SELF-DIRECTED CARE FOR OLDER PEOPLE Expectations and Outcomes

Transcription

1 SELF-DIRECTED CARE FOR OLDER PEOPLE Expectations and Outcomes Helping South Australians IAN HARDY HELPING HAND AGED CARE

2 AGED CARE POLICY OBSERVATIONS FROM JAPAN, UK, GERMANY, AUSTRIA. HOW CAN THEY INFORM THE JOURNEY TOWARDS CONSUMER CHOICE IN AUSTRALIA?

3 WHY JAPAN, UK, GERMANY AND AUSTRIA? Have moved over the past years to give consumers some level of choice and control over how they are supported; Japan and Germany have brought residential and community care under the same assessment and funding umbrella; UK extended disability experience to include aged services, with a series of personalisation pilots; Austria provides cash to every eligible consumer/family Note: in all four countries national policies are interpreted and implemented at municipal or provincial level

4 JAPAN Single eligibility and assessment process and related single funding mechanism for both residential and home-based care Assessment by a Care Manager, leading to: Support, for preventative purposes (at one of two levels), or Long Term Care ( LTC ) at one of five subsidy levels. Consumer uses that funded care entitlement either in a residential care facility (regulated by Municipalities) or their own home flexible choice as proposed by the Hogan Review On average only 50-60% of home care funding to which a person is entitled is expended

5 ACTUAL EXPENDITURE HOME CARE

6 UK Social Care disability personalisation being widened to include aged services, but - accessible primarily to those who are financially disadvantaged 13 Individual Budgets pilots established 2006 (evaluated October 08) - Virtual budgets (Local Authority administration) - Direct (cash) Payments (no parameters/acquittal requirements) 2008 Ibsen Evaluation: People in general want the capacity to choose what most appropriately will meet their individual needs, in ways managed by an agent acting in their interests. But a majority did not want the additional burden of direct control over services or workers.

7 GERMANY Three needs/funding categories (Low/Medium/High) Within each category, consumer can choose: Residential (additional charge for hotel costs) At-home with professional care At-home with paid family care Combination of professional and paid family care More people at the High level of care need are cared for at home via family payments or a mix of payments and professional services, than live in a residential care home.

8 AUSTRIA Two main elements: Cash Payment, not means tested, at one of seven levels ( / A$ per month), based on a doctor s assessment; this payment may be taken as cash, used to employ an individual(s), or used to access professional services Social Transfer System which provides funding for additional services, where deemed necessary Evaluation of outcomes heavily compromised by provincial-level administration

9 LEARNINGS? What can the international experience teach us in Australia?

10 CONSUMER OUTCOMES. Re-conceptualised as having the choice about how much choice you want to exercise. Internationally, many older people are cautious about managing their care arrangements Access to good information for consumers and their advisors is a universal challenge Readily available, independent assistance for consumers in planning and contracting their choice of service support is integral to effective CDC. A competitive market is seen as a driver of quality but all four countries are struggling with effective, non-intrusive ways of measuring quality in home care There is limited evidence of abuse of cash payments

11 CONSUMER OUTCOMES (continued) The single eligibility test/funding mechanisms in Germany and Japan does have the potential to promote genuine choice between institutional and home care, and In Germany, more people assessed at the highest need category are cared for at home than in a residential care environment BUT Japan appears to be experiencing a perverse outcome as underexpenditure in home care is encouraging municipal governments to restrict residential care capacity In the UK and Germany, ageing needs and disability needs are frequently met by the same providers, significantly improving the potential for continuity of care for those with lifelong disabilities

12 PROVIDERS Individualised arrangements have to be managed financially, so there is a back room cost - which will increase if there is frequent variation in client needs Staff motivation, imagination and skills may be challenging Investment in staff may be at risk if business stability is seen to be compromised Perceived threats to investment and business stability could be mitigated by a staged introduction, perhaps initially using growth funding

13 PROVIDERS (continued) Less business certainty may drive up costs for providers Voucher-driven choice between residential and home care may be seen to threaten existing capital investment in residential facilities, and Current return on investment (ROI) in residential services is currently so low that providers may be even more reluctant to invest in a more market-driven environment accelerating growth in home care

14 SYSTEM POLICY National policy, nationally implemented, is to be valued! Municipal-level implementation leads to widely varying consumer outcomes, frequently poor data for planning purposes, and inconsistent standards. Over time, real choice will re-shape the service sector. Local councils in the UK are having to re-think their 'block contract' model for purchasing services, which is often inconsistent with consumer flexibility Individualised arrangements have to be managed financially, so there is a back room cost - which will increase if there is frequent variation in client needs

15 SYSTEM POLICY (continued)... Cash payments may flow to families who would otherwise provide care without any payment. There may be potential for net savings as consumer preferences re-shape the service sector, as reflected in the Japanese experience of under-expenditure in home care payments and the German experience, where home care is delivered to greater numbers of people at each dependency level at an overall reduced cost. Conversely, fragmented purchasing may drive up costs.

16 SYSTEM POLICY (continued) CDC in Australia will require a change from a highly controlled, age-ratio based system of cost allocation and control, to one where supply is driven by demand, resulting in Greater role for a gatekeeping mechanism (ACAT) as a means of cost containment Direct employment of individuals by consumers may lower wage payments. Less business certainty may drive up costs for provider organisations.

17 SYSTEM POLICY (continued) In Germany and Japan, consumer choice has produced substantial growth and diversity in professional providers (in the larger markets), BUT Strategies to ensure service diversity and geographic accessibility are an unavoidable pre-requisite for true consumer choice. Selfevidently, consumer choice requires accessible, available services from which to choose