25 June 2013

Home Care CDC Evaluation Sub-Group Meeting 11 June 2013

Evaluation Paper for NACA Home Care Advisory Group

The NACA Home Care CDC Evaluation Sub-Group met via teleconference on 11 June 2013 to discuss the evaluation process of the CDC Home Care Packages. This briefing paper reflects the discussion of the Evaluation Sub-Group to date and is designed to inform the broader Home Care CDC Advisory Group in its future discussions.

The Sub-Group identified three core questions that any evaluation process should consider:

  • Are CDC packages better than the existing packages?
  • Are Consumers achieving their goals?
  • What are the management issues raised by CDC packages?

The evaluation process should attempt to seek information on these three core questions from the following stakeholders:

  • Consumers;
  • Carers;
  • Special/specific needs consumers; and
  • Service providers.

However, it was noted that the consumers, carers and special/specific needs consumers could be included in the same consultation process as long as they are separately identified.

The Sub-Group also identified a range of questions/areas/issues that would fall underneath these questions, which are outlined in Attachment 1.

Other issues of importance to the evaluation process highlighted by the Sub-Group include:

  • There are different interpretations of CDC and the evaluation process will need to map the differences between the CDC models implemented;
  • There needs to be 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;
  • That 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;
  • That 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;
  • That data collection should include the range of costs with particular reference to rural and remote versus metropolitan; and
  • That priority should be on special/specific need groups as a first design principles.

Additionally, it was noted that the evaluators will need to have an awareness of the sector in order to be sensitive to collecting the right data, and that they will require very clear guidelines to ensure consistency in the evaluation process. It was recommended that evaluators be given an orientation pack and that the Home Care CDC Advisory Group is well positioned to provide feedback in the drafting of such a information pack.

The tender process was seen to be important for framing the role of the evaluators and the Sub-Group recommended that:

  • The tender brief be very descriptive;
  • That the Home Care CDC Advisory Group have an opportunity to give feedback to the content; and
  • Ensure that the tender happens early enough to provide adequate preparation before the commencement of the evaluation process.

The Sub-Group also identified a range of Special/Specific Needsissues, 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 Sub-Group felt that planning the next stages of CDC is crucial, however the evaluation process should yield data that can be used in this planning. Therefore, the evaluation process should make clear that CDC packages are a work in progress and that the current model is not finalised. Additionally there should be consideration of what else needs to be in place to allow the broader roll-out of CDC packages in 2015.

ATTACHMENT 1

Question / Stakeholder / Sub-Question/Issue
Are CDC packages better than the existing packages? / Consumers, Carers, Special/Specific Needs / -Satisfaction with assessment (phone and face-to-face)
-Social inclusion/engagement
-Use of contingency planning and how it was spent
-Support provided to PWD to make decisions about care
-The ability for CDC Packages to cater for those in same-gender relationships and/or with sexual/affectional orientations (particularly including older people who do not publicly disclose or use particular identity labels);
-The ability for CDC Packages to cater for the specific needs of intersex, trans and gender diverse experience (including those who may identify as straight or who identify simply as women or men) and their health and relationship recognition concerns;
Service Providers / -Broad banded assessment levels
-Are these package levels working?
-Use of contingency planning and how it was spent
-Were existing package users given the option to change to CDC – did they choose to do so?
-What support was provided to consumers?
-Administrative charges
-Case managements charges
-Did the level of package referred through the Gateway assessment process meet the providers perceived needs of the client?
-How the dementia supplement was used (on additional services/support/training etc.)
Are Consumers achieving their goals? / Consumers / -Did the level of package allocated meet expectations following the assessment?
-Enough flexibility and innovation for you to get what you want
-Satisfaction with involvement in care planning and services
-Have you been able to have the amount of control you wanted
-Satisfaction with level of control over budget, including proportion of budget spent on direct care
-Measure of self efficacy
-Did you get your first preference in what, who, when, how of services etc. If not, why not?
-Experience of services being excluded
-Timeliness of decision making
-Satisfaction with inclusions/exclusions
-Take up by CALD customers
Service Providers / -Goals are achievable – are they reflective of what the consumer actually wanted
-Did CDC change provision of care – did consumers take up new approaches? Has the approach to care changed?
What are the management issues raised by CDC packages? / Consumers / -Satisfaction with administration charges
-Understanding of CDC and what is available
-Satisfaction with level of information available from the My Aged Care website and from the provider on packages and CDC
-The adequate disclosure management, confidentiality and privacy needs of each specific population in ‘LGBTI’ in CDC package delivery (e.g. concerns about requiring disclosure of LGBTI special needs status before gaining a face-to-face meeting);
-How many dementia supplements were allocated to packages? (what was the distribution across providers and geographically)
Service Providers / -Support for providers
-Training and education, including understanding of guidelines and what is excluded/included
-Understanding of CDC and relevant cultural changes
-What support was given to providers from the Department?
-What training did staff receive?
-Exclusions- document each time a service was excluded and why
-Level of funds set aside for contingency planning
-The inclusion of intersex, trans and gender diverse people in policies, procedures and practices—including currently sex-segregated aspects of care (including databases, services, social supports, etc.)
-The relationship between different interpretation services and customer satisfaction

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).

1

Home Care CDC – Evaluation