Evaluation of the consumer - directed care initiative - Final Report

6.4 Extent to which CDC enhanced community-based care

Up to Consumer Directed Care

prev page| TOC |next page

In considering the extent to which CDC enhanced community-based care, the evaluation focused on the impact of CDC on participant and carer perceptions of:

• quality of care
• their ability to achieve personal goals
• their quality of life, health and wellbeing.

Impact on quality of care

Overall, CDC participants and carers were slightly more satisfied with the quality of care they received than standard packaged care recipients. A number of CDCH and CDCHD participants and carers in particular, and those participants with prior experience of packaged care felt that their quality of care had improved. This was mainly due to them being able to have more control over when and how the care and services were delivered, such as choosing their support worker, being able to structure their support around their preferences and schedules, receiving support at night and over the weekend, and to a lesser extent the greater choice of providers.

"All I want is for my father to be cared for the way I would care for him. That is what (CDC) has given me, and I am very happy with it."

Carer of CDCH participant
Survey responses to the question “I am satisfied with the quality of care and services I receive” showed high levels of satisfaction in both the CDC participant group and the packaged care comparison group. However, there was little difference between the two (table B.19 in Appendix B refers). There were also no clear differences between those participants with prior experience of packaged care and those that had not (table B.64 in Appendix B refers). Consistent with the interview findings, CDCH participants were slightly more satisfied with the quality of their care than CDCL participants (table B.46 in Appendix B refers).

Achieving personal goals

While a number of providers used a goal-based approach to planning, participants did not talk about their ‘personal goals’ as such. They tended to focus on the hours of care they received, the range of services they could access and how they hoped these would help them remain at home and, especially for CDCL participants, remain independent.

Carers were more likely to articulate particular goals, and these often focussed around their desire for more flexible service delivery to fit around their lives so they could continue working (in the case of younger carers) or spend more time doing other things that were important to them, while knowing that the care recipient would be well cared for.

CDC participants and carers were more satisfied with their ability to achieve their personal goals than packaged care recipients. There was a higher level of favourable response to the survey question “Compared to six months ago, how satisfied are you with your ability to achieve the things you want to achieve?” for CDCL participants (compared with CACP recipients), and CDCH participants (compared with EACH recipients). Consistent with most of the other survey questions, the level of satisfaction was higher for CDCH participants compared with CDCL.

Among the CDC participant group, there was a noticeably higher level of satisfaction with their ability to achieve their goals among those with prior experience of package care compared with those that had not.

Table 17: Compared to six months ago, how satisfied were you with your ability to achieve the things you want to achieve? – by care level

	CDCL	CACP	CDCH	EACH
Not satisfied	3%	3%	3%	3%
Somewhat less satisfied	4%	6%	9%	10%
No different	28%	39%	21%	45%
Somewhat more satisfied	31%	23%	24%	24%
Much more satisfied	28%	26%	38%	14%

Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. ‘Don’t know’, multiple and blank responses have not been reported in this table.
Note that there were insufficient responses CDCHD and EACHD recipients to be included in the analysis
Source: CDC and comparison group surveys, conducted August 2011.

Table 18: Compared to six months ago, how satisfied were you with your ability to achieve the things you want to achieve? – by package care history

	Receive packaged care before	Did not receive packaged care before
Not satisfied	0%	7%
Somewhat less satisfied	3%	7%
No different	22%	27%
Somewhat more satisfied	32%	27%
Much more satisfied	36%	27%

Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. ‘Don’t know’, multiple and blank responses have not been reported in this table.
Source: CDC and comparison group surveys, conducted August 2011.

Top of page

Impact on quality of life, health and wellbeing

Even after a short period of operation, and considering the differences in implementation of CDC by providers (and the extent to which CDC is different from standard packaged care), CDC appeared to have an impact on participants’ satisfaction with various aspects of their life.

This included 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. For all of these aspects, satisfaction was higher for CDCH participants than for CDCL, and higher than standard package care recipients.¹⁸ CDC participants who had prior experience of packaged care tended to have higher levels of satisfaction with some of these aspects than those participants with no prior experience of packaged care. To a large extent, the flexibility of supports and the level of control and input that participants had over their supports were key contributors to these outcomes.

While there were noticeable differences, they are not substantial, and this may reflect the length of time that participants had experience of CDC. Further, on the single measure of wellbeing, there was no statistically significant difference between the CDC participant group and the standard packaged care comparison group.

Different aspects of participants’ quality of life, health and wellbeing are discussed below.

Independence

A number of participants and carers spoke about feeling more able to do the things they wanted to do because of the flexibility of their supports. This was particularly apparent for carers of CDCH and CDCHD participants, many of whom stated that they felt more independent and able to do things they wanted to do (as carers), and less burdened with their caring role.

A greater proportion of CDC survey respondents indicated that they were more satisfied with the level of independence compared with six months ago than the packaged care comparison group. In particular, CDCH participants had a considerably higher level of satisfaction with their level of independence compared with EACH recipients. This is illustrated in the table below.

A CDCH participant, aged in his 60s, living in a regional town needed personal care assistance in the evenings, and assistance to transfer from his wheelchair to bed. He occasionally attended music concerts in the evening. Through his CDC provider he arranged for supports to be provided later than normal on the nights he attended a concert – often after 10pm. Without this late night support, he would not be able to attend the concerts – an activity which he enjoyed.
There were no clear differences between those participants with prior experience of packaged care and those that had not, however (table B.75 refers).

Table 19: Compared to six months ago, how satisfied were you with your level of independence?

	CDCL	CACP	CDCH	EACH
Not satisfied	6%	3%	3%	7%
Somewhat less satisfied	10%	11%	15%	21%
No different	41%	55%	29%	62%
Somewhat more satisfied	19%	16%	32%	3%
Much more satisfied	19%	13%	18%	7%

Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. ‘Don’t know’, multiple and blank responses have not been reported in this table.
Note that there were insufficient responses CDCHD and EACHD recipients to be included in the analysis.
Source: CDC and comparison group surveys, conducted August 2011.

Participation in social and community activities

A higher proportion of CDC survey respondents indicated that they were more satisfied with their ability to participate in social and community activities than the packaged care group, and this was also reflected in the CDCL group (higher than the CACP group), and the CDCH group (higher than EACH). This is highlighted in the table below.

Many participants identified the flexibility of supports as a key enabler – allowing them to structure their supports around their own and their carer’s schedules, and being able to utilise supports (such as transport) to directly facilitate access to social and community events and activities for themselves and/or their carers.

Table 20: Compared to six months ago, how satisfied were you with your ability to participate in social and community activities?

	CDCL	CACP	CDCH	EACH
Not satisfied	3%	1%	3%	3%
Somewhat less satisfied	3%	10%	6%	17%
No different	40%	41%	32%	55%
Somewhat more satisfied	31%	26%	26%	14%
Much more satisfied	18%	16%	24%	3%

Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. ‘Don’t know’, multiple and blank responses have not been reported in this table.
Note that there were insufficient responses CDCHD and EACHD recipients to be included in the analysis.
Source: CDC and comparison group surveys, conducted August 2011.

There were no noticeable differences between those participants with prior experience of packaged care and those that had not, however (table B.70 in Appendix B refers).Top of page

Relationships

There were higher levels of satisfaction among the CDC respondent group with their ability to visit family and friends and their satisfaction with the quality of their home life and close relationships, compared with the packaged care comparison group. CDCH participants were noticeable more satisfied than EACH package recipients, and more satisfied than CDCL participants. This is illustrated in the tables below.

Table 21: Compared to six months ago, how satisfied are you with the extent which you are able to visit your family and friends?

	CDCL	CACP	CDCH	EACH
Not satisfied	3%	1%	3%	10%
Somewhat less satisfied	3%	9%	9%	7%
No different	56%	68%	29%	69%
Somewhat more satisfied	26%	8%	35%	7%
Much more satisfied	7%	11%	21%	3%

Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. ‘Don’t know’, multiple and blank responses have not been reported in this table.
Note that there were insufficient responses CDCHD and EACHD recipients to be included in the analysis.
Source: CDC and comparison group surveys, conducted August 2011.

Table 22: Compared to six months ago, how satisfied are you with the quality of your home life and close relationships?

	CDCL	CACP	CDCH	EACH
Not satisfied	3%	0%	0%	3%
Somewhat less satisfied	1%	5%	3%	7%
No different	46%	59%	50%	69%
Somewhat more satisfied	25%	18%	18%	14%
Much more satisfied	19%	16%	29%	7%

Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. ‘Don’t know’, multiple and blank responses have not been reported in this table.
Note that there were insufficient responses CDCHD and EACHD recipients to be included in the analysis.
Source: CDC and comparison group surveys, conducted August 2011.

As illustrated in the following tables, there were also higher levels of satisfaction with participants’ home life and close relationships and ability to visit family and friends among the CDC group who had prior experience of package care compared with those that had not.

Table 23: Compared to six months ago, how satisfied are you with the extent which you are able to visit your family and friends?

	Received packaged care before	Did not received packaged care before
Not satisfied	0%	7%
Somewhat less satisfied	3%	7%
No different	47%	56%
Somewhat more satisfied	32%	16%
Much more satisfied	12%	13%

Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. ‘Don’t know’, multiple and blank responses have not been reported in this table.
Source: CDC and comparison group surveys, conducted August 2011.

Table 24: Compared to six months ago, how satisfied are you with the quality of your home life and close relationships?

	Received packaged care before	Did not received packaged care before
Not satisfied	0%	4%
Somewhat less satisfied	2%	2%
No different	41%	53%
Somewhat more satisfied	29%	20%
Much more satisfied	22%	20%

Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. ‘Don’t know’, multiple and blank responses have not been reported in this table.
Source: CDC and comparison group surveys, conducted August 2011.

Health and wellbeing

There was also some evidence that CDC was having a positive impact on CDC participants’ health and wellbeing. While some participants interviewed stated that their physical health had improved since being on CDC (mainly due to direct access to health-related supports), a number of participants and their carers identified an improved sense of ‘wellbeing’ and a different outlook or perspective on life – predominantly due to feeling more in control of their care (and their lives). Survey responses also indicated a greater level of satisfaction among CDCH participants compared with EACH package recipients – as illustrated in the table below.

“After my wife died, I didn’t really care what happened to me. Now, I am starting to care a bit, and even think about the future. (The CDC coordinator and support workers) have helped me start thinking about the future.”

CDCL participant, formerly homeless
aged in his 60s

Table 25: Compared to six months ago, how satisfied were you with your general health and wellbeing?

	CDCL	CACP	CDCH	EACH
Not satisfied	7%	4%	3%	14%
Somewhat less satisfied	15%	23%	15%	14%
No different	26%	30%	35%	52%
Somewhat more satisfied	35%	25%	21%	14%
Much more satisfied	15%	16%	26%	7%

Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. ‘Don’t know’, multiple and blank responses have not been reported in this table.
Note that there were insufficient responses CDCHD and EACHD recipients to be included in the analysis.
Source: CDC and comparison group surveys, conducted August 2011.

There were also higher levels of satisfaction with general health and wellbeing for CDC participants who had received packaged care before commencing a CDC package compared with those with no packaged care history – as indicated in the table below.

Table 26: Compared to six months ago, how satisfied are you with your general health and wellbeing?

	Received packaged care before	Did not receive packaged care before
Not satisfied	2%	11%
Somewhat less satisfied	14%	18%
No different	27%	33%
Somewhat more satisfied	39%	18%
Much more satisfied	17%	20%

Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. ‘Don’t know’, multiple and blank responses have not been reported in this table.
Source: CDC and comparison group surveys, conducted August 2011.

Measure of wellbeing

The CDC and packaged care comparison group surveys included a partial measure of outcome – the ICECAP-O¹⁹ wellbeing measure.

The median ICECAP-O scores for the CDC and packaged care comparison group are outlined in the table below. As the table shows, there were only very slight differences between the median scores for CDCL and CDCH participants compared with the CACP and EACH comparison groups, and for the CDC participant group overall.²⁰ Differences were not statistically significant.²¹

Table 27: ICECAP-0 wellbeing measures – median scores

Response	CDC	Comparison
CDCL/CACP	0.85	0.84
CDCH/EACH	0.70	0.63
CDCHD/EACHD	...	...
Median score	0.77	0.79

A score of 1 is the maximum wellbeing score, and a score of 0 the minimum.
Based on responses received from 124 CDC participants and 126 standard packaged care (comparison group) recipients. Note that respondents who did not complete all five items have been excluded.
Source: CDC and comparison group surveys, conducted August 2011.

---

18. The number of responses for CDCHD and EACHD recipients was low, hence have not been reported.
19. The ‘ICEpop CAPability measure for Older people’ (ICECAP-O) is a validated measure of wellbeing in older people. The ICECAP-O tool uses a definition of wellbeing which is broader than most other measurement tools (which focus on health and/or functional capability), and covers five attributes of wellbeing that were found to be important to older people in the UK: Attachment (love and friendship), Security (thinking about the future without concern), Role (doing things that make you feel valued), Enjoyment (enjoyment and pleasure), Control (independence). The ICECAP-O tool provides a single wellbeing score (between 0 and 1) for each individual completing the five-question tool.
Source: http://www.icecap.bham.ac.uk/ICECAP-O/index.shtml, accessed September 2011.
20. Data is not able to be reported separately for CDCHD and EACHD given the low number of respondents, though they have been included in the overall median scores for CDC and comparison groups.
21. using the Mann-Whitney test for non-normally distributed data, p=0.05

Top of page

prev page| TOC |next page