Evaluation of the consumer - directed care initiative - Final Report

2.3 Description of the CDC initiative

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In July 2010, the Australian Government commenced the CDC initiative, comprising consumer-directed care (CDC) and consumer-directed respite care (CDRC).

The CDC initiative responds to trends towards self-direction in community care and other service settings in Australia and internationally, and anticipates demand for more choice and control by the ‘baby boomer’ generation.

Aims of the initiative

The aim of the CDC initiative is to provide community aged care consumers (care recipients and carers) with greater control of their lives by allowing them, to the extent that they are capable and wish to do so and relative to their assessed care need level, to make informed choices about the types of care services they access, and the delivery of those services, including who will deliver the services and when they are delivered.

Principles

The CDC initiative is governed by eight principles:

1. Integrated: CDC should be integrated into existing programs as an optional mode of care delivery and operate within the constraints of the current legislative arrangements.
2. Responsive: CDC should be responsive to changing needs and circumstances of care recipients and carers, and enable adjustment of budgets and services to meet those needs.
3. Inclusive: CDC should take into account the needs of care recipients and their carers and consider its contribution to or impact on the social inclusion of care recipients.
4. Equitable: Care recipients with the same or similar needs and circumstances should receive comparable allocations of budgets and services.
5. Optional: CDC should be offered to care recipients as a voluntary option.
6. Care recipient and carer-centred: CDC should take into account the needs and views of care recipients and carers and support them having control and choice over their care.
7. Supportive: Care recipients and carers should be provided with a range of support to make informed decisions and practise CDC, including education and advocacy.
8. Sustainable: CDC should provide an affordable, long term option for delivery of care for government that meets the needs of care recipients and carers.

CDC and CDRC packages

Consumer-directed care (CDC) packages

500 non-ongoing flexible care places were allocated to approved aged care providers through the Innovative Pool Program for CDC packaged care in 2010-11 and 2011-12. An additional 500 CDC packages were approved from July 2011, though these packages were not within the scope of this evaluation.

The target group for CDC packages are frail older people aged 70 years and over (or 50 years and over for Aboriginal and Torres Strait Islander people), with complex care needs who wish to remain living in their own home.

There are three levels of subsidy for CDC packages, broadly aligned to Australian Government funded aged care packages:

• CDC Low Care (CDCL) - similar to CACPs and may include services such as personal care, social support, transport, home help, meal preparation and gardening. The Commonwealth subsidy level in 2010-11 was $13,158 per package.
• CDC High Care (CDCH) - similar to EACH packages and may include services such as nursing, domestic assistance, in-home respite, personal care, transport and social support. The subsidy level in 2010-11 was $43,982 per package.
• CDC High Care Dementia (CDCHD) - similar to EACHD packages providing services to people living in the community with high level, complex care needs who experience behaviours of concern and psychological symptoms associated with dementia. These needs have a significant impact upon their ability to live independently. The subsidy level in 2010-11 was $48,504 per package.

The subsidy paid to providers is based on the participant’s ACAT-assessed care need level (as it is for standard packaged care). Individual budgets or allocations for each CDC participant are determined by the CDC provider, and do not need to correspond directly to the subsidy levels. CDC participant allocations are administered by CDC packaged care providers. Providers may charge an administration fee for managing the individual budget.

Consumer-directed respite care (CDRC) packages

In addition to CDC packages, 200 consumer-directed respite care (CDRC) packages were provided in 2010-11 and 2011-12 to carers registered with the NRCP, and were funded through the NRCP. An additional 200 CDRC packages were approved from July 2011, though these packages were not within the scope of this evaluation.

Target recipients for CDRC packages are carers of frail older people aged 65 years and over (or aged 50 and over for Aboriginal and Torres Strait Islander people), and carers of people living with dementia and/or challenging behaviour¹.

CDRC package funds are administered by 16 CRCCs. The CDRC package budget was $4,200 per package in 2010-11. An additional $2,000 per package was allocated to cover expenses relating to the administration of each package, client management, and participation in the evaluation.

Provider and participant roles and responsibilities

CDC and CDRC providers are responsible for selecting participants, undertaking needs assessments and care planning, administering participant allocations and organising and coordinating the delivery of supports.

Participants are actively involved in all aspects of planning and decision-making, and are able to take on aspects of package administration, management, and support coordination themselves - to the extent that they are able to and within the bounds permitted by their packaged care provider and the Aged Care Act.

Program logic

Figure 1 provides a diagrammatic map highlighting the context and principles for the CDC initiative, the intended outcomes of the initiative, and the implementation processes required to achieve those outcomes.Top of page

Figure 1: Program logic for the CDC initiativeThis figure in the HTML version is displayed as text for accessibility requirements. It is displayed as a figure in the PDF version.

Consumer Directed Care in Community Aged Care Initiative

Context

Objective of the CDC initiative

To provide consumers with greater control over their own lives by allowing them, to the extent they are capable and wish to do so, to make choices about the types of services they access, and the delivery of those services.

Aim of the CDC initiative

To demonstrate consumer-directed models of community aged care service delivery under the Innovative Pool program.

Principles

• CDC is integrated into existing programs
• CDC is responsive to changing needs
• CDC is socially inclusive
• CDC is equitable
• Participation in CDC is optional
• CDC is consumer-centred
• CDC is supportive to allow informed decisions by consumers
• CDC is sustainable and cost effective

Intended outcomes

CDC enhances community based care for consumers (care recipients and carers, including special needs groups)

• Consumers receiving CDC consider that they are better enabled to meet their personal goals
• Consumers receiving CDC perceive improvements in their quality of care, quality of life, health and wellbeing

CDC is person-centred and increases consumer choice and control, including consumers from special needs groups

• Care recipients and carers receiving CDC models have more choice and control over their care and services
• Sufficient care and services are available for care recipients and carers receiving CDC to exercise genuine choice
• Care recipients and carers receiving CDC have access to sufficient information to exercise informal choice
• Care recipients and carers (including special needs groups) are satisfied with CDC

CDC is equitable and provides value for money

• Comparable budgets and services are provided for care recipients and carers with similar needs and circumstances
• CDC provides value for money for government
• CDC is sustainable

Implementation processes

Initiation

• Department provides funding, program guidelines and operations manual to successful providers
• Providers select care recipients and carers to voluntarily participate in CDC
• Specific service needs of the consumer are assessed by the provider
• Consumers are provided with information about available care and services to meet their needs
• Consumers are provided with information about costs
• Consumers consent to participate

Planning

• Providers and consumers develop a care plan that details the services to be provided and the agreed service delivery arrangements
• Providers and consumers agree on an individual budget to deliver the care plan (including agreed administration fees for CDC packaged care)
• Providers ensure that a proportion of the budget is set aside for contingency in the event of changed care needs or emergencies

Delivery

• Providers arrange for the supply of the agreed care and services (through employees, contractors or brokerage)
• Providers continue to provide information and build capacity of consumers to participate in CDC
• Providers monitor care and services, including through quarterly care quality checks
• Providers monitor and reveiw care plans and budget
• Providers report activity to Department

NOTE: All references to 'CDC' included directed packaged care and consumer directed respite care, unless otherwise specified.

Special needs groups include people from Aboriginal and Torres Strait Islander people, people from non-English speaking backgrounds (culturally and linguistically divers backgrounds), people who live in rural and remote areas, people who are financially or socially disadvantaged, veteran's, homeless people, Care-leavers. Key issues may also include communities with groups of people who will significantly benefit from CDC places, eg people with dementia, people with challenging behaviours and people with limited access to existing services.

Source: KPMG

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1. In addition, the following carers are able to utilise a CDRC package where carers of frail older people have not been identified:

• carers of younger people (aged under 65 years or under 50 years for Aboriginal and Torres Strait Islanders) with moderate, severe or disabilities who are living at home

• carers of people with a terminal illness in need of palliative care.

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