Critique of Consumer-Directed Care: Health and Socio-Political Issues

This essay provides a comprehensive analysis and critique of consumer-directed care (CDC) within the Australian aged care system. It explores the political, legal, and ethical principles underpinning the CDC model, highlighting its philosophical background rooted in choice, control, and consumer preference. The essay discusses the implementation of CDC in Home Care Packages, emphasizing the increased flexibility, consumer involvement, and transparency. It also examines the roles and responsibilities of care providers and the different models of case management within CDC. The critique focuses on the impact of government policies and the involvement of various stakeholders, including aged individuals, service providers, and organizations like COTA and ACAT/ACAS, in shaping the delivery of aged care services. This document is available on Desklib, a platform offering study tools and resources for students.

Running head: HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 1
Health and Socio-Political Issues in Aged Care
Student Name
Institution

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 2
Introduction
Consumer-directed care (CDC) refers to the care developed for aged people living in
Australia where consumers are given choice and control of the service they receive. The CDC
model takes into account choice, control, independence and flexibility to better the service
delivery of home care. The government of Australia incorporated the consumer-directed care
into all the Home Care Packages throughout the country to be given on the CDC basis. The
whole care model employs a collaborative approach that enables both client and Provider to
develop a plan and manage the plan together. Approved Home Care Package that offers
consumer-directed care receives funding from the government. The provider and consumer
develop a budget that is continuously monitored and re-assessed to ensure that the goals of the
care are met. There are some other principles that foster the consumer-directed care and these
include legal principles, ethical principles and political basis of the CDC. For instance, the
government through the policy of better living develops the consumer-directed care that is also
incorporated into all the Home Care Packages. The consumer-directed care is also supported by
the Aged Care Laws that emphasis on the consumer right protection. The following analytical
paper provides that critique and analysis of the consumer-directed care (CDC) as offered in aged
care.
Critique consumer-directed care
Consumer-directed care (CDC) can be described as a health care model that involves
giving consumers opportunity to choose caregiver, control or manages the type of care given to
them. CDC model emphasis on the flexibility and choice of the care hence consumers feels the
sense of independence and flexibility. The elderly people are given the opportunity to choose the

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 3
caregiver and type of care with flexibility. The CDC has been incorporated into various care
models such as home care to improve the care services given to aged people within the
community. The government developed a policy to improve the lives of citizen with more focus
on aged people in the society (Bradley, 2017).
Understanding the consumer-directed care require a more understanding of the
underlying principles of political, legal and ethical principles. Firstly, the CDC has political
background since the Australia government developed the policy of better living aim to improve
the care for older people in the country. Since 2012, the government through the ministry of
health has come up the service delivery model that allows the consumer to have choice and
flexibility. The ministry first commences the CDC within the year 2010 to 2011 showing the
success that enables the model to be used since 2013. The political nature of the care is also the
promoting factor that influences the funding of the service that is delivered within the Home
Care Packages (Delp & Muntaner, 2011).
Secondly, the CDC is baked by legal principles that are majorly engraved on the Aged
Care laws (User Rights Principles 2014). The legal basis of the care is based on the client's rights
and freedom to make choice. Within the Aged Care laws people rights are used to design or plan
care with a view to better the care or living condition of these people. Respecting the rights of
aged people is an important factor when giving service to these people. Moreover, the ability of
the client to make their choice when it comes to the caregiver and the type of care is a
fundamental aspect of CDC. The legal basis of the care is also a contributing factor that has to
enable the care to be embraced within the health system of Australia (Department of Social
Services, 2014).

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 4
Thirdly, the ethical principles that are used in the consumer-directed care include the
independence of human and the need for choice. Within the ethical framework choice and
autonomy are two important factors that are used in the determination of the service delivery. In
addition, elderly people being mentally impaired do not make them lesser people and need
independence. This implies that there is a need for respect for people's choice is an important
determinant of the quality of care and is used to drive the basic model of CDC. Moreover, the
flexibility is also part of the ethical consideration that fosters normal working of the CDC. A
quality health care system requires high regard for human autonomy and this is an important
factor used to develop the consumer-directed care (Gunn & Rolf, 2013).
Philosophical background of the consumer-directed care lies on the principle of choice,
control, and preference of consumers. Consumer’s choice is paramount for effective and quality
service and this enable provision of care to aged people in the community. Consumers are also
given chance and opportunities express themselves in the care management service. Preference
of customers remains the most important aspect of the consumer-directed care and also forms the
core philosophy of the care model. Moreover, the consumers that are mostly elderly people are
given chance to determine the type of service and the kind of service delivered to them in home
care. Home care packages were rebranded to include these aspects of the consumer-directed care
so as to improve the care offered to aged people in the community. Consumers are also given a
part in the management of the care given or provided in the home care (Department of Health,
2016).
The Home Care Package was redesigned with the CDC model to help better the care
given to aged people in homes. Consumer-directed care was first incorporated into home care

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 5
packages in 2015 and this was used to ensure that all the Home Care Package is given on the
CDC basis. Various principles of the CDC have been used in home care packages and this makes
the lives of aged people better. The first principle of CDC that has been used in Home Care
Package is more choice and flexibility that give a more flexible care service to homes
(iCareHealth Blog, 2013). Secondly, consumers are given support to decide on care given to
them and the information on the care hence consumers can make a decision the type of care.
Thirdly, the partnership is also part of the model enabling a better quality of participation among
parties involved in the consumer-directed care. Fourthly, consumer-directed care enables a high
level of transparency since consumers are involved at various levels. The last principle that is
applied to Home Care Package is wellness and reablement adds more value to the care making
the care better as compared the previous home care (COTA Australia 2017).
Consumer-directed care enables the care providers to fulfill certain obligations and these
also include influence service delivery. Firstly, service providers discuss the care service with
their client based on the consumer needs and goals. Goals and needs enable both caregiver and
the client to develop the plan of activities. Secondly, caregivers are expected to show
transparency to clients on the funding and the amount of the funds that are available to the Home
Care Package. Thirdly, care providers will agree on the level of involvement that caregiver and
the client are expected to show. Lastly, the service provider is also expected to assess the Home
Care Package and monitor the whole program to ensure that the service is appropriate to clients.
The service providers are therefore expected to play an important role in the care with the help of
their clients that form part of care service (Shinan-Altman & Liat, 2017).

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 6
The case management of the consumer-directed care can be divided into individual direct
management or representative management. Firstly, the individual consumer is directly involved
in management or control of care service in collaboration with the service provider (Net
Industries and its Licensors, 2018). Consumers within this care program are also given sole
responsibility to manage the care they receive from care providers. Secondly, the consumer can
be involved in the management of the service delivery through a representative. Since the
consumer-directed care requires consumer consent and their preference, this can be through a
designated representative. Lastly, the consumer-directed care program also involves many
different types of case managers that are supposed to arrange and monitor the CDC within the
community (Chuanmei, Dunt & Doyle, 2014).
Critically discuss consumer-directed care
Consumer Directed Care (CDC) is the care that involves choice and control as applied in
aged care. Consumer-directed care offers a ground to bother caregiver and the client to choose
the type of care given and the caregiver at home. Care service provider forms a partnership with
the client to ensure that there is a choice of the care required and the client goal. The policies of
the government of Australia have put more emphasis on the need to make lives better for aged
people living in the country that is on the rise (Stacey, 2011). The government of Australia in
2012 developed a policy dabbed Government’s Living Longer Living Better aged care with the
main focus on making the aged care more flexible and the consumer has a choice on the type of
care. This created the need for a practice that includes choice and control hence the consumer-
directed care. Three area that the consumer-directed care involves include are managing of care
service, the cost of the service and the spending of the cost of care between caregiver and the
client. In addition, the consumer-directed care enables the client to have greater independence

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 7
during the care and control of care to the service. This implies that the client together with the
caregiver is involved in developing a plan for care and budget for the care service (Moorman &
Macdonald, 2013).
Characteristics of consumer-directed care involve various issues that enable the service to
reach numerous aged patients throughout Australia. Firstly, the client has said in the type of
service they receive, the way the service is delivered, and the caregiver that is involved in service
provision. Secondly, the client and the care provider are both involved in developing the plan for
the care. The plan that is developed can be budgetary plan or the plan of activities that will be
undertaken by the client and caregiver. Thirdly, the client determines the much involvement that
is needed during the care and the management of the involvement. The involvement can be in
terms of the number of the hours that the caregiver and the client are supposed to be together.
Fourthly, the consumer-directed care also gives the client opportunity to understand the funding
of the care and spending of the care funds. Funding element of the program is also
communicated to the client in order to understand the spent and unspent funds available for the
program. Lastly, the consumer-directed care enables the client to evaluate the level of which the
care is meeting the need of the client (Edward, Louise & Sara, 2015).
There are many stakeholders that form part of the consumer-directed care model and
have a high impact on the service delivery of aged care. Firstly, the government is a major
stakeholder that offers an important political, legal and funding for the model. Secondly, the
people especially the aged people within the home care setting are key stakeholders since they
form the main people that the care intends to benefit. Thirdly, the service providers are also part
of the system and are involved in planning and delivery of service. The caregivers work in

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 8
collaboration with clients to ensure that the service delivery is successful. Lastly, there are some
other organizations that are also stakeholders for the model and these include COTA, and
ACAT/ACAS (Beeuwkes, Haviland, McDevitt & Sood, 2011).
Funding of consumer-directed care (CDC)
There are many different sources of funds that are sued to foster the consumer-directed
care. Firstly, at the pilot stage of the Home Care Packages due to the incorporation of the
consumer-directed care model and was funded by Commonwealth. The Commonwealth funding
lasted during the pilot program that showed success leading to more need for the consumer-
directed care (Paraprofessional Healthcare Institute 2015).
The government of Australia provides the send funding solution for the consumer-
directed care. All the approved Aged Care Providers (Providers) are funded by the government
of Australia in order to provide Home care packages (Myagedcare, 2016). In order for the
homecare to receive the funds from the government, the care provider assesses the consumer on
their entitlement to service. The provider together with client develops a care plan that is
assessed and evaluated regularly. The care plan that is delivered to the consumer is closely
monitored and re-assessed periodically to ensure that it complies with the set standards (Kristen,
2015). Funding of the care program is meant to show commitment to offer quality care to people
within homes for a better living. In order to recognize this funding, the provider is expected to
recognize funds inform of unspent funds or deferred revenue. One of the issues within the care is
the fate of the unspent funds especially when the client changes the provider. These funds are
recognized based on the evidence that is available and enable the consumer to switch
automatically to another provider. The funds can behold by the provider for 28 days awaiting the

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 9
consumer to return; funds can be transferred to a new service provider or retained within the
home care for other consumers. The number of funds received from the government to provide
the consumer-directed care normally reach a maximum of $12,000 per year. Some other
expenses include the purchase of wheelchair and this requires high commitments to be shown by
the provider and client (Jenay, McBride, Tracy & Wendy, 2014).
Positive of consumer-directed care
The overall analysis of the consumer-directed care shows that the model of care is
beneficial and these are felt within the community of people living in Australia ranging from
towns to remote places within the country. Consumer-directed care has shows some positive
impacts or benefits when applied in the provision of care to aged people. Firstly, the consumer-
directed care (CDC) gives flexibility care that enables the aged people to receive better care as
required by the government of Australia through better living care policies. The flexibility of the
care is felt not only among clients but also among care providers (Iecovich, 2011). Secondly, the
consumer-directed care enables people under consumer-directed care to have choice and control
that make the everyday life better and enjoyable. The power of choice rests on the cognitive
capability of the client and enable them to make an informed decision during the service
delivery. Thirdly, the consumer-directed care provides clients with service satisfaction and
wellbeing that improves the lives of aged people. The characteristics of the care especially the
autonomy, choice, and flexibility make the CDC satisfactory and fit the need of consumers.
Lastly, the consumer-directed care is cost-effective care that is also coupled with better
outcomes. When comparing the cost and the benefit of the consumer-directed care, the whole
model has proved to be cost-effective (Ce et al., 2015).

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 10
Negative of consumer-directed care
Despite the benefits of the consumer-directed care (CDC), there are some negatives of the
model that can reduce its impacts or require improvement. Firstly, the client is always able to
control or manages the care given to them and this makes the consumer-directed care model not
applicable in some places. For instance, a client with cognitive impairment and frail elderly
people have limited ability to manage their care (Ashley, Hester & Leslie, 2017). Secondly,
balancing of funds to meet the client’s needs is challenging since there are many different needs
that also needs attention and funds. Clients and the service provider are both involved in
planning and budgetary planning and this can be tricky for those clients without the capability to
do planning. Thirdly, choices of some consumers may be unrealistic due to personal view on
care hence proves the negative impact of the consumer-directed care. Consumers within the
model have to make their own choice and control of the type of service offered to them
(Ahyoung & Yuri, 2017). Some choice may be unrealistic or unattainable care plan and this has a
negative impact on the consumer-directed care. Fourthly, the stressful work conditions have been
reported as some negatives of the consumer-directed care. More working hours and overtime
payment are key working conditions that make the home care working difficult for providers
leading to work dissatisfaction among those working within the Home Care Packages. Moreover,
some poor living conditions present at the home of some aged clients leading to unpleasant work
condition for service providers (Delp, Steven, Jeanne & Muntaner, 2010).
Conclusion
In conclusion, the paper analyses various aspects of the consumer-directed care (CDC)
based on the philosophical, legal, ethical and political basis of the care. The paper revealed three

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 11
main foundations of the CDC and these are choice, flexibility, and independence that are given
priority in the provision of care to aged people in the community. In addition, the paper identifies
Home Care Package as an important area that has been used to fully implement the consumer-
directed care in Australia. The government offers funding solution to those approved Home Care
Packages that help in making the lives of many aged populations within the country. This has
resulted in the improvement of care within homes leading to better lives of consumers involved
in the program. The management of the program is given to both consumer directly or through a
representative in collaborative with care service providers. The consumer-directed care has both
positive and negative implication within the service delivery of the care.

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HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 13
Reference
Ashley, L. S., Hester, L. & Leslie, E. P., (2017). Safety of union home care aides in Washington
State, American Journal of Industrial Medicine, 60, 9, (798-810),
Ahyoung, L. & Yuri, J. (2017).The Impact of Work/Family Conflict and Workplace Social
Support on Mental Distress in Home Health Workers, Home Health Care Management &
Practice, 29, 3, (176).
Beeuwkes, B.M., Haviland, A.M., McDevitt, R. & Sood, N. (2011). Healthcare spending and
preventive care in high-deductible and consumer-directed health plans. The American
Journal of Managed Care, 17(3):222-230. Retrieved from
http://europepmc.org/abstract/med/21504258
Bradley, S. (2017).Consumer-directed care. Australian Nursing and Midwifery Journal,
24 (11) (Jun 2017). Retrieved from
https://search.informit.com.au/documentSummary;dn=839749192424493;res=IELHEA
Chuanmei, E., Dunt, D. & Doyle, C. (2014). Impact of Consumer-directed Care: Perspectives of
Case managers and Lead managers in community aged care. 23rd Annual Tri-state
conference & Exhibition 24th February 2014. Retrieved from
https://www.cmsa.org.au/documents/item/139
Ce S., et al., (2015).Consumer-Directed Care for Beneficiaries With Mental Illness: Lessons
From New Jersey's Cash and Counseling Program. American Psychiatric Association
Publishing, 59 (11). Retrieved from
https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2008.59.11.1299

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 14
COTA Australia (2017). About Consumer Directed Care (CDC), Home Care Today. Retrieved
from https://homecaretoday.org.au/provider/about-consumer-directed-care
Delp, L., Steven, P. W., Jeanne, G.B & Muntaner, C. (08 July 2010). Job Stress and Job
Satisfaction: Home Care Workers in a Consumer‐Directed Model of Care.
doi.org/10.1111/j.1475-6773.2010.01112.x
Delp, L. & Muntaner, C. (2011). The Political and Economic Context of Home Care Work in
California, NEW SOLUTIONS: A Journal of Environmental and Occupational Health
Policy, 20, 4, (441).
Department of Social Services, Australia (2014). Home Care Packages Programme Consultation
Paper. User Rights Principles 2014. Retrieved from https://engage.dss.gov.au/wp-
content/uploads/2015/04/hcpp-consultation_paper_april2015.pdf
Department of Health, Australia (2016). Consumer Directed Care: Home Care Reforms. My
Aged Care, retrieved from https://www.msqld.org.au/site/images/fact_sheet_-
_consumer_directed_care.pdf
Edward, S., Louise, M. H. & Sara, P. (2015).The Moderating Effects of National Age
Stereotyping on the Relationships between Job Satisfaction and its Determinants: A
Study of Older Workers across 26 Countries, British Journal of Management, 26, 2,
(255-272).
Gunn, R. A. & Rolf, H.W. (2013). Understanding significant processes during work environment
interventions to alleviate time pressure and associated sick leave of home care workers –
a case study, BMC Health Services Research, 13, 1.

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 15
Iecovich, E. (2011).What Makes Migrant Live-in Home Care Workers in Elder Care Be Satisfied
With Their Job?, The Gerontologist, 51, 5, (617).
iCareHealth Blog (2013). CDC: Key considerations for home care providers. The iCareHealth
Team. Retrieved from http://www.icarehealth.com.au/blog/cdc-key-considerations-home-
care-providers/
Jenay, M. B., McBride, S.E., Tracy, L. M. & Wendy, A. R. (2014).Understanding challenges in
the front lines of home health care: A human-systems approach, Applied Ergonomics, 45,
6, (1687).
Kristen, W. (April 08, 2015). User pays means buyer beware with senior services. The West
Australian' is a trademark of West Australian Newspapers Limited. Retrieved from
http://health.thewest.com.au/news/1917/user-pays-means-buyer-beware-with-senior-
services
Moorman, S. M. & Macdonald, C. (2013). Medically Complex Home Care and Caregiver Strain,
The Gerontologist, 53, 3, (407).
Myagedcare, (2016). Consumer Directed Care (CDC). Retrieved from
https://www.myagedcare.gov.au/help-home/home-care-packages/consumer-directed-
care-cdc
Net Industries and its Licensors, (2018).Case Management - Consumer-directed Care. Retrieved
from http://medicine.jrank.org/pages/254/Case-Management-Consumer-directed-
care.html

HEALTH AND SOCIO-POLITICAL ISSUES IN AGED CARE 16
Paraprofessional Healthcare Institute. (2015). Occupational projections for direct-care workers
2010–2020. Retrieved from
http://phinational.org/sites/phinational.org/files/phi_factsheet1update_singles_2.pdf.
Shinan-Altman, S. & Liat A. (2017). Perceived control among migrant live-in and local live-out
home care workers in Israel, Aging & Mental Health, (1),
Stacey, CL. (2011). The Caring Self: The Work Experiences of Home Care Aides. Ithaca, NY:
Cornell University Press.