Evaluation of the consumer - directed care initiative - Final Report

6.6 Considerations for special needs groups

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There were a number of issues identified specific to special needs groups.

People from Aboriginal or Torres Strait Islander backgrounds

About 3 per cent of CDC participants identified as being of Aboriginal or Torres Strait Islander origin. Providers indicated that there was a lower than hoped for take-up of CDC by Aboriginal and Torres Strait Islander clients, suggesting that the CDC approach may not be cultural appropriate in its current form, and that modifications to the approach may be warranted for Aboriginal and Torres Strait Islander participants (for example, including the broader family or community in the planning process, or planning at a community level rather than an individual level).

One issue that was a concern for some Aboriginal and Torres Strait Islander participants (and providers targeting the Aboriginal and Torres Strait Islander special needs group) was ‘humbugging’. For some clients, the CDC individual budget statements were useful for managing this, because they could show people where all of the funds were being expended. Other participants, however, thought the budget statements added to the problem. The number of participants represented in the evaluation data collections was too small to form any firm conclusions; however this concern should be examined further.

People living in rural and remote areas

CDC participants and carers living in rural and remote areas indicated similar levels of satisfaction as any other group with the CDC planning process, choice of services, level of control and quality of care. This was interesting, because in many cases there was less choice of service providers and/or increased costs involved in using services (because of the transport costs involved in engaging out-of-area providers).

People from culturally and linguistically diverse backgrounds

Culturally and linguistically diverse clients indicated similar levels of satisfaction with the CDC planning process, choice of services, level of control and quality of care as any other group. Of particular importance to these clients was having the ability for services to be delivered by workers who spoke the same language as the care recipient. For a number of people, this was their key requirement of CDC.

Outside of major cities, it was not always possible to broker support workers with the required language skills (and even in major cities it could be challenging to ensure that all support workers have the necessary care skills and language skills).

People who were homeless or at risk of homelessness

People in the homelessness special needs group experienced significant benefits from highly tailored and flexible responses, the provision of ‘wrap-around’ supports from a range of other providers (including health care and supported or independent housing) with intensive case management by the CDC provider or sometimes in partnership with a homelessness outreach or supported housing provider.

The benefits experienced by people in this group were clearly related to having access to care and services (given that many of them had often had no access to health, community care or stable housing for many years), and access to case management support. Aside from the tailoring of the services and the inclusion of non-traditional services, such as direct health care, these benefits were not particularly associated with the CDC model.

Clients in this group expressed little interest in the individual budget and little desire to self-manage their package. It was clear from the interviews that they particularly valued the care planning and services offered by the CDC providers.

People who were financially or socially disadvantaged

There was little evidence from this group.

Veterans and care leavers

There was little evidence from either of these special needs groups. Take-up by people identifying as veterans or care leavers was relatively low.

People living with dementia²²

Carers of people living with dementia indicated generally indicated a high level of satisfaction with CDC, most often related to the ability to ensure continuity of care workers and to exercise more control over the type of support worker (for example, level of skills, experience with dementia, personal rapport with the care recipient).

A number of carers of people living with dementia suggested that there were tangible benefits to the care recipient from having more tailored services – they were able to have support workers that they liked, and activities were structured around their personal interests and preferences.

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