LiveWell Care’s Angus Kerr was invited to address the Federal Minister of Aged Care, the Hon Ken Wyatt at a recent forum held by the Association of Aged Service Professionals. In Angus’ address he highlighted to the Minister the impacts of recent reforms in Home Care Packages and how policy makers can make it easier for consumers to exercise choice and control when accessing a Home Care Package. The below is an extract of his address;
Choice is a great thing, as long as the options are fully understood- Otherwise it is confusing.
Have you ever tried to choose something and been overwhelmed by the number of options available? Maybe you’ve browsed a extensive menu but ended up ordering a standard meal, or looked for a movie only to end up choosing nothing at all?
While we sometimes think of endless choice as being an irrefutable positive force, an increasing amount of research shows that excessive choice can produce what behavioral economists call choice paralysis. Faced with too many options, people find it harder to make decisions and often report lower satisfaction with the decisions they do make, even when these decisions are good.
Global best practice in support of older people clearly shows that greater choice and control for service users leads to better life outcomes and more efficient and effective services. This is why choice and control are the fundamental principles of Aged Care Reform.
But how might increased choice actually reduce consumers experience of choice and control?
Firstly, the current marketing practices in our sector make it next to impossible for participants to compare choices within or across providers. Most providers follow an All Things to All People approach, making broad brush statements about their values without much detail about what this looks like in action. We meet very few providers who can succinctly describe what sets them and their offering apart from others. If an organisation can’t describe what makes them the right choice, how can we expect consumers to do the same? The consumers we work with are often confused by the current system. They tell us they lack clear information to make informed decisions about providers. They have limited confidence in exercising choice because of difficulties comparing providers.
Secondly, the online Service Finder via My Aged Care, although enabling some price comparison (it is not compulsory for providers to upload this information) and being able to identifying areas of specialisation, the service finder does not enable consumers to explore and compare varying service models through this platform.
While the reforms will enable greater choice, our experience tells us it will also require more decision making. This will present challenges for consumers, let alone vulnerable consumers (e.g. those with cognitive decline, English as a second language, limited or no family support etc) and their families as they attempt to navigate their way through the system to choose a provider. We currently support consumers to exercise their rights to informed choice, so they are able to engage a quality provider that will tailor an individualised support plan while also providing ‘value’. Our concern is, if consumers are not able to easily gather the information required to make informed choices and don’t fully understand their options, they may opt out and fall through the cracks.
Beyond February 27 2017, we think there will be increased demand for support to assist consumers to choose and access a Home Care Package provider. All consumers will naturally want to choose a provider that meets their own individual needs, but they will also want to understand the varying associated costs and varying service models to help determine what presents as ‘value’ to them. The questions around who identifies an individual as being vulnerable and in need of support to access a Home Care Package provider, and where can this support be accessed, needs clarification. What we want is to avoid “choice paralysis”, that is, previously enthusiastic participants putting “choice and control” in the Too Hard Basket and simply choosing to keep their support arrangements as is or opting out.
Many of the consumers we support report they are unable to exercise significant choice and control of their aged care services with many saying they felt unsupported or uninformed to navigate a still complex system. The only way they know what providers offer and whether the services are any good is through first-hand experience or through information from others with first-hand experience. Our consumers have discovered that experience and developing clear expectations through supported investigation and decision making is critical because the information provided about a service does not necessarily match the reality.
What is currently being proposed to support vulnerable consumers?
My Age Care Contact Centre – Consumers who cannot navigate the online service finder can call My Aged Care Contact Centre staff who, via the service finder, can identify service providers and send consumers hard copy information on providers. Early indications are that many Home Care Package providers are advising, via the My Aged Care Service Finder, that they cater for all special needs groups, cultural, religious and language specialisations, as well as providing all specialised service offerings outlined. This is to ensure they do not to miss out on being displayed on any My Aged Care Service Finder search results. The intention was to support consumers identify providers who may specialize or have a focus in particular areas.
Age Care Assessment Teams (ACAT)- The My Aged Care Concept of Operations document indicates that assessors (ACAT in this context) will have capacity to support vulnerable consumers choose a provider.
“After the assessment has been completed, assessors will work with clients to match their assessed needs to suitable aged care services, and select their preferred service provider(s). For Commonwealth funded services, assessors will work with clients to select a referral method, i.e. an electronic referral in order of preference, an electronic referral broadcast to all available service providers, or a referral code that can be given to a service provider by the client. The assessor can also provide clients with contact details for non–Commonwealth funded services.” (My Aged Care Concept of Operations, Page 15 of 36)
This raises questions about the roles and responsibilities for such assessing agencies. Traditionally ACAT’s objective is to comprehensively assess the care needs of frail older people, assist frail older people to gain access to the most appropriate types of care, including approval for Commonwealth subsidised aged care services and improve the health and wellbeing of frail older people through the delivery of high quality ACAT assessment services. Although not technically expanding ACAT’s role, it does raise some concerns around their capacity and resources to fully explore the consumer’s options.
Historically, ACAT’s have tried to be seen as remaining independent by only providing a list of approved service providers operating in the geographical area of the consumer. If it is expected that ACAT’s will support consumers to “make choices” beyond this, then this in practice will be an added responsibility. We fear any lack of ACAT capacity (be it understanding of the varying providers service models, costs etc. or just lack of time and resources to fully explore the options with consumers) would cause an over use of ‘broadcast referrals’ to Home Care Package providers- completely stifling choice for those people who need the support most.
Draft National Aged Care Advocacy Framework – The framework outlines that the National Aged Care Advocacy Program (NACAP) provides free, independent, confidential advocacy support to older people who are suffering frailty or disability and receiving or seeking to receive Commonwealth-funded aged care services, including their families or representative. With regards to access and choice, the aims and objectives of the Framework are to ensure older people:
–can effectively interact with the aged care system;
-better transition between service types;
-be enabled and empowered to apply informed decision making to exercise their right to choice in accessing and receiving care.
Although within NACAP’s purview, the role of funded advocacy agencies and how they fit within the operations of My Aged Care and ACAT’s to support identified consumers to be empowered to access and choose a Home Care Package provider is unclear.
Actions Required: Development of Consumer Support Platform
So how can we make it easier for consumers to exercise choice and control in choosing a Home Care Provider? Is the answer to restrict the number of choices available to consumers? Certainly not.
There are conditions we can create that mitigate or eliminate the negative side effects of too much choice in a Home Care Package context.
Identify vulnerable people who may require support to access and choose a suitable Home Care Package provider.
From 27 February 2017, assessors (ACAT’s) will be able to identify a vulnerable client who may require extra assistance to enter into home care services via the ‘Goals & Recommendations’ tab of their support plan. The decision on whether a client is ‘vulnerable’ will always need to be based on the clinical judgment and reasoning of the assessor. By identifying a vulnerable client, an assessor will receive notifications in the assessor portal under ‘Tasks and Notifications’ whenever a client receives a letter on home care from the Department. ACATs can nominate themselves or someone else from their outlet to be contacted for a vulnerable client. At the point where it has been flagged with ACAT’s that the identified vulnerable person has been offered a Home Care Package a referral should be made to specialised independent advocate.
Where consumers have not have been identified by assessors as ‘vulnerable’ but My Aged Care has been notified that they require more time or support to access or choose a Home Care provider, a referral should also be made to a specialised independent advocate.
Development of a Consumer Support Platform- Providing specialised independent advocacy focused on ‘Access to Services’ for those who require or want support in choosing and accessing a Home Care Package provider.
Research shows that for people who know a domain well, more choice is better than less. This is great for consumers and their families who know the sector well and are eager to make the most of the opportunities available to them. For those without this insight, however, advocates are a critical piece of the puzzle that makes choice and control possible.
A need for face-to-face information and support as well as hard copy documents rather than online-only information will provide improvements to the quality and delivery of information and support given to consumers to help them better understand and exercise choice and control in aged care.
Advocacy is so much more than merely linking participants to providers and ensuring the committed supports are accessed. At its best, Advocacy engages participants in exploring what is possible through their Home Care Package. It provides them with clear expectations of what a Home Care provider can and indeed will provide. It reduces the administrative burden of choice and control and supports the consumer (with the chosen Home Care Provider) to put together a package of supports that genuinely facilitates progress towards their goals and wishes.
Older people, advocates, carers and families have worked so hard for so long to make increased choice and control in Home Care Packages a reality. The challenge now is to make sure we continue to break down the barriers that inhibit choice and control. We must ensure that all consumers and families can really make the most of the opportunities this reform presents.