An innovative trial in Western Australia has been piloting the concepts of client choice and control in the Home and Community Care program, including giving clients the option of engaging their own support worker. Linda Belardi reports.
With consumer directed care now embedded across all home care packages, an Australian-first trial has sought to design and test a model of self-direction in Home and Community Care (HACC) in Western Australia.
The project, which commenced in May 2014, was a collaboration between the WA Department of Health, two home care providers – Avivo (formerly Perth Home Care Services) and MercyCare – and the Regional Assessment Services (RAS) from Perth north and south metropolitan areas.
The pilot broke new ground by being the first to experiment with individual budgets in HACC. Clients were given an individual allocation of HACC funding based on their needs, as determined by the RAS. They were then encouraged to exercise choice and control over the services and supports they purchased. Client outcomes were assessed by Curtin University over a two-year period and, at the time of writing in late October, a final evaluation report was being prepared for the WA Government.
In total, 103 clients participated in the project – 74 Avivo customers and 29 from MercyCare, and the majority were aged over 65. While Avivo has a 10-year history of supporting older people and people with disabilities to self direct their services, MercyCare was relatively new to the approach.
Rosie Lawn, CEO of Avivo, said trial participants had greater autonomy and flexibility to choose and direct their support and services to meet their individual needs. Clients were also encouraged to think creatively about how to maximise their HACC funds.
Some examples of the tailored and flexible ways Avivo clients used their funding included enrolling in an online education program and purchasing a one-off service with a home decluttering specialist.
Another client modified his garage, which was his preferred environment for socialising and connecting with family members.
Lawn said in a self-directed model the focus shifted from simply receiving a service such as cooking or cleaning to the pursuit of particular goals or life outcomes.
“The focus becomes more on what’s important, missing or could be explored,” she told Community Care Review.
“With a focus on outcomes over service delivery people can choose to become more engaged with their communities, build friendships, pursue education and get out of the home.”
Instead of slipping into typical patterns of solving problems or ways of providing support to people, Lawn said a model of self direction encouraged more personalised and client-focused outcomes.
“Self direction is based on the belief that people are the experts in their own lives and are best placed to know what they need and what will work for them.”
By having control, knowing where funds are spent and being able to adjust services and supports, a feeling of independence is restored to the individual, she said.
MercyCare’s manager of innovation and development Bev Wheeler said in addition to purchasing traditional services, trial participants used their HACC funding more flexibly. For example, some clients purchased a piece of equipment to support their independence or chose to use taxis rather than HACC transport.
Choice of support worker
Pushing the boundaries of CDC, the trial also supported clients to directly employ or contract their own support staff. This option has been operating in the disability sector and in CDC models internationally.
Clients in the pilot were not permitted to employ family members as support workers and the service provider managed payment of the worker.
At Avivo, Lawn says support workers were primarily engaged through an independent contracting relationship and were sourced through avenues such as local community networks, an existing service relationship, via private advertising or using online matching platforms.
Carlo Calogero, executive director of aged care services at MercyCare, said two of the 29 trial participants elected to directly employ their own worker.
He said supporting a person to engage and roster their own staff advances the government’s agenda on consumer choice and control.
“This isn’t a model for everybody, but it allows a greater level of choice and control,” he told CCR.
“There will be consumers in the aged care sector who will want to have a lot more say in directly managing their workers, and there will be other people who will want to have a service that’s fully controlled and managed by the service provider. This option provides that continuum.”
He said an advantage for clients in engaging their own worker is that services are price competitive due to reduced administration costs, which means client budgets stretch further.
By saving on admin charges, the client can choose to pay their worker a higher rate than what is offered by the industry, which has occurred in the trial, he said.
A MercyCare client who chose to employ her own support worker said she felt empowered by the process and regarded as an equal partner, said Calogero. By controlling who and when a person entered her home, she reported feeling safer and more satisfied with her supports.
There can also be better matching of client with worker under this arrangement.
“The client knows what they want and they can pick out the people to fit in with their needs, values and personality,” said Calogero.
Better communication and greater flexibility over when services can be delivered by the support worker are other benefits, said Lawn.
Like Calogero, she said supporting clients to engage their own worker is one option that sits along a continuum of self direction. It’s not for everyone, but for those with the preference and ability, it provides an additional degree of control.
Wheeler said MercyCare’s advisors acted as a critical safeguard in this model by assessing a person’s ability to self-manage and provided support and advice to the client when required.
“It’s not a case that the client wants to engage their own worker and we leave them to it.”
MercyCare developed a resource guide for clients and the person was supported to ensure the appropriate insurances, police and reference checks were in place.
Staff could also be involved in helping the client write an advertisement or be present during the interview process, if the client wished.
“To ensure this functions well for people, the appropriate systems, processes and resources need to be in place to provide that support,” said Calogero.
Lawn said under a self-directed model the role of the service coordinator transitions to providing information, support and advice to assist older people to manage as much as possible for themselves. “This requires a flexible approach that puts the choices firmly in the hands of the customer,” she said.
“It’s much more of a guide and advising relationship and working alongside the person, but also stepping back when you can, rather than coordinating services.”
In addition to the support and oversight provided by advisors, Lawn said ensuring compliance with the program guidelines and the role of the RAS were other important safeguards throughout the trial. The RAS were involved in approving the person’s budget plan and in ongoing client reviews.
She said the model also helped to tap into community networks and build stronger relationships. “People can choose and use local services from trades to personal supports, which builds local community around that person.”
The annual mean cost for setting up a participant was estimated at $815 and the average annual funding package for ongoing support of a participant, including funds to purchase goods and services and provide staff support was $4,541, she said
For Lawn, some of the challenges in the pilot involved building the confidence of the person to self direct and finding supports that were a good fit.
A new opportunity for providers
Calogero said by supporting clients to engage their own worker, service providers could compete with the online matching platforms such as Better Caring and add on additional services such as professional supervision and training of the chosen worker to further safeguard the client.
“It’s an opportunity for providers to maintain consumers and not lose them to the disruptive services.”
He said providers could offer this model of self-direction in parallel with traditional services.
MercyCare was now looking to offer the option of clients engaging their own worker in the home care packages program, he said.
This article appears in the current edition of Community Care Review magazine.
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