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Cash for care

A recent program overview from the Department of Health and Ageing is clearly in favour of the ‘consumer’ model of care. But is that what we really need? 

The term “consumer”, rather than “care recipient”, is used in this document.”

So begins the new program overview of the Home Care Packages and Consumer Directed Care, issued by the Department of Health and Ageing.

“Consumer”, the document continues, ‘refers to the person receiving the care package as well as those supporting the person such as carers and family members.’ Remember that. It is sure to come in handy in the next few years.

Welcome to the new world of consumer-directed-care, or CDC. The terms ‘consumer’ and ‘CDC’ are key in the new aged care reforms.

The change of terminology is intended to signal a new direction in the way that services are provided, and their use will be a hallmark of the way that community aged care packages operate.

Oh, that’s another word we won’t see any more – ‘community’. It certainly won’t be used alongside the term ‘care package’.

So, what’s in a name? And why should anyone worry about this? After all, they come as part of a policy that is intended to see more funds for care packages, rather than less. In fact an extra $880 million has been announced to increase the total number of Home Care Packages from around 60,000 to 100,000 over five years. More than 40,000 further packages are expected to be available over the following five-year period, from 2017–18 to 2021–22.

There are also some extra categories of services to be made available. The new program will provide 4 different levels of support, adding one below the existing CACP and one between the CACP and EACH levels, as follows:

Home Care Level 1 – a new package to support people with basic care needs
Home Care Level 2 – equivalent to the existing CACP
Home Care Level 3 – a new package to support people with intermediate care needs
Home Care Level 4 – equivalent to the existing EACH package.

The term consumer suggests that aged care services are no longer being provided to people because they need care. Instead of being a care recipient, they will be consumers, actively making choices about what they want.

But is it fundamentally a good idea to adopt a consumer model of care? Being a consumer normally means that we make informed choices about what we ‘consume’ or use. The idea suggests that there is an option. If we choose to eat a vegetarian diet instead of meat, that makes some sense. Most other things we consume are also optional.

But is care really a choice? Indeed, many older people who need help don’t understand that they need it at all. Given the choice, many older people who need help would probably choose not consume any care at all. Who wouldn’t prefer to be ‘independent’?

DCD is an American term, used in the USA where insurance is often private and there is no universal program of home support for elders.

In the UK, where they are also known to speak English, the term they use is the far less emotive term cash-for-care or care payments. And despite many years of trials and tentative beginnings, a full national roll-out of a cash-for-care program is yet to take place.

There is a lot welcome in the proposed aged care reforms. But I, for one, am not sure whether I will be able to be enthusiastic about the new terminology. And I fear that with a future change of government, the terminology may involve much more than just a new set of words with extra funding to expand coverage.

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