What is Required to Implement CDC to Achieve Positive Outcomes? Sharing Client Case Studies - McLean Care

Introduction

McLean Care Ltd (McLean Care) was established as a community - owned, not for profit, registered charity in 1953 and is now one of the largest accredited providers of Aged Care services covering 100,000 square kilometres throughout the New England and North West regions of New South Wales. McLean Care services over 700 clients and employs in excess of 350 staff.

The move towards the Consumer Directed Care (CDC) model is a significant change for all providers, and has required McLean Care to expand our vision for new business opportunities, as well as recognition that our case coordinators (now to be known as “Lifestyle Facilitators”) would need enhanced skills to have those potentially challenging conversations with consumers about how the changes may affect their services.

"What was really needed was a shift in staff mind-set"

Part of our preparedness for CDC transition was attendance of two McLean Care managers at the workshop run by Home Care Today, titled “It’s Time to Act: Shaping Your Culture and Practices to be CDC Ready”. This workshop really highlighted the need for education for our staff, especially our Lifestyle Facilitators (LF’s), to enable understanding of the “what and the why” and to fully engage them to be able to lead and involve consumers, as well as care staff, in the “how”.

Following their return from this workshop, the managers identified that what was really needed was a shift in staff mind-set from a care - focus to one that really involved enquiring minds, a team approach; the head and the heart. Again, Home Care Today, were the “GO TO” reference with a series of five FREE facilitated modules titled “Constructive Conversations with Consumers”, that includes a facilitator’s guide, participant workbooks, all activities, video clips and evaluation criteria - a total of 10.5 hours of face to face education.

How did we prepare our workforce for the CDC transition?

Before any of the existing Home Care Package (HCP) clients could be transitioned to the CDC model, it was deemed essential that our LF’s receive these 5 education modules. The modules were delivered over 5, mostly consecutive, weeks in our Northern and Southern New England service areas, in small group settings of between 6 - 10 LF’s. The sessions were a great way of learning from each other’s experiences…the good, the bad and the ugly. There were some very robust discussions and some suggestions which really got people thinking outside their comfort zone.

Prior to the delivery of the first module, the groups were asked to identify the skills and knowledge that they hoped to gain from their attendance. These included, to name a few;

• 

  "The sessions were a great way of learning from each other's experiences"
  Confidence in selling
• Negotiation skills
• Budgeting skills
• Care planning with client focused goals and outcomes
• How to deal with the constant changes that the transition to CDC represented
• Persistence
• Conflict resolution
• Effective listening

What methods were used?

As the session facilitator, I spent time prior to each new session becoming familiar with how the session was to run, with the activities, the videos and how to lead each discussion. Every effort was made to program each session so that it ran to the prescribed schedule. The 5 modules covered the following topics:-

1.     Setting the Scene - explained the philosophy of CDC and described the service delivery as one of choice and control for the consumer and their carers. There were group activities that asked participants to compare traditional service models to the CDC model, as well as discuss the meaning of person centred care and investigated what older people say they want. Included in this module was also a video that demonstrated a humorous account of how NOT to give good customer service.

2.     How to Work Within a Consumer Directed Care Model - This module became very personal for our participants as it included an activity called “Know Yourself” to engage them in self-reflection and explore their own values and also what values underpin the person centred approach. The activity really encouraged our people to explore the challenges they could face when asking consumers what they value most. Choosing only two personal values really stretched them to understand how they work within their own values system and to describe what those values would look like in action. This activity was intense and produced a few tears, from some of the participants, as well as some anxious moments for me as the session facilitator.

This module also investigated some barriers, or brick walls, that LF’s might face, as well as the importance of not applying “labels” or “badges” to people that might hide the real person underneath. Short videos in this module showed firstly a great representation of how discrimination can be applied to older people, where the images were set to a particularly poignant song which resonated with everyone present. A second video demonstrated a fear of discrimination in aged care from the perspective of the LGBTI community.

3.     Supporting Consumers to Live a Good Life - looked at what is really important to consumers in terms of choice, independence and the wellness philosophy, with a short video investigating the language of wellness. The inclusion of a poem read out by the session facilitator was a powerful and thought provoking moment of self reflection. The “My Story” booklet was introduced and each participant was asked to complete sections on what is important to them and for them, as well as what good days and bad days looked like for them. The relationship circle was a useful tool in identifying the interconnecting circles of resources and support they each had.

4.     Consumers Continuing Control of Their lives - this was one of the longest sessions at 3 hours and introduced the “scales of control” whilst looking at the triggers which may cause a change in service delivery. This module also asked participants to reflect and share on a time in their own lives when they did not have control because someone took over or made decisions on their behalf, without consultation. This module also investigated ways of supporting consumers to set and to achieve their short and long-term goals, building on their current skills and interests. This was supported by a goal setting video and role play. This module was also used to introduce the topic of the budgets using a series of video scenarios, with particular emphasis on how to explain budgets to consumers. The group were asked to provide feedback on the scenarios, which again sparked a lot of robust discussion.

5.     Our Approach Counts - This was the final module and addressed the issues of supporting the consumer to make decisions Vs the dignity of risk. The challenges of balancing risk and duty of care were discussed, with the notion that life and risk are inseparable being put forward for discussion. Participants were asked what role they saw themselves having in monitoring consumers against their identified goals and outcomes. Finally participants were asked to share with each other the most important thing they had learned from completing the five modules. Some of our peoples answers were:-

• Communication strategies & listening to consumers were identified as an important element
  Creativity
• Asking more in-depth question about consumers’ lives and hobbies
• Better listening skills
• Different communication strategies
• Empathy and trust
• Identifying their own strengths and weaknesses
• Learning to be more honest with myself

What were the learnings for the training participants?

At the completion of the five modules, I asked each of the groups to revisit their lists of expected outcomes that they had established prior to the training. The intent was to see what outcomes had been met, and more importantly, if they had developed the skills and confidence to have “those” conversations with clients.

Most participants were generous in their praise of the resources that formed part of the education, with some of the comments shared below:-

“The values card game was a great idea where we picked out cards”.

“The short clips you showed were also great, making us think of how we can incorporate pets, and also the people that clients may wish to have service them “.

“The My Story booklet will be a good tool for coordinators and clients”.

And learnings for me, the facilitator?

1.     To expect the unexpected

I did not expect to have the intense reaction to Module 2 when one of the group identified their values and at least half of the participants became very emotional, to the point of tears. I also did not expect some of the more intangible results such as the example above, for example learning to be more honest with myself

2.     As the facilitator, make certain to be prepared

Thankfully I had taken the time to read all of the facilitator guides and to time each session, to review the activities and the video clips and to really time each session so that it ran to time. I felt confident in my presentation only because I was familiar with the content

3.     It wasn’t the be-all and end-all of education on CDC

We still needed to develop a budgeting tool that worked for us as an organisation

“The budgeting probably was most confusing, but now having a budget tool to work with it is clearer to understand... and not as intimidating!!”.

4.     The sense of achievement in bringing the modules to life and sharing the learnings with the LF’s
5.     Utilising available technology

“iPads have become a useful tool in many ways. We are now using them in the CDC client transitions and their use has made the whole process more productive as the answers are right there”.

Training Evaluation and Feedback

Comments received as part of the evaluation process included the following:-

“Exciting and innovative workshop delivery - thoroughly enjoyed the day.”

“I love it; bring it on”.

“Very, very enjoyable, challenging, confronting and thought-provoking”.

“I am feeling more confident to be able to bring these choices and changes to clients”.

“I can’t wait to help clients get motivated and identify the goals to enhance their lives”.

“The sessions confirmed that I need to be more prepared before going into homes”.

“The sessions instilled confidence, provided tools and new ideas. The training bought self-awareness to the forefront of my mind”.

“Your education gave me clarity and encouraged me to open up a new world for clients to regain their level of choice and goal identification”.

What were the outcomes?

Technology is providing more opportunity for consumers

1.      Using technology - Utilising iPad's for client lifestyle services with the goal for clients being to learn to use the iPad to Skype family members and to use different apps for brain training, learn to read etc.”.

2.     Conversion of our HCP’s to the CDC model commenced in 2015. As at 10th June and with 3 weeks to go, almost all have been successfully negotiated and converted. Community Managers accompanied the LF’s to many of the clients in order to facilitate the conversions and to support the LF’s in what was essentially a new role for them.

3.     Development of management tools -We have developed our own budget tool and staff received additional education from our finance team on how to use it. The Community Managers and LF’s work through each budget prior to every client transition meeting. This enables a very clear picture of where funds are currently being spent and allows options to be identified.

CDC in Action - Real Outcomes

The following case studies demonstrate the positive outcomes achieved for clients transitioning to CDC.

Case Study 1

A young Level 4 CDC client, who in June 2014 suffered a CVA. Under CDC he identified his goals to be:-

a)      To learn to speak more clearly and,

b)      To learn to interact with his 12 year old son again, as the relationship became strained after his CVA and his son has been living with his uncle for the past year.

Outcomes:

• The client is now in speech therapy and under his package was able to purchase a $75 speech app on his iPad (suggested by speech therapist so client can continue to learn between appointments).
• Since April he can now clearly be understood with basic words... Yes, no, what, repeat, please, thanks...
• The LF learned that the client and his son used to go motorbike riding. They have now been linked into Ability Links and are gearing up to both go on a day ride with volunteers!
• The client now goes to watch his son play basketball on a weekly basis.

For this particular client these achievements would not have been possible as all family members were way too busy to initiate or plan these adventures. Both client and son are now laughing together and other family members were reported to be in tears with happiness as they thought the relationship was irreversible.

Case Study 2

A client was living in squalor and wanted desperately to change her lifestyle. Friends had become distant because of her personal odour and judgemental of the way she lived.

From this:-

Using a multi-agency approach:-

Outcomes:

• Using a CDC model meant we were able to save toward getting her life on track;
• Over a period of 3 weeks, McLean Care worked with other service agencies, such as the areas’ Family Support, to coordinate the cleanup of the client’s home
• With the full participation and involvement of the client’s choice of the client, her home was totally cleaned up.
• This client is now so happy, is now regaining her independence and she has higher self esteem.
• Her family are now happy to visit again and she is gaining a new friendship network.

To this:-

Case Study 3

Manager & LF met with a 94 yr old man and his neighbour. The client was from a wealthy German family and became a Journalist prior to WWII. At the age of 21 he was made to go to war as a German pilot. Towards the end of the war he spent 4 years as a POW. He then came to Australia as a refugee in 1949 and met his wife, who was Jewish and has since passed away. They were never able to have children due to the treatment of his wife as a Jewish POW. The client had never returned back to his home land and had never had contact with his own family. Up until eight months ago he had never told another person in Australia that he was a German soldier. One day his neighbour asked him about his life before and after the war, and the client finally told him his story. The client and his neighbour have tried writing to his wife’s sister but had no reply, and as she would be 90 years old now it was thought possible she had passed away, but they knew she did have children. The package would enable us to work with the client to try to find his family back in Germany.

Outcomes:

• We rostered I hour per week where a staff member who is familiar with ancestry research will take a computer and start the search with the client. We can obtain important information from our client such as, the town he was born, where he lived before he went to war, the birth dates of his mother and father.
• All his life in Australia, the client has kept to himself never getting close or sharing his story with anyone. Now he is alone he has started to talk about his history.
• The LF has another current client who was also born in the same home town as this client and once trust has been gained, there may be a possibility of arranging for both clients to meet.

As the staff left the client’s home, the manager noticed the smile on his face and wondered how long it had been since anyone had shown any personal interest in his life.

“What an experience and this is why we do what we do”.

Angela Pankhurst

Education & Continuous Quality Improvement Manager