Better health and ageing for all Australians

Evaluation of the consumer - directed care initiative - Final Report

10.1 Implementation and operation

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Program implementation

Key finding: The initiative was implemented in a relatively short period of time, and providers would have appreciated more time to roll-out their CDC and CDRC packages, and more proactive guidance and support from the Department.

The initiative was implemented over a relatively short period of time, and the length of time between providers being informed that they had secured CDC or CDRC packages and rolling-out packages to participants was very short. As a result providers had little time to develop their approach to CDC and CDRC and to select participants.

Many providers indicated that they would have preferred more proactive support from the Department during the implementation, in addition to the helpdesk and frequently asked questions that the Department published. Providers suggested that some initial training or face-to-face briefings by the Department would have been useful, as well as more regular information exchange and discussion with other providers and the Department. In addition, providers would have preferred earlier provision of operating manuals.

Some providers appreciated the flexibility of the operating guidelines during the pilot period, but also would have liked clarification about a number of specific program issues.

Key finding: There were variations and inconsistencies in the way CDC in particular was implemented across different providers, and variations in the degree to which CDC was different from standard packaged care.

Variations were particularly evident in planning processes, in providers’ degree of flexibility around the range and choice of services offered to participants, and in providers’ openness to innovative or non-traditional services.

The degree to which providers were already flexible and person-centred in their approach influenced the degree of change that was needed for them to implement CDC. Those that were less flexible or person-centred, and/or that had less experience of consumer direction and person-centred approaches, appeared to face greater challenges in operationalising a form of CDC which was different from standard packaged care.

Participant selection and planning

Key finding: There was a higher level of interest in CDCH and CDCHD packages compared with CDCL.

Providers used a mix of approaches to selecting CDC participants, with some targeting existing packaged care clients and others new clients. Generally, there was more interest in (and demand for) higher care level packages.

In selecting participants, providers commonly targeted those with a carer or a family member actively involved in the older person’s life (for CDCH and CDCHD). For low care participants, providers looked to people who they thought had sufficient capacity and who might have an interest in self-managing their package.

Key finding: There was a considerable level of interest in CDRC, with very few carers approached declining to participate.

CDRC providers tended to target potential participants who were already known to them, and who were considered a ‘priority’ (such as carers under stress or who had little or no access to formal supports), and who had the ‘capacity’ to participate in CDRC. A number of providers targeted younger carers who they considered were more appropriate for CDRC than older carers.

Several providers experienced considerable demand for CDRC packages from self-referring clients once the program became known.

Key finding: CDC and CDRC assessment and planning processes were either goal-based or menu-based.

Goal-based planning focussed on identifying the goals, desires and objectives of the participant and carer, and then looking to identify possible care and support options. Menu-based planning focussed on the ACAT needs assessment and provision of a list of available supports, providers and price list to the participant or carer.

Goal-based planning tended to be used with CDRC participants, for CDCH and CDCHD participants, and by providers who were more ‘person-centred’ in their approach to CDC and CDRC.

Delivery and coordination

Key finding: There were different models for delivery and coordination of CDC and CDRC. Those models that involved a progressive increase in consumer control appear to be the best suited for enabling a consumer-directed approach.


There were different models for delivery and coordination of CDC and CDRC. The predominant model used offered participants ‘enhanced choices’, with providers being responsible for coordinating and managing packages. Other models based on a progressive increase in consumer control and self-management, with structured variations in the level of support coordination and management undertaken by providers, appeared to be the most transparent and flexible approaches.

Key finding: Few participants fully self-managed their package to the extent that they were able to under the initiative.

Most participants were able to manage their package to some degree, at least to the level of making simple, day-to-day bookings and scheduling changes, maintaining timesheets, and managing problems such as support workers being late. However, few participants took on a substantial self-management role – either because they were not given that option by their provider, had no interest in self-managing their package and their support arrangements, or did not feel that they were able to.
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