Home Care Package Evaluation Group Member Feedback

Home Care Package Evaluation Group Member Feedback

Reflective of individual member feedback and NOT of formal NACA Advise

The Home Care Packages Working Group Teleconference on 17 July 2013 included discussion on the Home Care Package Evaluation Process. Members suggested that the evaluation of home care packages should include:

·  If the Packages are meeting their policy and programme intended objectives;

·  Evaluation of the new level 1 & 3 packages, including:

-  How they are used;

-  Outcomes for consumers;

-  Any challenges or learnings;

-  Their contribution towards providing a seamless continuum of care for consumers;

·  Acknowledgement of the different interpretations of CDC meaning the evaluation process will need to:

-  Identify ‘what is CDC’;

-  Map the differences between the different CDC models being implemented;

-  Evaluate the level of consumer choice, flexibility and control available in different models, including level of control consumers choose to exercise over their individualised budgets and why;

-  Evaluate the CDC models to ascertain which are the most effective at each stage – i.e. eligibility, access, service design and planning, service delivery, and review/reassessment;

-  Identify what design features facilitate/restrict consumer choice;

-  Identify which models are assisting consumers to reach their goals;

·  Identification of the most useful quality indicators/measurements of successful CDC services;

·  Reasons for consumers taking up/not taking up CDC packages, including the relevant barriers/enablers;

·  Consumers’ understanding of administration fees and satisfaction with their inclusion in the individualised budgets – could be used to develop information products for consumers/providers;

·  Evaluation of the broad-banding of assessment levels (1&2, 3&4);

·  Separation of new consumers existing consumers in data collection and evaluation;

·  If the packages are being managed and implemented effectively, efficiently, and appropriately;

·  Examination of how the new Home Care Package levels and CDC work in the context of the broader aged care, health and disability systems as well as the current focus on individual consumer and provider experiences;

·  Interface between the Home Care Packages Program and other elements of the aged care system such as the Home and Community Care Program and residential care;

·  Impacts on workers under CDC packages due to choice of service delivery timing/method;

·  Collection of information on how are organisations and individuals making transitioning to the new program, including any barriers being experience;

·  Evaluation of the strengths/shortcomings of the Guidelines;

·  Costs in the new program, including:

-  Differences in costs that exist and reasons for those differences;

-  Design features that help in managing costs;

-  Requirements of special needs groups;

-  Impact and benefits of supplements;

-  Transition costs;

·  Evaluation of the Dementia and Cognition Supplement, including:

-  How was the supplement used to achieve consumer’s goals;

-  Data about how many consumers were found to be eligible;

-  Distribution of subsidy by geographical area; and

-  Distribution of subsidy by special needs groups.

The evaluation process should attempt to seek and include information from the following stakeholders:

·  Consumers;

·  Families;

·  Carers;

·  Special/specific needs consumers;

·  Community, including health sector and general community; and

·  Service providers.

Other considerations for the evaluation process highlight by the Working Group included that:

·  An awareness that negative feedback in the trail phase may lead to changes in the CDC packages, which is a positive opportunity to further develop and perfect the model;

·  The timing of the evaluation will be crucial and that providers and consumers should be informed about the time frames and the information they will be required to provide in order to allow them to collect/record relevant data in preparation for the review consultation;

·  The evaluation should be an ongoing process to allow the collection of longitudinal data to measure growth and learn from the evaluation process and outcome;

·  Data collection should include the range of costs with particular reference to rural and remote versus metropolitan;

·  The inclusion of a substantial qualitative methodology would add benefit;

·  Priority should be on special/specific need groups as first design principles;

·  The role of evaluators will be crucial:

-  Evaluators will need to have an awareness of the sector in order to be sensitive to collecting the right data;

-  Very clear evaluation guidelines should be drawn to ensure consistency in the evaluation process;

-  An orientation/information pack should be developed for evaluators with input from the Working Group;

·  The tender process will be instrumental in framing the role of evaluators:

-  The tender brief should be very descriptive and include feedback from the Working Group;

-  The tender process should occur early enough to provide adequate preparation before the commencement of the evaluation process;

·  It would be useful if the evaluation were able to look at outcomes of case management or links such as hours of case management and rates of hospitalisation, entry to residential care etc. (though this would need to over a significant length of time);

·  There are a range of Special/Specific Needs issues, such as the importance of methods of data collection for CALD participations, as well as data collection, privacy issues, and language sensitivity for LGBTI participants. More in-depth recommendations on the involvement of CALD participants and groups in the evaluation process are outlined in Attachment 2;

·  The evaluation process should be designed to inform the next iteration of CDC in Home Care Packages and make clear that CDC packages are a work in progress and that the current model is not finalised; and

·  There should be consideration of what else needs to be in place to allow the broader roll-out of CDC packages in 2015.

ATTACHMENT 2

FECCA Feedback on the Evaluation Process for CALD Participants

Data Collection Method: When collecting data from CALD consumers it is important to use a collection method that is suitable for consumers to provide feedback. In the KPMG report the following two methodologies were adopted:

·  Participant Surveys

·  Interviews

Page 22 of the KPMG report acknowledged that it was challenging to collect data from participants from special needs groups.

Thus the following needs to be considered when conducting the evaluation:

·  The use of participant surveys is often limiting for CALD consumers as they do not have the language and literacy skills required to complete such documents. Even when these survey's have been translated into their native language, many CALD consumers are still not able to complete these documents as many have not completed formal or tertiary education and thus are also not able to read in their native tongue.

·  Participant Interviews- these will need to be conducted in the native tongue of the CALD Consumer. Another significant issue to consider when conducting participant interviews is the manner is which the interviews are conducted (eg. Focus Group, over the phone etc.). Many CALD Consumers are not able to communicate over the phone, they prefer to have face to face contact with people and often misunderstand information received over the phone even if it is delivered in their native tongue.

Unfortunately the KPMG report does not state whether or not surveys and interviews were administered/conducted in the native tongue of the consumer. Only that "Survey tools were designed to be simple, easy to read and understand, and of appropriate length to gather the required data while minimising the burden on the respondent from completing the tool" (KPMG, 2012 pg. 22).

Involvement of Ethno-Specific Organisations in the Evaluation: There has been criticism that the Consumer Directed Care model of care is a mainstream, middle income, Anglo-Saxon model of care. Page 24 of the KPMG evaluation report stated that " there was a reasonable representation of some special needs groups in the CDC participant group- in particular people from culturally and linguistically diverse (CALD) Backgrounds" (KPMG, 2012 pg. 24). However, in New South Wales, only two Ethno-Specific organisations received a combined total of 18 CDC packages in the pilot program (DoHA, 2011). In total 37 CALD CDC packages were made available however the remaining 19 CDC packages were administered by a mainstream provider. Only 6 CDCHD packages were piloted on CALD consumers (DoHA, 2011).

This under-representation of CALD Consumers and Ethno-Specific services can suggest the recommendations and analysis from the KPMG report may not be conclusive and may not apply in a CALD setting.

Therefore the recommendations for any future evaluation are:

·  To ensure feedback is obtained from Ethno-Specific services regarding the delivery of New Home Care Packages under a CDC model. Particular emphasis should be placed on whether CALD Consumers are more empowered to manage their own care (budgets, care plans etc) via an Ethno-Specific Organisation where most administration and care staff speak their native tongue, versus a mainstream service providing care to a CALD consumer whom may not have the staffing/resources to cater for the linguistic needs of the consumer.

·  It would be important to compare whom the key decisions makers are for CALD consumers and whether this differs if a consumer receives a package from an Ethno-specific provider vs a mainstream service provider. (This will generate data to identify the importance to continue to fund Ethno-Specific organisations under a CDC model).

·  It would also be important to identify why an alternate (other than the consumer) decision maker has been appointed within CALD communities to identify if this is a result of the consumers cognitive capacity or due to the consumers literacy skills. (This will provide feedback for the argument that the Consumer Directed Care model of care is a mainstream, middle income, Anglo-Saxon model of care).

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