed Care (CDC) in 2011 and applied for 12 CDC packages. During the ACAR round, 2 homeless, 2 general, and 2 CALD packages were applied and granted for the low level CDC's, and 4 CALD and 2 general for the high level CDC's. It was important for MACS to demonstrate in their application how the CALD packages were going to be managed including addressing language barriers.

The CDC model introduced was to provide consumers with a "menu" of services which could be purchased. The approach provided the consumer with a choice in which they could make decisions, manage their expectations and budgets. The new framework included clear guidelines and processes for staff to schedule visits for consumers as per their agreements.

The budgeting system was developed to incorporate costs for services provided, administration, case management and contingency costs. All were negotiated except for the administration costs, however overall consumers were happy with the breakdown of their budgets, and agreed to a set case management and a contingency component.

Karin recognised very early in the trial that it was important to establish a budget framework so each individuals budget could be clearly outlined and shared with the consumer ensuring needs were met while ensuring a viable and workable business model.

Sample of a Budget

Income

Consumer received $200.00 from government

Costs

20% = $20 to admin.

10% case management $10.00

10% contingency was allocated for consumers receiving high care. This provides some level of cover for costs if you go over or in the event of an emergency.

Overhead costs may include, travel costs, equipment, continence, wound, district nursing, medical supplies, podiatry, speech therapy.

Process for Admitting Consumers to the CDC Program

Redesigning the admission process was the next important task for the trial. The following steps are the key aspects learnt as a result of the trial.

• New consumers wanting to join the program were visited approx. 2-3 times during the first week.
• During the 1st visit an overview of the services offered and the service agreement were explained and left with the consumer. It was important to communicate and establish commitment from consumers during this first visit, explaining the CDC principles.
• An information pack was provided to consumers and includes material on CDC packages such as: What does CDC mean, facts sheet, current level of subsidy, draft sample budget, cost of services as well as providing the cost of other services in the local area, for example the cost of District Nursing. Transparency is a key factor in managing expectations and negotiating the package of care with the consumer to meet their care needs.
• The next visit included the completion of the self-assessment which assists in identifying the consumers' needs and goals and their ability to manage their care. Develop budget - checking to see if the consumer is able to develop and manage their own budget at this point is important to determine if they can accurately cost out services and perform simple math formulas when a service is only required on a 6 weekly basis for example: podiatry. Or calculate 20% of their monthly subsidies for administration.
• The last visit is to finalise the budget and sign off agreement.

Once the admission process is well established, Karin found the time taken to admit new clients became shorter and more efficient.

Challenges during the Trial

• Educating consumers from CALD backgrounds to navigate the aged care system.
• The majority of CALD consumers have limited education because they were forced to leave school during and after World War II.
• The majority found it difficult to understand why services are charged at $40+ an hour.
• Families time poor and under stress, didn't want the extra burden of managing CDC's.
• Continually monitoring & meeting with consumers that had constant enquires on how their surplus could be spent.
• Assisting consumers to understand and manage their budgets.
• Goals sometimes unrealistic to justify spending any surplus on unnecessary purchases.

Outcome of the Trial

• Of the 12 consumers receiving CDC services, one client was able to successfully manage their own budget with the help of their daughter.
• Towards the end of the trial the majority of care planning, budgeting, and coordination was managed by Care Managers. Consumers no longer wanted to manage their own care and were happy to receive their monthly statements with the amount they could spend the following month. Consumers would then contact care managers for extra services if their budgets allowed.
• Initially the guidelines were loose and consumers would make unreasonable requests for purchase to use up the money.

Current Challenges

• Consumers who are part pensioner or self-funded retirees having to complete the 16 page income assessment, and then pay an additional fee for service, as well as the contribution fee.
• The time taken to complete the income assessment form; can become very complicated.
• Of the 10 new prospects in the past month, we have had 2 new admissions due to consumers having to contribute towards their care which is currently at 17.5% of the single pension. Other consumers didn't want to disclose their income. We are still competing with a much cheaper HACC service that has been very generous with their service provision sometimes exceeding the funding on a low care package.