Home care packages: insights into the experiences of older people leading up to the introduction of consumer directed care in Australia

Abstract

This paper reports phase one, conducted from March to June 2015, of a two-phase, qualitative descriptive study designed to explore the perceptions and experiences of older people before and after the introduction of consumer directed care (CDC) to home care packages (HCP) in Australia. Eligible consumers with a local HCP provider were mailed information about the study. Data collection occurred before the introduction of CDC and included face-to-face, in-depth interviews, summaries of interviews, field notes and reflective journaling. Semi-structured questions and 'emotional touchpoints' relating to home care were used to guide the interview conversation. Line-by-line data analysis, where significant statements were highlighted and clustered to reveal emergent themes, was used. Five older people, aged 81 to 91 years, participated in the study. The four emergent themes were: seeking quality and reciprocity in carer relationships; patchworking services; the waiting game; and technology with utility. Continuity of carers was central to the development of a trusting relationship and perceptions of care quality among older consumers. Care coordinators and workers should play a key role in ensuring older people receive timely information about CDC and their rights and responsibilities. Participants' use of contemporary technologies suggests opportunities to improve engagement of HCP clients in CDC.

Experiences of older people following the introduction of consumer‐directed care to home care packages: A qualitative descriptive study

“…Five months after the commencement of CDC participants were pleased with HCP support. To be able to live at home after gaining a HCP was as valued as it was prior to CDC . However, as with previous studies , participants were unsure about the concept of CDC, the ramifications for their care and financial position, as well as their ‘choices’, and control, over current and future care.…”

“…This study reports the post‐CDC phase conducted by experienced qualitative researchers from the disciplines of nursing, humanities/social science and information technology. The pre‐CDC phase is reported elsewhere . An advisory committee with representatives of HCP providers and consumers provided oversight of the research.…”

“…Using convenience sampling, people with a HCP, 65 years and over and who could communicate in English, were recruited from two not‐for‐profit community aged care SPs located in the same town in regional New South Wales, Australia. An invitation to participate in the study, information about CDC, study details including a request for participation in interviews before and after the introduction of CDC, a study website address, consent form and a reply paid envelope, was mailed to older people from SP1 ( n = 69) prior to the introduction of CDC . As only five people from SP1 consented to participation in the post‐CDC phase, a second SP was invited to the study.…”

“…The interview guide (Table ) adapted the ‘emotional touchpoint technique’ whereby touchpoint/emotion phrases or words (Table ) were individually recorded on cards and used as prompts to explore experiences during interview. Drawing upon ideas from the literature on CDC and brainstorming experiences of HBC, the researchers developed touchpoints for the pre‐ and post‐CDC study phases . Key staff from the SPs critically reviewed the touchpoints and suggested minor revisions.…”

‘One size does not fit all’: Perspectives on diversity in community aged care

“…The identified themes from this study are of relevance to the current philosophy of CDC in the Australian aged care system. In other literature, older people have identified the need for trusting and reciprocal relationships , responsive services with choice of provider(s) and support worker(s) . For such needs and wishes to be realised, diverse characteristics that are meaningful to the older person and their carer must be identified: firstly, through awareness of diversity and own biases and prejudices; and secondly, organisational support to ensure front‐line workers have capacity and capability to embed diversity principles into practice.…”