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Home Care Today. | PW CDC Conversations Module 1 - CDC Setting the Scene | of 20

CONSTRUCTIVE CONVERSATIONS

WITH CONSUMERS

MODULE 1

Consumer Directed Care – Setting the scene

Participant workbook

LEARNING MODULES OVERVIEW These learning resources are provided for advisers/case managers working within community care environments. The aim of these modules is to enable advisors to embrace the thinking, skills and practice (TSP) for transitioning to and working in a Consumer Directed Care (CDC) model. It will provide participants with the knowledge and skills to work, and have conversations with consumers and their carers to achieve positive outcomes. The resources are designed to be delivered by an experienced trainer. The learning modules have been prepared for Home Care Today by CommunityWest Inc. a respected not-for-profit organisation with over 20 years' experience working alongside service providers in the home and community care sector.

Who can I contact for further information or assistance?

Please feel free to contact us for assistance or conversations regarding the implementation of CDC.

Email us at: [email protected]

Phone: COTA Australia 03 9909 7910

DISCLAIMER

This website provides some general practical advice for Home Care providers and is not intended as legal or financial advice. This website should not be the only source of information for providers of Home Care. Home Care Today encourages anyone who has questions about providing Home Care to get the relevant professional advice to discuss their organisation’s particular situation.

Home Care Today makes this information available on an as is basis. Home Care Today makes no representations or warranties of any kind with respect to the contents of the information. To the maximum extent permitted by law, Home Care Today disclaims any such representations or warranties as to the completeness, accuracy, merchantability or fitness for purpose of the information.

This work is licensed under a Creative Commons Attribution-Non-commercial-Share Alike 4.0 International License.

http://creativecommons.org/licenses/by-nc-sa/4.0/

CONTENTS

Training overview .................................................................................................................. 4

Section 1 CDC: Setting the scene – an introduction ............................................................... 5

1.1 About this module .................................................................................................. 5

1.2 Key concepts ........................................................................................................... 5

1.3 Aim ......................................................................................................................... 5

1.4 Objectives ............................................................................................................... 5

1.5 Methodology .......................................................................................................... 6

1.6 Participant workbook .............................................................................................. 6

Section 2 Consumer Directed Care ........................................................................................ 7

2.1 Overview of CDC ..................................................................................................... 7

2.2 Setting the scene .................................................................................................... 8

2.3 What is CDC? .......................................................................................................... 8

2.4 Timeline for CDC ................................................................................................... 10

2.5 Guiding principles of CDC ...................................................................................... 10

2.6 Why implement CDC? ........................................................................................... 11

2.7 What older people say they want.......................................................................... 11

Section 3 Service centred ersus person centred and consumer directed ............................. 13

3.1 Activity .................................................................................................................. 13

3.3 Person centred, person centred approaches, person centred planning ................. 15

3.4 Establishing person centred partnerships .............................................................. 15

3.5 Activity – person centred support ......................................................................... 16

Bibliography and further reading ........................................................................................ 17

Home Care Today PW CDC Conversations Module 1 - CDC Setting the Scene of 20

TRAINING OVERVIEW

This training is provided for advisers working within Home Care environments. The aim of these training modules is to enable advisors to embrace the thinking, skills and practice (TSP) for transitioning to and working in a Consumer Directed Care (CDC) model. It will provide participants with the knowledge and skills to work and have conversations with consumers and their carers to achieve positive outcomes.

For the purpose of this training the preferred terminology is ‘adviser’, however other names that may be used in the sector could be ‘case manager’ or ‘coordinator.’

There are numerous skills that advisers need to facilitate positive consumer outcomes. Each adviser will develop their own personal style. Some of these are learned informally through life whilst others are learned theoretically and developed through formal training.

There is an assumption that advisers completing this training will be familiar with and understand essential adviser skills.

Some of these include:

interviewing

communication

critical thinking

negotiation and collaboration

advocacy and mediation

awareness of diversity.

This training aims to provide advisers with the skills and tools to work in a CDC model to support people to remain living at home for as long as possible. It also aims to equip them with knowledge that can enable consumers to have choice and flexibility in the way that care and support is provided at home. Quotes, ideas and tools will be embedded throughout the modules as will the underpinning values and principles of CDC.

The content of these training modules is centred on giving advisers the tools to create partnerships and build relationships with consumers. The training includes practical strategies to have empowering conversations with consumers from their first point of contact through to monitoring, review and potential exit.

This training is broken into five training modules that can be used as a full training session or standalone units.

The five modules are:

Module 1: Consumer Directed Care - Setting the scene

Module 2: How to Work within a Consumer Directed Care model

Picture source: iStock


Module 3: Supporting consumers to live a good life

Module 4: Consumers continuing control of their lives

Module 5: Our approach counts.

The training explores theoretical concepts of CDC and the key principles that underpin this approach in Home Care environments. Practical activities and videos are used throughout each module to reinforce CDC philosophies and principles as a wellness and enablement framework. Videos are a central component of the training that include interviews with subject matter experts, advisers and consumers. Quotes, ideas and tools are embedded throughout the modules, with the underpinning values and principles of CDC.

A recommended reading list is provided for each module, with reference to other training that is available and that may be useful.

SECTION 1 CDC: SETTING THE SCENE – AN INTRODUCTION

1.1 About this module

Welcome to Consumer Directed Care: Setting the scene developed by CommunityWest. This module provides a brief and essential summary of Consumer Directed Care (CDC) including an overview of key values, philosophies and principles that underpin CDC.

1.2 Key concepts

The key concepts that are central to this workshop are:

overview of CDC

traditional service model versus a CDC model

customer service

person centred planning and approaches.

1.3 Aim

This workshop aims to assist staff to understand the philosophy of CDC provided within a wellness framework.

1.4 Objectives

The workshop objectives are to:

provide a brief overview of CDC

make a comparative analysis between CDC and traditional packaged care

identify strategies to implement and maintain a self-directed culture with consumers

building on the importance of inclusivity, respect and partnership



person centered planning overview within a CDC model.

1.5 Methodology

The module is designed to be interactive; providing information to enable advisers to support clients within a CDC model. The material is developed within a practical and reflective framework and is designed to be delivered as a facilitated workshop. It will be activity based with workshop participants’ learning being drawn from their reflections and responses to the activities and peer discussion. Brainstorming, sharing experiences and visual tools are utilised to enhance personal reflection and peer and facilitator engagement.

1.6 Participant workbook

This Participant workbook is designed to provide a resource for advisers to utilise during and post workshop. Each session will be outlined along with associated reference material.

Picture source: CommunityWest


SECTION 2 CONSUMER DIRECTED CARE

2.1 Overview of CDC

CDC introduces a significant paradigm shift within the Australian residential and Home Care environments. It is a move from a service-led industry to a consumer driven one as individuals are enabled and encouraged to have greater control over their support. CDC initiatives aim to provide consumers with the decision making by allowing them (to the extent that they are capable and wish to do so) to make informed choices about the type of care and support they access. In addition, it enables greater consumer choice regarding the delivery of those services including who will deliver the services and when they are delivered (KPMG 2012). The Home Care Packages Program replaces the former Community Packaged Care Programs which comprised Community Aged Care Packages (CACPs), Extended Aged Care at Home (EACH) packages and Extended Aged Care at Home Dementia (EACHD) packages. There is not a minimum age requirement for eligibility purposes regarding CDC, but the Home Care Packages Program is targeted at frail older people. In 2011-12, the average age of admission into a CACP, EACH or EACHD package was 81 years. For Aboriginal and Torres Strait Islander people the average age of admission into a package was 66 years.

In some cases, younger people with disability, dementia or special care needs may be able to access a Home Care Package – if the person has been assessed and approved by an Aged Care Assessment Team (ACAT) and a Home Care provider is able to offer an appropriate package for the person.

The 2013 Home Care Package Program guidelines recommend CDC packages should be offered within a wellness/reablement framework to enable the consumer to be as independent as possible, potentially reducing the need for ongoing and/or higher levels of service delivery. This recent change in has a direct influence on businesses providing services to these consumers as individuals are enabled to exert choice and control over matters affecting their lives.



2.2 Setting the scene

CDC is both a philosophy and an orientation to service delivery where consumers, including care recipients and their carers, can choose and control the services they receive to the extent that they are capable and wish to do so (ACSA 2010).

The main objective of CDC is to offer consumers more choice and control than they would have had from traditional and agency directed programs (Tilly & Rees 2007).

2.3 What is CDC?

The Australian Government defines CDC as care that:

“…allows consumers to have greater control over their own lives by allowing them to make choices about the types of care they access and the delivery of those services, including who will deliver the services and when.” (Dept. of Health and Ageing, Australian Gov. 2013)

Basic principles of all person centred approaches are:

keeping the person at the centre

treating family and friends as partners

a focus on what is important to the person

an intent to build connections with the community

being prepared to go beyond conventional service options, and

continuing to listen and learn with the person.

“The overarching aims of self directed (consumer directed) support are about enabling people who need support to move away from formal mechanisms of delivery where services, agencies and professionals retain control to a situation where people can live independently and have control over their own lives, and make real choices about the nature and level of support they access from a wide range of networks, options and opportunities.” (Bowers et al 2008)

“A ‘one person at a time’ approach. It starts in the heart and mind of the worker, the supporter, the advocate, the citizen, in me and in you.”

(Simmons 2008)



Note space - include ideas, insights, queries and comments



2010

Pilot of CDC delivery begins.

2011

Productivity Commission report recommends move to CDC.

April 2012

Living Longer Living Better reforms announced including move to CDC.

1 August 2013

All Home Care packages allocated from this date to be applied for and delivered on a CDC basis.

1 July 2015

All Home Care packages to be delivered on a CDC basis from this date.

2.4 Timeline for Consumer Directed Care

The following diagram depicts the timeline for the introduction and implementation of CDC in Australia.

Consumer Directed Care timeframe

(KPMG Consulting Group 2012)

2.5 Guiding principles of Consumer Directed Care

The guiding principles for CDC are to enable consumers to experience greater:

choice and control

upholding of dignity and rights

respectful and balanced relationships

transparency

participation and partnership

wellness and enablement.



2.6 Why implement Consumer Directed Care?

CDC was implemented due to:

changing consumer expectations.

people wanting more choice and control.

current system being viewed as extremely complex.

research which shows that people are healthier and happier when they have more control over their lives.

services wanting and needing to be competitive.

government direction to provide CDC.

2.7 What older people say they want

Older people and younger people with disability are changing their mindsets towards how they want to live their lives and towards the type of support services they want. They are requesting that support is more flexible, targeted to their needs and wants and is provided in a manner that upholds personal choice and control.

CDC can deliver what people say they want if the right structures attitudes and values are in place to underpin this form of support.

Older people say they want:

choice and control over their lives/services

to strive to be oneself not withstanding any limitations

to be known and understood

individualised, targeted, flexible and enabling support

enhancement of health and wellbeing

connection and contribution to the community.

Quotes provided by older people include:

“I want to be known and understood.”

“It's not just what you do...it's how you make me feel.”

“Know what I can do and support me to do it.”

“Remember, all the little things add up.”

“Remember…I’m more than the sum of my parts.”



Older people say

(CommunityWest 2013)



SECTION 3 SERVICE CENTRED VERSUS PERSON CENTRED AND CONSUMER DIRECTED

3.1 Activity

Using the service centred statements as a guide, complete the person centred and consumer directed statements. The statements should demonstrate the differences between types of delivery.

Service centred Person centred Consumer directed

Planning for

Talking about you

Doing things to you

Following a program

Live where you ‘fit’

Start with what’s wrong


Health and safety determine what you do

Words like ‘let’, ‘allow’ and ‘place’

Lifeless plans updated annually

You learn the next step



3.3 Person centred, person centred approaches, person centred planning

Person centred – attitudes and values that honour a person’s unique individuality and perspective and are concerned with their full inclusion.

Person centred approaches – a range of ways in which we can make our own practice more respectful of a person’s choices and wishes.

Person centred planning – a process of individual discovery and action that assists a person to live the life they want to live and find their place in their community. (Simmons 2010)

Self-direction is about the choice and control over assistance and support needed to live daily life. It is about people’s lives and improving their quality of life and sense of control. It is not about service based solutions.

With older people the work is about rebuilding or renewing control for people who have lost control due to ill health, exclusion, discrimination or life events.

3.4 Establishing person centred partnerships

Person centred approaches are a key feature of successful consumer directed support. CDC programs typically include person centred approaches to needs assessment and planning resulting in a goal focused, individual care plan.

CDC necessarily means more active involvement of the consumer in the planning and design of the supports they receive. The development of a person centred individual plan considers the strengths, needs and goals of the consumer, as well as their family/carer and life circumstances.

Building effective person centred partnerships can motivate individuals to improve their health, wellbeing and quality of life.

The key to establishing effective person centred partnerships include:

appropriate attitudes and behaviours

individual empowerment

upholding dignity and respect.

The most important thing for advisers to get right from day one is to view the consumer as a partner. The following quotes sum up some of the most important aspects of CDC:

“It is not all about the fact that we will give you more choices. It is about how we can work together to design the best package of support for you.”



“A wellness/enablement approach starts with understanding what a ‘great day’ or a ‘great life’ might look like for the consumer. From there, aim to understand what strengths and attributes a person has to realise their potential, and specifically, what challenges they have in achieving their goals on a day‐to‐day basis.”

“There is an inherent contradiction on the surface between the philosophy of choice and control and enablement, which means providers must also take on the role of educator.”

(Hilary O’Connell 2012) For example, to give an older person the basic choice between having their cleaning done or undertaking an exercise program to be able to do it themselves may be problematic as the consumer may choose the least taxing option. Focusing on healthy living and options that can maximise wellbeing will have a flow on effect to basic tasks of daily living.

3.5 Activity - person centred support


“You spend your whole life making decisions about things – your work, your relationships, your children – you don’t want to suddenly give up that responsibility because you are older.”

(Bowers et al 2008)



BIBLIOGRAPHY AND FURTHER READING

Helen Sanderson and Assoicates, 2013. Person centred planning. [Online] Available at: http://www.helensandersonassociates.co.uk/reading-room/how/person-centred-planning.aspx [Accessed 20 June 2014].

Aged and Community Services Australia, 2010. Guiding Principles for Consumer Directed Care, South Melbourne: Aged and Community Services Australia.

Aged and Community Services SA and NT, 2011. Imagining a Better Life for Older People, Coordinators Handbook. Adelaide: Better practice project.

Australia Bureau of Statistics, 2004. 4430.0 - Disability, Ageing and Carers, Australia: Summary of findings 2004, Canberra: Australia Bureau of Statistics.

Australia, Aged and Community Services, 2010. Guiding Principles for Consumer Directed Care, South Melbourne: Aged and Community Services Australia.

Australian government, Department of Health and Ageing, 2008. A New Strategy for Community Care, The Way forward Revised edition, Commonwealth of Australia: Department of Health and Ageing.

Australian Government, Department of Health and Ageing, 2013. Living longer Living Better. [Online] Available at: http://www.livinglongerlivingbetter.gov.au/internet/living/publishing.nsf/Content/Consumer-Directed-Care-Home-Care-Packages [Accessed 20 June 2014].

Bowers, H. et al., 2008. Person Centred Thinking with Older People: Practicalities and Possibilities. [Online] Available at: http://www.helensandersonassociates.co.uk/reading-room/who-/older-people.aspx [Accessed 21 August 2013].

Cumming, E. & Henry, W. E., 1961. Growing Old, The Process of Disengagement. New York: Basic books.

Gerald Wistow, E. W. a. M. G., 2003. Living Well in Later Life: From prevention to promotion. Universtiy of Leeds: Nuffield institute for Health.

Glasby, 2011. Whose Risk is it Anyway? Risk and regulation in an era of personalisation, York: Joesph Rowntree Foundation.

Helen Sanderson Associates, n.d. Person Centered Thinking Tools. [Online] Available at: http://www.helensandersonassociates.co.uk/reading-room/how/person-centred-thinking/person-centred-thinking-tools.aspx [Accessed 21 August 2013].


Kendall, E. & Rogers, A., 2007. Extinguishing the Social?: State Sponsored Self-Care Policy and the Chronic Disease Self-Management Programme. Disability and Society, Volume 22, pp. 129-143.

KPMG, 2012. Evaluation of the Consumer Directed Care initiative: Department of Health and Ageing. [Online] Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/F072F0C75198E936CA257BF0001A35BF/$File/CDC-Eval-Final-Rep.pdf [Accessed 20 June 2014].

Laragy, C. & Naughtin, G., 2009. Increasing Consumer Choice in Aged Care Services: A position paper, Melbourne: Brotherhood of St. Lawerance.

McMurray, A., 2007. Community Health and Wellness: a socio- ecological approach. 3rd ed ed. Sydney: Mosby Elsevier.

Naughtin, C. L. a. G., 2009. Increasing consumer choice in aged care services: A position paper, Melbourne: Brotherhood of St. Lawerance.

Neill, M. et al., 2008. A Positive Approach to Risk Requires Person Centred Thinking. [Online] Available at: http://www.helensandersonassociates.co.uk/media/15308/a%20positive%20approach%20to%20risk%20requires%20person%20centred%20thinking.pdf [Accessed 21 August 2013].

Philips, S., 2013. How to Protect your Organisation in a Consumer Directed Era. Australia, Kennedy Strange Legal Group.

Rees, D. J. T. a. G., 2007. Consumer-directed care A way to empower consumers?, Australia: Alzheimer's Australia.

Sciacca, K., 2009. Motivational Interviewing - MI, Glossary & Fact sheet. [Online] Available at: http://www.motivationalinterview.net/miglossary.pdf [Accessed 20 June 2014].

Simmons, H., 2010. Person Centred Thinking, Working and Planning: A presentation for the better practice project. s.l., s.n.

Tilly, D. J. & Rees, G., 2007. Consumer Directed Care: A way to empower consumers?, Australia: Alzheimer's Australia.

United Kingdom Department of Health, November 2010. A Vision for Adult Social Care: Capable Communities and Active Citizens, United Kingdom: Department of Health UK.

United Kingdom, Department of Health, 2007. Independance, Choice and Risk: A guide to best practice in supported decision making, United Kingdom: Department of Health UK.


United Kingdom, Department of Health, November 2010. A Vision for Adult Social Care: Capable Communities and Active Citizens, United Kingdom: Department of Health UK.

Weik, A., 1992. Building a Strength Based Perspective for Social Work In D saleebey (Ed.). New York: Longman.

William, C. E. a. H., 1961. Growing Old. New York: Basic books.

Wistow, G., Waddington, E. & Godfrey, M., 2003. Living Well in Later Life: From prevention to promotion. Universtiy of Leeds: Nuffield institute for Health.

ABOUT US Home Care Today is a national resource that aims to support both consumers and Home Care providers to make the most of the implementation of consumer direction in Home Care packages.

Home Care Today supports consumers accessing Home Care by providing information, resources and peer supports to make the most of the benefits and opportunities that CDC can offer.

To providers Home Care Today offers a range of tools, resources, and learning modules that will assist them to implement CDC across their organisations.

Who can I contact for further information or assistance?

Please feel free to contact us for assistance or conversations regarding the implementation of CDC.

Email us at: [email protected]

Phone: COTA Australia 03 9909 7910

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