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A compelling case for self-management in home care packages: opinion

It was March last year when I read about research commissioned by then Minister for Aged Care Ken Wyatt investigating the quality of Australia’s in-home support since the 2015 changes to the home care system. The research focused not on the views and perspectives of government, service providers, professional bodies or policy makers, but on the lived experiences of people receiving in-home support.

The findings of the qualitative study were not particularly positive.

A full reading of the research report, Older people living well with in-home support, undertaken by Dr Sarah Russell of Research Matters, revealed a catalogue of insufficiencies, inadequacies, complaints and disappointments.

Some of them were systemic. Extraordinary waiting times, frustrations with My Aged Care and the rush of sales pitches once a package had been allocated unsurprisingly featured prominently, as did poor access to information. Other complaints were more directed at the practices and approaches of service providers: high fees but poor financial transparency and patchy case management; a focus on administration and efficiency, rather than the individual needs and desires of the client; high staff turnover and a lack of continuity of support workers; the inability to communicate directly with support workers; limited interest or capacity for matching clients with particular support workers; and a general lack of choice and flexibility.  

It was no surprise to me. Indeed, this was the experience of my own parents and family with the in-home care system and it is what drove the development of Mable.  

An evidence-based comparison

I contacted Dr Russell about her research and briefly described Mable’s self-management model. These are precisely the problems that our model seeks to address, I told her. Dr Russell had little understanding of Mable at the time. She proposed that an independent research project, using the same methodology as this national research but focusing on self-management using Mable, would provide an evidence-based comparison of the two models. It has. 

As expected, most of the participants who elected to be part of the study [Self Managed Home care packages – how Mable is improving the quality of life of older people] had switched to Mable from a traditional provider-managed arrangement. While most could identify some room for improvement, participants overwhelmingly described their self-management experience as ‘much better’, ‘much easier’ and ‘less stressful’ than their provider-managed experience. 

They said they felt empowered because they had genuine choice and control about who worked in their home, when they worked, what they did and how much they were paid. They liked that they could engage a range of support workers with different qualifications, skills and qualities to meet their different needs – qualified healthcare and personal care professionals when needed, but also cleaners, gardeners, experienced cooks… sometimes teachers, musicians and engineers.

Importantly, they could hire people who had similar interests, spoke their language, lived locally and knew their neighbourhood. And when plans changed unexpectedly, they – or their family member – could phone or text their support workers directly.

Not only were they able to get more hours of support from their package with self-management, people really valued the relationships that could develop. It is the relationships that are most critical for people – and indeed the relationships that form between people are a key reward for support workers too.

Our right to choice

These findings (and the many others in this report) shouldn’t be surprising. We live in different ways, with different priorities, in different homes and communities all around the country. Throughout our lives, most of our relationships and support networks come from within our communities.  Strong community connections become even more important for both safety and quality of life as people grow older and may have less independence. Think about it.

I would never suggest that self-management or the ‘Mable model’ is a panacea. No single approach to human services could ever hope to meet all the unique demands and preferences of all the humans that it ‘services’. These demands are complex. 

However, a system designed to support us to live ‘our best lives’, even with impairment and incapacity, must enable us to have choice and control if we want it. It is our right. And many older people do have the capacity – built throughout their lives – and express the desire to make decisions about what is right for them.

Mable will never be the option of choice for every older person in need of services and support but it (and any equally safeguarded, choice enabling model) must be an option.  

This research shows in clear, accessible, real-life examples, that self-management does work well for the majority of people who choose it. As Dr Russell confessed, “Never in my research career have I ever spoken to such a universally happy group of people.” I think it is important to share these findings* with the sector and encourage wide reading. 

Peter Scutt is co-founder and CEO of Mable.  

* Mable has withheld the section of the report relating to specific recommendations for improvements on a Commercial in Confidence basis.

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