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 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 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 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 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 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 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 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 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.
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