Critical Analysis of Consumer-Directed Care in Australian Aged Care

This essay critically examines the implementation of consumer-directed care (CDC) within Australian aged care services, highlighting the challenges and ethical considerations that arise from this model. It discusses the shift towards consumer-directed approaches in response to the growing aging ...Read More

Running head: SOCIO-POLITICAL AND HEALTH ISSUES IN AGED CARE
Socio-Political and Health Issues in Aged Care
Name of the Student:
Name of the University:
Author Note:

1SOCIO-POLITICAL AND HEALTH ISSUES IN AGED CARE
The growing ageing population in Australia has resulted in an elevated need for the community
aged services. In order to ensure that the older people receive the services properly, they require
the aged care community services and this service has been reformed to use a consumer-directed
care model. Aged care is one of the fastest growing sectors in Australia and this sector deals with
the significant number of challenges. The facilities around the country have the responsibility of
managing the problems associated with the growing number of the aged population, right skills,
staff sourcing and managing the finances. Policy in the aged care gets frequently changed and is
due to the fast-evolving nature of the sector. The recent policy changes have resulted in the
alteration in the residential care subsidy. The rise in the number of the elderly population
requires a very trained body of workers that will be taking care of the elderly patients. However,
Australia is not prepared to address such an issue. The aged care facilities that are present
throughout the country requires to bring forth greater number of the skilled staff, high levels of
healthcare and attract new residents all within a balanced budget (Myagedcare.gov.au, 2018).
Thesis statement- I think the aged care in Australia requires a redesigned and revamped
consumer-directed care that will be able to address the issues related to the aged care. The
outline of the discussion will include what the consumer-directed care is and it will include the
ethical and the political positions. A critique and discussion of the issue in providing the
consumer-directed care for the care providers and the consumers.
Discussion on the consumer-directed care and the various issues that are occurring
presently and how the consumers and the provider are affected. The consumer-directed care
(CDC) can be described as a model that deals with the delivery of the service that is designed to
provide more choice and control over the types of services that are rendered to the consumers.
The consumers that receive the home care packages will have the more control and access over

2SOCIO-POLITICAL AND HEALTH ISSUES IN AGED CARE
the types of the services and the care along with the choice of how the service will be delivered
to them. CDC can be considered as an approach for the purpose of management and planning of
the care, that allows the carers and the consumers to influence the design and the delivery of the
services that the consumers will receive (Laver et al., 2018). CDC also allows the consumers to
exercise the greater control over what the services are to be delivered, along with when and
where it will be delivered. In the year 2010-2011, the CDC was considered as a model of care
within the home care packages programme. After the success of the initial project, a new form of
the home care packages from the year 1 August 2013 was delivered through the CDC
(Agedcare.health.gov.au, 2018). The issues that are currently being faced by the consumer-
directed care are the several challenges experienced by the informal carers, clients and the staffs.
The staffs started to differentiate the CDC from the tradition aged care services and complained
that previously the clients used to have much more control over the services are delivered. Others
felt that the CDC is directed towards the placing the control and choice over the clients that
promoted the respect and dignity. The experience by the clients however indicated that the
changes are very small and thus the clients continued to use the previous services. Some of the
staffs mentioned that the client expectations and the industry controls influenced the range of the
services and thus the clients are unable to differentiate between the different types of the service
models. Role change is the next big issue and CDC created difficulties for some of the staffs.
The role of the coordinator in reviewing and assessing the clients along with managing the staff
is changing. The experienced staff coordinators needed to change according to the requirement
of the job and also develop requisite knowledge and skills for the intervention and the
assessment role (Ottmann, Allen & Feldman, 2013). This has resulted into negative impacts on
the clients. However, some of the clients still perceive that the advantages in the long run. Within

3SOCIO-POLITICAL AND HEALTH ISSUES IN AGED CARE
the community aged services sector in Australia, it has been seen that the sub-contracting is very
common and this has created challenges for both the client and the fund holding organization.
The staffs mentioned the issue that the third party organizations do not take any direction from
the clients. The geographical coverage of the service also created an issue for the clients and this
prevented the clients from accessing the preferred service supplier. It has been identified that the
restrictions applied on the number of the places that the organization will operate created a sort
of hindrance. Some of the clients and the carers identified issues that are related to the unmet
service needs. It has been observed that due to the discontinuity in the services between the
community sector and the hospital has resulted into discrepancies (Bradley, 2017). The industry
culture data highlights the fact that the CDC requires a considerable amount of change and it is
challenging from the perspectives of the carers, staffs and clients. The cultural impact is seen in
what the clients are being offered and also in differentiating the CDC services. It has been found
that the conflicts arise due to the case manager perceptions and obligations of the client safety,
family or carer pressure, heavy caseloads. Thus, it has been seen that the with regard to the older
people, the existing beliefs and the values have been identified to be affecting the decision
making and the clinical judgement (Gill et al., 2017). The above facts suggest that consumer-
directed care came across several issues and the majority of them arose not only at the level of
the staff, carer, client but also at the level of government and the third party health organization.
The political, philosophical, legal and ethical issues associated with the implementation
of the consumer-directed care are discussed in this section. It is important to note that the
consumer dedicated care is one of the humanitarian mission that are directed towards serving the
aged people. The present scenario reveals that the competition between the third party service
providers took to the competition of providing the healthcare, and also attract the maximum

4SOCIO-POLITICAL AND HEALTH ISSUES IN AGED CARE
number of the aged people in to the service. It has also been seen that the policies are marketed
and advertised like any other commodity rather than as a separate care service. Once in power,
the politicians see the power as an opportunity to influence the aged people so that they can get
into the system. The case is same for the users of the aged care services. It is found that the aged
people fell as a victim of the misdirected ideology. Earlier the community welfare projects, aged
and the health remained out of the political fray, but the present scenario is different (Wynne,
2018). Due to the well-established fund holder/provider organizations, operational practices and
the administrative practices that are responsible for the implementation of CDC are facing
hurdles and challenges in providing support to the clients regarding the usage of the CDC funds
for the purpose of the non-traditional and the innovative consumer desired services. It is
important to note that the capability of an organization or an industry to innovate is entirely
dependent on the culture that supports the creativity, dynamism and risk-taking. However, the
conservative climate and the culture of the service sector that provides the services to the aged
people is underscored by the philosophies of caring and care, and it is not in accordance with the
consumer-centric objectives and the innovation of CDC. It has been found that the innovations
are implemented, assimilated and adopted far more easily when there is a consensus and
compatibility with the perceived needs, norms and values of the adopter. Innovations that are
taken up the key players are easily implemented. The innovation at the same time must be able to
correspond with the main mission and solve the problem that is actually neglecting the
realisation of the service objectives (Gill & Cameron, 2015). The second major issue is the
existing packages need to be converted to the CDS for the greater compatibility.
The ethical issues that arise with the consumer-directed care are elder abuse. Elder abuse
can be carried out by the one who is delivering the care to the aged person or any family

5SOCIO-POLITICAL AND HEALTH ISSUES IN AGED CARE
member. The abuse can be social, financial, psychological and physical. An older person will
suffer from different types of abuses. This can result from the predatory action, deliberate intent,
negligence and ignorance. The World Health Organization designates elder abuse as violation of
the human rights and is caused due to the despair, isolation, lost productivity, illness and injury
(World Health Organization, 2018). Abuse of the elder is a complex issue and this challenges the
views of the older people in the community. The victim and the perpetrator is actually is not
aware of the what is occurring is actually abuse. The abuse of the older people is a major social
issue and this requires a complex and careful consideration of the responses. The abuse of the
elder people can occur to anyone and it can occur irrespective of the ethnicity (health.vic.gov.au,
2018). In order to solve the ethical issues associated with the consumer-directed care, the
Australian Human Rights Commission provides laws to deal with the violation of the human
rights of the elder people. The universal declaration of the human rights are set in the Article 1
and it states that the all humans are born free and are equal in the terms of the rights and dignity.
Thus it is important to note that the rights and the dignity of the people are not changed and even
if they grow old and thus possess the same rights just like others. Australia has the Age
Discrimination has the Age Discrimination Act 2004 and it protects the rights and the dignity of
the aged people and they must be respected for the choices they make in the aged care services
(Humanrights.gov.au, 2018). The aged care services that range from the modest assistance like
assistance for the age people to providing the specialised care for the ill and the very old people
in the residential facilities. The moral and the philosophical basis of the aged care services for
the older people actually goes beyond the welfare concept. The difficulties within the health
services leads to the several problems like the complications at the level of the providers and the
consumers and the care is delivered. The consumer-directed care emphasizes on the betterment

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of the consumers and allows maximum care delivery options for the same. The major problem
that arise is with the existing care options that confuse the consumers (Nationalseniors.com.au,
2018).
How the consumer-directed care assist and provide better services for the aged care and how
both the providers and the consumers get affected will be discussed in this section. The
consumer-directed care provides a big opportunity for the consumers to take control over the
delivery and the management of the home care programs. Thus, it is important to note that the
implementation of the consumer-directed care had significant implications both for the state
administrators and the consumers as well. For the consumers the CDC offers a choice with
respect to the services and an increased amount of autonomy. This includes the better quality of
care, who provides the aged care services, flexibility in scheduling the services and also the
hours of the service (Kaambwa et al., 2015). Thus, it is also important that the consumers also
must know about what they want and need form the service providers and the services and then
make realistic expectations. While the employer-related responsibilities also play a major role in
the consumer-directed care and it requires a lot of time and energy. Hiring and recruiting the care
is a difficult task especially where there is worker shortage and there are low wages for the
workers. For the state officials the CDC also have serious implications. The consumer-directed
care also has a potential of reducing the problem that arises from the shortage of workers by
recruiting the independent providers (Fine, M. (2018). However, the downside is that such a
provider will receive less wage and the also the service will lack some amount of benefits. Thus,
enabling the consumers to appoint independent providers can allow better matches between the
workers and the clients, at the same time it improves the consumer satisfaction. However, in the
long term of this care system, there are chances of abuse and fraud and especially in the states

7SOCIO-POLITICAL AND HEALTH ISSUES IN AGED CARE
that has the low monitoring of the quality of care delivered. Consumer-directed care also has the
potential of reducing the costs associated with the aged care through the usage of the
independent service providers that provide the care without much of the overhead charges. This
cost savings also help in serving the additional clients. It is, however, important to note that the
cost savings play act to balance the other costs associated with the consumer-directed care
(Elder, Aylen & O'Keefe, 2016). The cost might include the service management responsibilities,
training the clients. Although several nurses might lack experience and thus will require
guidance and training. There are issues of liability as well. States that are thinking of
implementing the consumer-directed care need to reconsider the nursing practices. The consumer
direction is still at an infant stage within the world of the ageing services. There is, however, a
lot of research that needs to be done in order to analyse the quality of care and the cost-
effectiveness. The results from the various demonstrations reveal that the independent choice
programs, cash and counselling demonstration are likely to provide results that at the same time
also provide further evidence of CDC as a long-term option for care policy (Medicine.jrank.org,
2018). Moving to a consumer-directed care is due to Australia's governmental policy of
providing and funding the aged care through health packages. The consumer can now choose
what they want to be delivered and simply move to such care plan. This provides a big chance of
providing the client or the consumer in control of the care, while the care itself depends upon the
choice of the service provider. The consumer-directed acre is based on the rights of the
consumers, consumer choice and control, participation, balanced and respectful partnerships,
participation, re-enablement and wellness and transparency. These principles, in turn, guide the
home package delivery. The home care packages take up the approach of consumer-directed
care. The consumers are directed to recognise and identify their goals and based upon that the

8SOCIO-POLITICAL AND HEALTH ISSUES IN AGED CARE
care plan will be delivered. The consumers are told to decide the degree to want to get involved
in managing the home care packages. The consumers can choose the way services are to be
delivered and the way it is to be delivered and also by whom the service will be rendered. The
consumers are allowed to have individualised budget and a monthly statement of the expenditure
and income. The consumer can also expect the regular contact with their provider and this will
change the support that the consumers need (Home Care Today, 2018). According to the Day et
al. (2017), a study conducted among the users of the consumer-directed care revealed that they
are generally satisfied and with the type of support provided by the home care packages. It has
been also found that the clients are able to develop a meaningful relationship with the care
coordinators and the care workers by continuing the care provisions. The participants described
that they have been able to engage with the private services.
Thus, from the above study, it can be concluded that the consumer-directed care is based on the
paradigm of self-direction. The self-directed support is one of the key aspects of the reform that
has been brought into the healthcare services. The consumer-directed program is all about the
client directed care and this takes into account how the care is to be delivered and in what way it
will be delivered. The care services rendered by the service care providers highlighted that there
are certain requirements and the guidelines that need to be followed for the effective
implementation of the CDC. The new rules that are framed by the Australian government have
now mentioned that the provider faces new challenges due to the some of the practical
difficulties. The previous care packages used to have a different set of rules and guidelines,
however realigning the newly formed community directed care takes into account the new
innovations and the demands of the consumers. There are other aspects of the ethical issues that
to a large extent reduce the effectiveness of the CDC. The ethical generally pertain to the abuse

9SOCIO-POLITICAL AND HEALTH ISSUES IN AGED CARE
and this is mostly done by the family members or the care providers. There are however laws and
the human rights commission of Australia directly deals with the ethical violations and the
dignity and respect are well taken care of the elder people. There are however no specific
guidelines that can align the wellbeing and the healthy ageing of the older people and thus the
providers can assist the clients to self-determine the customised care.

10SOCIO-POLITICAL AND HEALTH ISSUES IN AGED CARE
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