In May this year, the Federal Government announced in the budget that The Aged Care Approvals Round for home care packages will be abolished with funding to be allocated directly to consumers rather than providers from February 2017. This next step in Consumer Directed Care (CDC), individualised funding, has been operating in earnest in the UK since April 2013. There all funded service users and carers already receive personal budgets with the option of direct payments (cash payments given directly to service users).
In the UK, direct payments can be used to employ a personal assistant, hire care workers from a domiciliary care agency or fund other services that enable independence such as meals on wheels, transport and day centres. This may paint an image of empowered consumers with choice over how their individual needs are met, however scratch the surface and the reality is a little different.
One of the main issues impacting on the level of consumer choice in the UK is cost. Cash payments are given to older people based on the amount local authorities deem sufficient to buy services that meet their eligible needs. Local authorities often base their assessment of the cost of services on the fee paid in the past to domiciliary care and other agencies working on preferred provider contracts. On these agreements providers were able to tender low rates for care packages due to guarantees of large volumes of work. When providing services directly to individuals, providers cannot offer these lower rates as there is no guarantee of volume. This leads to a discrepancy between the direct payment individuals receive and the quoted cost of a service from providers, leaving individuals faced with either paying top ups or taking standard care packages offering no more choice in how needs are met than before.
The implementation of personal budgets in the UK has also been greatly affected by significant budget cuts to social care. In his 2015 study, Dr John Woolham looks at the question, ‘Are personal budgets always the best way of delivering personalised social care to older people?’ Inadequate resourcing has meant that subsidies allocated to older people’s care packages are low. Once basic care and support services are paid for, there is little left over to meet the social needs of older people. As such, receiving direct payments has not always translated into more choice.
Having worked within aged care in the UK for many years I have already once witnessed the changeover to Consumer Directed Care and individualised budgets. Thinking about the impact and implications for both care providers and consumers I wonder, will the same issues present themselves in Australia? Only time will tell.
