Evaluation of the consumer - directed care initiative - Final Report
10.2 Impact of CDC in participants and their carers
Table of contents
- Executive summary
- Glossary
1 Introduction
2 The consumer-directed care initiative- 3 Evaluation of the consumer-directed care initiative
- 4 Profile of participants and the supports they accessed
- 5 Implementation and operation of the initiative
- 6 Impact of the initiative for CDC participants and their carers
- 7 Impact of the initiative for CDRC participants and the people they care for
- 8 Impact on providers and the broader service system
- 9 Cost assessment and cost-effectiveness of the initiative
- 10 Key findings
- 10.1 Implementation and operation
- 10.2 Impact of CDC in participants and their carers
- 10.3 Impact of CDRC on participants and the people they cared for
- 10.4 Considerations for special needs groups
- 10.5 Impact of CDC/CDRC on provider 'culture' and the broader service system
- 10.6 Cost-assessment and cost-effectiveness
- 11 Lessons learnt and strategies for consideration
- Appendices
- References
Extent to which CDC was person-centred and increased choice and control
Key finding: CDCH and CDCHD participants and their carers were more interested and actively involved in planning and decision-making than CDCL participants.
CDCL participants were less interested in the planning aspects of CDC than CDCH and CDCHD participants (and their carers), particularly if they had transferred from a CACP and were satisfied with their current support arrangements. The majority of new CDCL participants were focussed on the supports that they could access – similar to new standard package recipients. This was due, in part, to the relatively limited CDCL package budget and the low level of supports available under a CDCL package.
CDCH and CDCHD participants, and specifically their carers, appeared to be more actively involved in planning and decision-making. Some participants and carers (usually younger carers) with prior experience of community care had clear ideas about what they wanted in terms of supports, and what they wanted to be ‘different’ with their CDC package – largely driven by dissatisfaction with their previous package.
Key finding: Participants chose the similar types of supports as those available under standard packaged care, and exercised choice and control over how the services were delivered (mostly around flexible service delivery and continuity of support workers).
Participants exercised choice and control over how the services were delivered, including choice of support worker, and being flexible in delivery days/times and tasks undertaken by support workers.
Participants generally used their package for ‘core services’, though in many cases also used some of their package funds for innovative and non-traditional supports. Provider attitudes to requests for services or other supports that were different from the ‘usual menu’ of services varied, however. Differences were driven by the variable understanding of and commitment to the initiative, and in some cases the variable commitment to a consumer-directed care approach.
Extent to which CDC enhanced community-based care
Key finding: Even after a short period of operation, CDC appeared to have a positive impact on participants’ level of satisfaction with various aspects of their life, particularly for CDCH participants.
Participants reported increased satisfaction with their ability to participate in social and community activities, their ability to visit family and friends, the quality of their home life and close relationships, and their health and wellbeing.
Satisfaction was generally higher for CDCH participants than for CDCL, indicating that there is potentially more benefit for people with higher levels of need (and receiving more sizeable packages). Key enablers to these higher levels of satisfaction were the degree of flexibility and control participants hade over their support arrangements.
Satisfaction was also generally higher for CDC participants who had prior experience of packaged care compared with those participants with no prior experience of packaged care, indicating that CDC represents an improvement over standard packaged care for many participants.
On the single measure of wellbeing, however, there was no statistically significant difference between the CDC participant group and the standard packaged care comparison group.
Key finding: For CDC, there can be a conflict between the level of consumer choice to expend their funds as they wish, and a provider’s responsibility and duty of care to ensure they receive supports they need.
Several CDC providers had concerns about balancing the consumer choice element of CDC with the provider’s duty of care. Several providers gave examples of requests by participants or carers for use of CDC funds that they had refused because they considered that the request would compromise the participant’s care (for example, reducing the amount of personal care or clinical care a participant could use). Other providers were also concerned by participants choosing to build up a sizeable contingency fund by foregoing some regular supports. While providers discussed and negotiated alternatives with participants, it highlighted one of the key tensions in the CDC model.
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