Ethnic Communities' Council of NSW

How to define Consumer Directed Care

In previous posts we have explored what it means to age well, or as we discussed earlier, asking ourselves the question: What does ageing well mean to you?. We then explored the concept of wellness and reablement, that ageing well is important, but sometimes things do not go quite the way we want them to go and we find ourselves in a situation where our health, physical or mental wellbeing is affected. This is where reablement or restorative care services help older persons to get back to where they were before, or at least as close to that as possible.

We want people as they age, to be independent, have choices and live the life they want to live and to do the things they want to do, regardless of their physical and mental health, gender, cultural background, language or faith.

Consumer Directed Care (CDC) is a model adapted by the government which supports the wellness approach and is designed to give older people more choice and flexibility.

This is particularly for older people who have had, what is called an assessment and have been given a selection of services that can help them stay in their home longer. This collection of services is what we call ‘Home Care Packages’. Consumer Directed Care Home Care Packages, underpinned by a consumer-directed philosophy, now provide older people more control over the type of care and services they can access, the delivery of those services, including who delivers the services and when.

From 1 July 2015, all Home Care Packages must be delivered in a CDC focus. The Increasing Choice in Home Care reforms commenced on 27 February 2017 which aim to improve the way that home care services are delivered to older Australians.

Now with Consumer Directed Care Home Care Packages, an older person with a package is probably likely to have someone who will talk to them about:

•.What their goals and needs are rather than have someone decide for them
•  Developing plans that are easy to understand so that the older person is clear about the services they have chosen and how they work
• Understanding the costs and fees • Managing their services. That they will be updated and informed of any changes, and are involved in making the final decisions about their package.
• How they are travelling, finding out if anything has changed and asking the person if they would like to adjust or make changes to the kind of services they are receiving.

It is about placing the older person or consumer in the drivers’ seat of their own car. Sure, someone else has to service that vehicle, give it an oil change and change the tyres, but the older person is still
the owner of that car. They decide the kind of wheels, the kind of oil, how much they want to spend, even down to the type of fuzzy dice they want hanging off their mirrors. It is the same with an aged
care package.

The older person or consumer decides who mows their lawns and how often, whether they choose to have transport to take them shopping, or to the doctor, to a show, to a cultural event, or to church. They decide on how that package is designed to help them live well, and lead the kind of life they want to live. The main goal of CDC is to offer older people greater control over their own lives by providing them with the opportunity to make choices about their care, to the extent they wish to do so.

In the event that the older person cannot make their own decisions, because of their health, physical, emotional or psychological limitations, then a family member, carer or a by-law an enduring guardian becomes responsible for that package. That is not to say that the older person loses control. It is important to continue to engage or have the person involved as much as possible via supported decision-making. As much as they can, want to and are capable. It is about choice.

Person-Centred Care

A Person-Centred Care approach is different to Consumer Directed Care. A Person-Centred Care approach ensures an organisation develops and delivers its services and all its activities in a way that is:
respectful of, and responsive to, the preferences, needs and values of consumer, carers and their families.

An organisation with a person-centred approach believes that in order to deliver respectful and responsive services within a consumer-directed care model (as discussed in previous pages), it requires a whole of organisation commitment and effort. The concept ensures that everyone in the organisation is on board and plays an important role that can affect the way in which services are delivered.

In other words, providing care for the older person is not just about the aged care worker who is visiting the person at home, but it is everyone in the organisation who is directly or indirectly involved in the client’s care. It is the understanding that everybody is responsible and that staff are trained, engaged and committed to delivering the best service possible at all levels of the organisation.

This means that each person in the organisation sees themselves as an important element and influential factor that affects the way in which a client receives care. Whether it is the client, their family, staff members, care workers, management, volunteers, right down to the organisation’s environment, planning, training, culture, philosophy, policies and procedures. These are all factors that contribute to the quality and care given to a client and their family. Person-Centred Care looks different in different organisations and settings. There have been various models that have been developed to meet the needs of specific care environments, including person-centred care for residential care settings and hospital environments.

Regardless of the different environments and locations and models, what is a common factor is that each member of the organisation can describe and show how they, in their roles, contribute towards their organisation providing a person-centred care approach. This is not easy to achieve. An organisation that embraces a person-centred approach would value respect, equality, authenticity and being genuinely
connected to the process.

 

What Does Consumer Directed Care promote?

CDC Promotes:

• Focus within a positive framework. on strengths and goals while working
• Having a whole of organisation philosophy and approach to care and support
• Respecting and valuing each individual as unique
• Recognising the need of all people to have purpose and to feel they matter
• Providing a positive attitude
• Actively listening to the whole person in context
• Focusing on strengths and goals and working within a positive framework
• Recognising the significance of a positive social environment
• Supporting rights, values and beliefs
• Recognising that all behaviour is meaningful
• Supporting positive relationships across all stakeholders
• Enabling choice wherever relevant to the person and within an environment of respect for others

What are there six key principles of person-centred care 

1. Valuing and respecting people
Treating people with dignity and respect by:
• Being aware of and supporting personal views, values, beliefs and preferences.
• Listening to one another and working in partnership to design and deliver services.

This includes clients, carers and their families and those involved in their care including aged care staff, coordinators, workers, supervisors and all levels of management.

2. Autonomy
Providing choice and respect for clients and their carers at all levels of the organisation. This mean balancing rights, risks and responsibilities.
Assisting a client to make the most of that which is within their control and supporting them to make decisions. This creates greater independence and looks at a client’s strengths, their interest and their abilities, and empowers them to make their own decisions.

3. Life experience
Supporting a person’s “individual identity” by understanding the importance of a person’s past, their present-day experiences and their hopes for the future. This is particularly important when working with clients who have culturally diverse backgrounds and history that influences who they are and the decisions they make today.

4. Understanding relationships
Collaborative relationships between the service provider, service user and their carers. This may mean social connectedness through the local community through opportunities to engage in meaningful activities in and outside the person’s home or the organisation’s direct services.

5. Environment
Creating an organisational environment that sees person centred care as its foundation and philosophy. For example delivering support that is tailored to the individual needs. This may mean providing information that the client understands, using appropriate language, even down to the simplified manner in which clients are informed about their accounts. For example time is taken to explain accounts, costs and fees deducted and
funds remaining so that the family and older person can make informed choices.

6. Valuing people during the assessment process
This will help to identify areas in need of improvement and help the client find ways of addressing them. A person-centred approach helps organisations provide accessible, responsive and flexible services that meet the diverse needs and preferences of people living in their community. Many of these individuals want to remain independent for as long as possible and rely on the community care system to help them achieve this.

What are the benefits of Person-Centred Care?

Person centred care:

• Allows consumers and their carers to have greater control over their own lives by allowing them to make choices about the types of care and services they access and how and when they are delivered.
• Supports staff to value and seek to know and understand the people they care for, to understand their experience and to support them to retain as much independence and dignity as possible
• Results in happier staff who want to stay in an organisation
• Means that organisations are well placed to provide culturally appropriate responses
• Enhances an organisation’s reputation and standing
• Provides the foundation for delivering Consumer Directed Care.

How can an organisation implement person-centred care?

Organisational structures and culture can be powerful influences on whether or not person-centred approaches are successful. Dementia Australia have a Valuing People Assessment Process tool which can help organisations to:

• Identify areas in need of improvement
• Plan the necessary steps for undertaking quality improvement activities and,
• Embark on a journey of organisational change This may require organisations to make changes to current structures and practices where:
• Consumers and their carers are at the centre of planning by involving them in decision-making about service development and delivery
• Treating staff in a person-centred way so they can, in turn, deliver person-centred care.

What is the difference between PCC and CDC?

Person Centred Care and Consumer Directed Care are central to Australian and State government health and aged care policies. Although they sound similar, in essence, they are quite different.
It is important that these terms are used correctly and that the fundamental differences and ways in which they are meant to work together are clearly understood.

Person-Centred Care is a whole of organization approach to care. It:

• Assesses the action and input of the person
• Provides skilled, supported and trained staff in CDC approaches to care
• Implements a whole of organisation approach including policies and practices which embrace PCC and CDC
• Values the independence and the wellbeing of all persons involved in the service provided

Consumer Directed Care focuses on delivering services where the consumers are given the opportunity and are supported to:

• Assess their own needs,
• Determine how, when and by whom these needs should be met, and
• Evaluate their services according to their own expectations.

Consumers have greater control over their own lives and well-being. An organisation which practices and implements

Person-Centred Care is able to effectively deliver activities, services and options using a Consumer Direct Care approach.

Both Person-Centred Care and Consumer Directed Care have come from the same philosophy but they are not the same thing:

Understanding the differences and using the terms consistently is incredibly important and improves the outcomes for all involved.

An Overview of the Various Approaches