People at Centre Stage: evaluation summary report

This report presents the results of an evaluation of consumer-directed community aged care. Consumer-Directed Care (CDC) is central to the aim of rendering community aged care more flexible and responsive. In Australia, it builds on experiences of consumer-directed community-based disability care and is intended to offer greater decisional authority to care recipients over the services they receive. Since the 1990s, there has been growing interest among Australian community care providers, service users, and policy makers to ‘modernise’ and reform community aged care. A suite of reports were commissioned that highlighted the facts that: fragmented programme arrangements in community care create planning and operational difficulties and inefficiencies; the service provision model is too complex, making it difficult for lay people to access the services they need or are entitled to; funding gaps exist throughout the care pathways; the system is inflexible and unresponsive to transitions in people’s lives and/or illness trajectories; the needs of a significant minority of care recipients are not sufficiently addressed, resulting in poor quality of care as well as resource wastage. The People at Centre Stage (PACS) project aimed to address some of these issues. The aim of the project was to—within the limitations of current legislation and guidelines—develop, implement and evaluate a community aged care model that gives care recipients with more complex needs the option to have as much control of their own care as they aspire to and feel comfortable with. The project intended to offer a continuum of care ranging from customary case management to CDC. This summary report provides a brief outline of the results of this evaluation. It is structured in two parts: following a brief overview of the PACS model, Part 1 outlines the key findings from the quantitative analysis, while Part 2 offers an overview of the qualitative findings. Part 2 deals exclusively with the experience of people participating in the intervention group

Making it work: a workforce guide for disability service providers

This guide provides strategies for disability service providers to draw upon when creating and sustaining a workforce of support workers to meet the aims of DisabilityCare Australia and implement the National Disability Insurance Scheme Act 2013. In particular, the Guide is designed to assist providers develop a workforce strategy that will enable support workers to: i)    support the independence and social and economic participation of people with disability ii)    provide reasonable and necessary supports, and iii)    enable people with disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports. The essence of DisabilityCare Australia is to be supportive, responsive, flexible and creative. This Guide offers a wealth of ideas and practical suggestions without being prescriptive. It includes ideas relating directly to support workers as well as to their interactions with service users and their employing service provider, and there are varying cost implications. The Guide does not attempt to provide one integrated workforce management strategy. Instead, it is intended that providers will take away ideas to develop their own unique workforce strategy relevant to their environment and provider type. The aim of this guide is to contribute to the development of enthusiastic, competent and satisfied workers who will embrace the aims of DisabilityCare Australia and provide excellent support to people with disability. The Guide is organised around the following themes: Communication Organisational culture, values and expectations Recruitment Flexible, responsive and creative work Training, mentoring and support Recognition and incentives Career Pathways Authors: Dr Carmel Laragy, RMIT University Associate Professor Paul Ramcharan, RMIT University Associate Professor Karen Fisher, Social Policy Research Centre, University of NSW Karen McCraw, CEO, Karden Disability Support Foundation Robbi Williams, CEO, Purple Orange (Julia Farr Foundation

Towards a framework for implementing individual funding based on an Australian case study

Although individual funding is increasingly being used around the globe as a mechanism to fund social care, its implementation is proving to be problematic and implementation strategies are not well developed. This paper proposes a framework for the successful introduction and implementation of individual funding programs based on the analysis of data collected in a qualitative case study conducted in an Australian not-for-profit disability agency over a 4-year period from 2003 to 2007. Data were gathered through participant observation and interviews with program participants and managers, and the findings were validated with those involved. Bronfenbrenner&rsquo;s ecological systems theory is used to analyze the findings from a micro, meso, exo, and macro perspective. The following factors were found to be important for successful implementation: the meaningful involvement of the person with disability in decision-making; adequate resources; access to information and appropriate supports; suitable activities being available; knowledge of policies and procedures; policies ensuring oversight and responsible accountability; employment conditions for workers being safeguarded; and support for staff and managers to adjust to their new roles. Knowledge of effective implementation strategies is important for disability agencies and for governments promoting individual funding because this radically different funding arrangement requires new implementation strategies.<br /

Community aged care case managers transitioning to consumer directed care: more than procedural change required

Consumer directed care (CDC) is increasing in community aged care. However, limited information is available to successfully transition social workers and other case managers to their new role. This paper reports on a case study of six senior case managers who supervised staff in three Australian community-aged care agencies as they transitioned from agency directed care to consumer directed care. A change management framework was used to analyse the qualitative data collected in 12 semistructured interviews. A key finding is that changes in values, attitudes, and organisational culture are needed before staff can fully implement CDC principles of service user self-determination, empowerment, and choice. Process changes needed to assist staff transition to CDC are: using a change management strategy that maximises certainty; monitoring and responding to feelings of anxiety through ongoing consultations; and providing ongoing education and support in group sessions

Coproduction in practice : participatory action research to develop a model of community aged care

Coproduction has become synonymous with innovative approaches to public service delivery in European Union countries as well as in Australia. Coproduction has the potential to bring together individuals, communities, and organisations in a process to collaboratively develop new models and services which improve public services. Yet, Australian policy makers and practitioners who would like to deploy coproduction within the context of older adult social care can only draw on a handful of papers and reports that could guide implementation. This paper fills this gap by reporting on the implementation of a multi-stakeholder coproduction approach to the development of a consumer directed care model for older people with complex health issues. The paper describes and critically highlights methodological challenges encountered during the 12 month-long participatory action research phase of a larger project involving older people with complex care needs, their carers, and government and non-government stakeholders. The paper outlines key considerations regarding (1) the involvement of older people with complex needs, (2) collaboration with industry partners, (3) engagement of government representatives, and (4) reflects on implementing participatory research projects within a context of outsourcing and interlinked supply chains. While not all challenges encountered could be resolved, the coproduction approach was successful in bringing together a wide range of stakeholders with competing agendas in an iterative process geared to resolve a plethora of concerns raised by older people, carers and services providers. This paper provides an example for others seeking to use coproduction and participatory methods to provide person-centred care services for older people.<br /

Practice standards in Australia: implications for social work education

In 2003, the Australian Association of Social Work launched Practice Standards that define minimal expectations for all social workers. The Practice Standards are outcome focused and specify what social workers are expected to achieve in the areas of Direct Practice, Service Management, Organizational Development and System Change, Policy, Research, and Education and Professional Development. This paper outlines the rationale for developing the Practice Standards, the process undertaken and the need for social work educators to build a curriculum that prepares students to be competent and effective in a complex working environment

Asking the customer: Exploring consumers’ views in the generation of social work practice standards

The present paper reports on the application of consumer participation principles in the development of social work practice standards. The Australian Association of Social Workers Practice Standards Committee consulted with 48 consumers of social work services from four different practice areas about aspects of social work practice. Participants were asked their expectations of social workers. Their responses emphasised the importance of the social worker-client relationship, confidentiality, practical support and client-empowering practice. The consultations contributed to the development of the Standards and the attributes cited were incorporated and are explicit in sections dealing with areas such as mutual engagement and good communication skills. The process of developing a relationship, and its importance, remains integral to the Standards and all outcomes specified are dependent on forming good social worker-client relationships. The consultations were useful in developing the Standards, but they were restricted in number because of a commitment to paying participants while having limited resources and they used opportunistic rather than representative sampling

Addressing the housing needs of participants is critical to NDIS success

Recent reforms in the disability sector through the National Disability Insurance Scheme (NDIS) will allocate funding to individuals who will be able to exercise greater control over its use. More people with disabilities will be able to access support to move from congregate care, group homes, their parents’ home or unstable housing to more independent living arrangements. The researchers analysed ABS data and interviewed staff of disability and housing agencies. They also interviewed people with disabilities—most with individualised funding packages—who moved, or planned to live more independently in the community. Interviews were conducted in New South Wales, Victoria and Western Australia. Reasons for moving home were varied, but many wanted to live independently in housing that met their preferences for design and location. A key barrier they faced was lack of affordable housing. Those that had succeeded in accessing social housing had done so through special programs, or by being classified at risk of homelessness. Those achieving ownership received family financial support or utilised shared equity arrangements. Those in private rental had established relationships with landlords. Sharing was also a feature in private rental and ownership options. Where people with disabilities had been able to move to preferred housing in a suitable location (close to family, public transport and services), they experienced positive outcomes such as feelings of independence, social participation, and improvements in physical and mental health. Those in social housing experienced more secure and affordable tenancies, while those owning their own homes (including shared equity arrangements) experienced pride and sense of security. Those in private rental, by contrast, were less secure and experienced affordability stress. Detailed housing policies and strategies will be needed to respond to the NDIS. New supplies of affordable housing are a priority, but so also is adaptable design to enable people with disabilities to age in place. Home sharing is a useful strategy to pool support funding and would improve overall utilisation of housing stock, but provisions to enable people to choose flatmates and preserve privacy will be important. The study highlights the benefits of choice and flexibility in funding, but also recognises that strategies will also need to integrate sufficient advocacy, information and tenancy management assistance to prepare and support people into new living arrangements. Separate program funding to build capacity in formal and informal support networks will also be required