Home' Community Care Review : CCR May-Jun 2015 Contents "It is quite reasonable that for some older people gaining
swift improvement in general wellbeing and the quality of key
relationships is what counts most," the report said.
On the issue of the risk of abuse, the TLAP report said the
evidence to date suggests personal budgets, including direct
payments, put older people at no greater risk than other forms of
care and support.
Older people who reported their views were included in a
support plan and processes were easy were more likely to report
Laragy says that keeping people connected to their wider
communities and building networks through individualised budgets
can act as an important safeguard for vulnerable clients.
FACTORS INFLUENCING IMPLEMENTATION
OF CASH PAYMENTS
A study led by Dr John Woolham from Coventry University released
in February 2015 found a range of factors impact the take-up
and success of direct payments among older people in the UK --
including a lack of services and information, administrative burdens
on budget holders, small budgets, low expectations among older
people and a risk-averse culture among staff.
The research explored whether the care needs of older people
were best served by taking their personal budget as a direct
payment, and compared staff, consumer and carer experiences of
social care between those with a direct payment and those with a
managed personal budget.
According to the study's findings, having a direct budget did not
always translate into actual control over care. For example, the timing
of taking a bath or a shower was frequently a compromise between
what a consumer would like and what was possible, and in over a
third of direct payment cases people were given no choice at all.
However, older people receiving council-run services fared
even worse. Due to inadequate resourcing, subsidies allocated to
older people's care packages were low, which meant that once basic
care and support services were paid for, there was little, if anything,
left over to meet the social needs of older people.
While councils were working to make direct payments more
useful and easier to administer, managers acknowledged there was
a long way to go.
Woolham argued that older people may want different things
to younger adults and may be less interested in choice than in
organising support and care that offered continuity and reliability.
"Control may be more effectively exercised through opportunities
to develop a relationship of trust and ideally friendship with paid
carers," he said.
When it comes to older people, he said local authorities may
need to think less about choice and more about the quality of the
The implementation of personal budgets overseas has been affected
by significant budget cuts to social care, says Ronda Held, manager
of Home Care Today, a COTA-led CDC resource, and a close
observer of the international experience of CDC.
"In the UK, their resource allocation systems, like our Aged Care
Assessment Teams, have gone from being facilitators of individual
budgets to being 'budget controllers' and trying to keep people out
of the system because they have a lot less money in the system.
That immediately impacts on implementation," Held tells CCR.
"Also, at a local level, we hear anecdotally that councils have
limited the choices of people just to save money, for example
by restricting service choice to two or three contracted providers
because they can get a bulk deal from them and their budgets can
stretch further. That is certainly a risk in the current environment,"
"CDC requires a good resource allocation and system of
entitlement so that people are supported based on individual need."
Laragy agrees strongly about the importance of financing
programs adequately. "All the other changes will be useless, or
worse than us eless, if people don't get enough funding," she says.
Held says overseas experience has also demonstrated the
importance of separating advice and capacity building from a
care recipient's individual budget for services. For example, Held
says in the Cash and Counselling model in the US, counselling
and assistance is offered alongside a person's care package and is
utilised as needed.
In Australia, the costs for translating and interpreting services
and travel are directly funded out of a person's consumer directed
"Individuals could be on the same level package and be getting
varying levels of direct service based on where they live, what
language they speak and how much they need a case manager to
help them, and that's not very equitable," says Held.
"The clear message from the overseas experience is older
people need good information, simple administrative systems and
opportunities to learn about the system through consumer capability
building to be able to make the most out of personal budgets and
that's what we are grappling with in our Australian CDC project."
ACCEPTANCE AND CHAMPIONING
A critical success factor in individualised funding approaches is the
attitudes and willingness of case managers to give consumers a
more active role in their care.
For example, case managers in the UK and the US have reported
initially feeling hesitant about transferring responsibility to their
clients and expressed anxiety over the decisions consumers will
make, which has influenced uptake.
While there are important lessons to be learned from overseas
and from the disability sector, ultimately the attitudes of older
Australians and the implications for aged care won't be known
until a cash payment option is trialled locally, such as in the area of
respite care as recommended by the Productivity Commission. n
Cashing out: what
produces the best results?
Results from the 2014 National Personal Budget Survey,
published by Think Local Act Personal, In Control and
Lancaster University, show the best outcomes for people who
have a personal budget are generated when:
• people have their views heard through the assessment,
budget setting and care and support planning processes.
• people get support to help them manage their personal
budget from a broker or their provider rather than the
council, or family or friends.
• people are enabled to spend their personal budget on
community and leisure activities rather than only on
traditional care and support services.
• people employ a personal assistant to meet their needs.
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