Evaluation of the consumer - directed care initiative - Final Report
5.5 Participant selection
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
- 11 Lessons learnt and strategies for consideration
- Appendices
- References
Selection of CDC participants
Many providers felt that existing clients with experience of standard packaged care would be best placed to participate in CDC, and first sought to approach existing clients to participate in CDC. A limited number of providers did this through a mass mail-out to all clients inviting them to elect to participate in CDC, but the majority used a more targeted approach by using their coordinators to identify clients they thought might be interested and have capacity to self-direct.Characteristics of participants
Providers looked for certain characteristics in potential CDC participants.For high care categories, the presence of a carer (or a family member actively involved in the person’s life) was considered to be a critical enabler for a package. Carers who were under very high levels of stress, or who had their own health problems, at the time of entry were generally not considered suitable. Carers who asked a lot of questions, expressed ideas about how they wanted care and services delivered, or showed some interest in the financial aspects of a package were considered more suitable.
For low care participants, providers looked to people who they thought had sufficient capacity and who might have an interest in self-direction. This included those who may have expressed dissatisfaction with some aspect of their package in the past.
Some providers also looked at factors such as a person’s previous work history or education levels in identifying potential participants – using this as an indication of their capacity to be actively involved and self-directed aspects of their package and support arrangements.
Level of interest from existing packaged care clients
Providers reported relatively low levels of interest from existing packaged care clients, especially at the low care level. Many existing clients did not see any additional benefit to them from having a package in terms of the types or level of supports they might be able to access, and many were satisfied with their existing care arrangements. Many existing clients also felt unable or were unwilling to become more involved in their care planning and decision-making and a number were concerned about the potential burden of being involved. A number were also concerned about the pilot nature of the initiative.Providers had more success in recruiting existing EACH and EACHD clients to CDC, particularly clients who had a younger carer (usually an adult daughter or younger spouse). These carers were attracted to having more control and to take on coordination themselves (to free up funds for more care hours), or were attracted to the potential for more flexible service delivery.
“We thought there would be more demand for CDCL. We could fill 10, 20 more CDCH places tomorrow, because the carers want it, but people don’t see the benefits at the low level – they’d rather stay on a CACP.”
CDC provider
“CDC is a model we want people to want, but people don’t really want it yet.”
CDC provider
Targeting new packaged care clients
Where providers were unable to recruit sufficient existing clients, they looked to fill their CDC places with new packaged care clients.A number of providers also specifically targeted new clients first – either newly referred to them, or on a waiting list for a package. New clients were identified by the provider as part of their initial assessment and care planning process, or based on an indication from an ACAT of a person’s potential suitability for CDC. If a person demonstrated an interest in the budget details, appeared to have the capacity and interest in self-direction, or indicated a desire for certain ‘non-traditional’ responses, then they would be referred to the CDC coordinator who would then discuss options for a CDC package with them. For some participants who had not received packaged care before, the CDC package was the only package available.
A small number of clients directly approached providers about CDC. Typically they were younger carers of CDCH or CDCHD participants who were familiar with the CDC approach and wanted more flexible service delivery, and more control over their package budget. These carers were also typically dissatisfied with their experience of traditional packaged care.
Role of ACATs
Providers did not see a role for ACATs in determining whether people were appropriate for CDC – this was a decision that providers made themselves – though many providers relied on ACATs to provide an indication of who might be appropriate for CDC.Some ACATs specifically referred people to CDC providers rather than non-CDC providers where they thought a person might be appropriate for CDC, though left the decision as to whether the person received a CDC package or a standard package to the provider. Where providers had difficultly filling their CDC packages, or where they were targeting specific special needs groups (such as people who were homeless or at risk of homelessness), they relied more heavily on ACATs to identify potential participants.
However, initially ACATs had little or no understanding of CDC and were not in a position to indicate who might be appropriate for CDC. A number of providers spent time with ACATs explaining the CDC model and what they expected from ACATs regarding CDC – something which a number of providers considered should have been the role of the Department. Top of page
Selection of CDRC participants
CDRC providers tended to target potential participants who were already known to the CRCC, rather than seeking to recruit through a mass mail-out or marketing. Providers sought to target CDRC packages to those carers who seemed to be the most in need and who might realise the most benefit from the CDRC approach, as well as those who they thought had the capacity and the interest in directing their package:- high users of emergency and other respite services
- those with limited access to ‘traditional’ respite services
- those with limited or no access to other formal and informal supports, including community aged care packages
- carers of people living with dementia or disability
- younger carers of frail older people with capacity and interest to self-direct.
Generally, there was a high level of interest in CDRC from potential participants, and almost all of the people that providers approached agreed to participate in CDRC. Often, they expressed profound surprise and delight at having a package of funds made available to them. For many CDRC participants, this was the first time that someone had talked to them about their needs, goals and desires, rather than talking about the care recipients’ needs.
“They felt like they’d won the lottery when we told them about the package. Some of them weren’t sure what to do with it at first – they didn’t understand it was about them, not just the care recipient – but they were thrilled to have it.”
CDRC provider
Some carers told providers they were happy to continue making occasional use of respite when they needed it, and were uninterested in having planned and regular respite, or concerned about the burden a CDRC package might create. There were also a number of carers who refused to participate because of the pilot and short-term nature of the program (noting that at the time most participants were being recruited, CDRC packages had been approved only to the end of June 2011).
Some providers experienced difficulty attracting and retaining Aboriginal and Torres Strait Islander carers for CDRC. This was attributed to a variety of factors: lack of time to build rapport and understanding about CDRC with Aboriginal and Torres Strait Islander communities, use of assessment and planning approaches that were perhaps not culturally appropriate, pressure on carers to share CDRC resources with the wider community (humbugging), and, in the case of Aboriginal and Torres Strait Islander carers living in remote areas, various difficulties presented by distance and remoteness.
Key points – Participant selection
- Providers used a mix of approaches when selecting CDC participants, with some targeting existing packaged care clients and others new clients. A ‘targeted’ approach to participant selection was more effective than an open approach (such as a mass mail-out).
- 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-direction. Providers also looked at a person’s capacity to be actively involved and self-direct aspects of their package and support arrangements.
- The level of interest in CDC was lower than providers expected. There was a low level of interest in CDCL packages from existing CACP clients, and to some extent from new clients. There was more interest from existing EACH and EACHD clients and their carers in CDCH and CDCHD packages.
- There was a moderate level of interest from new clients in CDC, though a number of new clients chose a standard package over a CDC package. In some cases, the CDC package was the only package available.
- 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.
- There was a considerable level of interest in CDRC from those approached, with very few declining to participate.