Evaluation of the consumer - directed care initiative - Final Report

5.8 Consideration for special needs groups

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Providers suggested that the effectiveness of CDC and CDRC planning, delivery and coordination processes sometimes varied based on the special needs group status of the participant or carer.

People from Aboriginal or Torres Strait Islander backgrounds

A number of providers suggested that a different approach may be needed to improve take-up by this group. The CDC/CDRC focus on an individual, rather than the broader family or community, may not be appropriate in the Aboriginal and Torres Strait Islander context.

The potential issues around ‘humbugging’ also need to be considered (‘humbugging’ refers to pressure that may be applied by members of a community to an individual seen to be receiving financial benefits, to share those benefits amongst the community).

It is unclear the extent to which Aboriginal and Torres Strait Islander stakeholders were consulted in the development of the initiative and its appropriateness for Aboriginal and Torres Strait Islander people. This would need to be addressed in any wider rollout of CDC.

People living in rural and remote areas

The key challenge for providers supporting participants in rural and remote areas was being able to offer genuine choice when there may only be one service provider available in a region, and the travel costs involved in engaging an out-of-area provider prohibitive. However, it was suggested that the goals-based approach to planning was particularly helpful for participants and carers in rural and remote areas where there were limited formal services because it encouraged innovative thinking to respond to identified goals and needs.

Another challenge for CDC and CDRC providers was managing their own travel costs and travel time when dealing with participants face-to-face –especially in the up-front initiation and planning stages. For CDRC providers, their challenge was managing these costs within the pre-determined administrative budget for the package. For CDC providers, the challenge was the extent to which they could reasonably pass on travel costs to the participant’s package.

People from culturally and linguistically diverse backgrounds

Planning, coordination and delivery approaches seemed broadly responsive to many of the commonly-cited preferences of culturally and linguistically diverse communities (preferences for gender, language spoken and cultural practices of support workers). A number of CDC and CDRC providers targeting this special needs group already had a large number of clients in this group, and significant experience in meeting the needs of people from culturally and linguistically diverse backgrounds.

People who are homeless or at risk of homelessness

The key challenge for providers targeting homeless clients was in the initial recruitment. Having identified significant need amongst this group, providers then had to find a way to recruit the actual clients. Most older homeless or itinerant people do not access health services regularly (other than emergency presentations) and there were practical challenges in organising an ACAT assessment or delivering home care services to a person without formal housing.

Providers overcame these challenges by partnering with other organisations, or other sections of their own organisation that provided homelessness outreach services and accommodation. They developed a joint response with the partner provider assisting with recruitment and accommodation, and the CDC provider facilitating the ACAT assessment and then undertaking the CDC planning, delivery and coordination processes. Feedback was that these partnership arrangements were effective, but it did mean that there were delays in operationalising these CDC places because it took time to get the client into stable housing and ACAT assessed. It also took a lot of time to develop the necessary trust between this very independent and sometimes wary client group and the CDC coordinators.

Participants in the homeless special needs group often required a longer, more intensive assessment and planning process, and more intensive case management. They typically had more difficulty identifying their own goals and needs, especially if they have not accessed health or community services in many years, and took more time to feel comfortable engaging in self-direction. They benefited more from a holistic assessment, which included consideration of other services they might not be accessing, particularly medical care, podiatry, dental care and social support, and they valued the case management – once sufficient trust had been established with the coordinator.

In addition, participants in the homeless special needs group generally showed little interest in the ‘consumer-directed’ aspects of the CDC model, including choice of support and support providers, and their individual budgets.

People who are financially or socially disadvantaged

There was less direct evidence relating to people in the financially and socially disadvantaged special needs group. This is in many ways a much broader client group than other special needs groups, and it is therefore more difficult to identify particular considerations that can be applied to this group.

Veterans and care leavers

Only one interviewed provider targeted the Veterans special needs group, though the number of packages allocated to participants in this group was too small to draw any conclusions.

None of the interviewed providers targeted care leavers, and as such there is no information about the applicability of planning, initiation, coordination and delivery processes for these groups.

People living with dementia¹⁵

The goals-based process of assessment and planning as described by providers seemed particularly appropriate for people living with dementia and their carers, notably because of the increased focus on the interests, preferences and goals of both the participant and the carer, rather than just a focus on available, pre-determined services. Providers described the steps they took to directly or indirectly include the person living with dementia, and particularly to identify opportunities for social participation and engagement that they might enjoy as part of the holistic planning process.

For this group, it seemed that the planning process (and putting in place appropriately tailored supports in response to that process) was a critical factor in the success of the package. If the planning and initiation process was successful, then the delivery and coordination approaches were also effective. This highlighted the benefit of an initial goal-based planning process.

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15. People living with dementia are not a designated special needs group under the Aged Care Act.
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