C-D-C does not spell quality in aged care

Consumer directed care is not a silver bullet for aged care improvement and is at risk of being hampered by a poor understanding that if not addressed could result in premature entry into residential care, according to HammondCare's CE Dr Stephen Judd.

Dr Judd said there was anecdotal evidence that Consumer Directed Care (CDC) was being "wrapped around the axle of budgets" for both providers and consumers, through a fixation on budget that can lead to clients saving up monetary entitlements at the expense of their care.Dr Judd told the Quality in Aged Conference in Sydney today that “C-D-C does not spell quality” and while it is a vital component of improving quality, if done poorly it could lead to reduced standards of care.

"If providers and clients become fixated on the budget they risk losing sight of what really matters – the quality side of the equation – and getting bogged down in the financials.

“We’re already starting to see Home Care Package clients with significant assessed needs who choose to build up their budgets at the expense of their unmet care needs.

“Now I’ve got nothing against being thrifty and putting things aside for a rainy day, but if you are on Level 4 care at home, it already is a rainy day!

"...if this kind of practice continues, I predict that we will see the average length of stay on a Level 4 at-home package drop and the number of people who suddenly find themselves looking to enter residential care....

“Surely we don’t want to see more people being pushed into residential care prematurely. That’s not a quality outcome for anybody, is it?

“We all – providers and clients alike – need to remember that control over budgets exists to empower clients and increase their choices, not to funnel people down the path of perverse unintended consequences.

“That’s particularly important when you consider that the majority of clients – at least so far – don’t even want full control over their budget.”

Finding what makes people tick, not ticking boxes

Dr Judd said that despite these concerns, he welcomed CDC because it was a powerful way of helping aged care quality to move away from ticking boxes, to finding out what makes people tick.

Quality of care in the CDC context would require a focus on getting to know the person, building relationships of trust and transparency, not overwhelming people with choices they did not understand, and implementing a case management approach.

“I know that with the transition to CDC there has been some bad press about ‘case management’, particularly with the proportion of fees that were charged for ‘case management’ in some cases,” Dr Judd said. “But case management, done well, is actually a good thing for the consumer. It’s a good thing for satisfaction. It’s a good thing for quality services.

“A dedicated case manager works with clients to ensure their needs are assessed properly, to understand and develop their goals and to monitor and assess the effectiveness of care.

“Clients can decide the extent to which they exercise control over their own package – and can use information and expertise provided by the case manager to help make that decision.”

Defining people as cases or consumers

Dr Judd said that while he strongly supported a case management approach across aged care and including with CDC he was not a big fan of the name.

“It needs a new name though because I don’t think I’m alone in my preference to be thought of as a person and a citizen as opposed to a ‘case’.”

And nor was he happy with the very widespread use of the term “consumer” in aged care, which he feels may exacerbate the dominance of a financial approach to care.

While acknowledging the term was a way of highlighting the choice and autonomy of a person who is a partner in their care provision, there was a danger important non-economic values could be lost.

“Taken to its logical conclusion, ‘consumers’ have no worth or value to peddlers of goods and services beyond their capacity to consume. People – and citizens – become little more than economic units. Is that how we want to describe relationships in aged care? I certainly don’t.”

Quality is subjective

Finally, Dr Judd argued that aged care providers in the CDC environment need to be strongly attuned to the thoughts, opinions and feedback of their clients and this required robust systems to ensure they know how their clients feel.

“If we really accept that quality is subjective and, indeed, changes over time, we need to continuously drill down to determine what a quality outcome looks like for each client, monitor to ensure that those requirements are being met – and make changes if they’re not.

“At the end of the day, the ultimate arbiter of quality is the client. And if they’re not happy, then it’s pretty hard to turn around and say that you’re providing a quality service.”