Introducing consumer directed care in residential care settings for older people in Australia: views of a citizens’ jury

Abstract

Objectives Health services worldwide are increasingly adopting consumer directed care approaches. Traditionally, consumer directed care models have been implemented in home care services and there is little guidance as to how to implement them in residential care. This study used a citizens' jury to elicit views of members of the public regarding consumer directed care in residential care. Methods A citizens' jury involving 12 members of the public was held over two days in July 2016, exploring the question: For people with dementia living in residential care facilities, how do we enable increased personal decision making to ensure that care is based on their needs and preferences? Jury members were recruited through a market research company and selected to be broadly representative of the general public. Results The jury believed that person-centred care should be the foundation of care for all older people. They recommended that each person's funding be split between core services (to ensure basic health, nutrition and hygiene needs are met) and discretionary services. Systems needed to be put into place to enable the transition to consumer directed care including care coordinators to assist in eliciting resident preferences, supports for proxy decision makers, and accreditation processes and risk management strategies to ensure that residents with significant cognitive impairment are not taken advantage of by goods and service providers. Transparency should be increased (perhaps using technologies) so that both the resident and nominated family members can be sure that the person is receiving what they have paid for. Conclusions The views of the jury (as representatives of the public) were that people in residential care should have more say regarding the way in which their care is provided and that a model of consumer directed care should be introduced. Policy makers should consider implementation of consumer directed care models that are economically viable and are associated with high levels of satisfaction among users.

My Voice, My Choice: A systematic review of the literature relating to consumer-directed care in Australia

“…Russell [8] emphasises the significance of consumers having access to a range of high-quality providers that cater to their diverse needs and preferences, enabling them to select those that best meet their individual requirements Further, Bennett [3] Gill's [28] observations on consumer hesitancy and the fear of negotiating for more tailored services highlights the need to create a supportive and understanding environment that empowers consumers to voice their concerns and actively engage in decision-making regarding their care [28]. To facilitate consumer choice, Laver and others [30] emphasise the need for greater transparency and improved provider communication, particularly regarding any change in consumer circumstances.…”

“…The existence of a marketplace where service providers distinguish themselves by offering value-driven, high-quality services is beneficial [30]. However, concerns about consumer vulnerability and the potential exploitation by unscrupulous providers have been raised [30].…”

“…The existence of a marketplace where service providers distinguish themselves by offering value-driven, high-quality services is beneficial [30]. However, concerns about consumer vulnerability and the potential exploitation by unscrupulous providers have been raised [30]. In a competitive market, it is imperative for service providers to proactively understand and meet the needs and preferences of their target audience to remain viable and ensure quality care that aligns with consumer expectations [30].…”

“…However, concerns about consumer vulnerability and the potential exploitation by unscrupulous providers have been raised [30]. In a competitive market, it is imperative for service providers to proactively understand and meet the needs and preferences of their target audience to remain viable and ensure quality care that aligns with consumer expectations [30]. The literature suggests prioritising transparency of arrangements and access to advocacy services to safeguard consumer rights and wellbeing [30,31,32,33].…”

Are people in residential care entitled to receive rehabilitation services following hip fracture? Views of the public from a citizens’ jury

“…Policy makers and health system planners in Australia have supported the use of citizens' juries and they have been used to inform priorities and make recommendations for a number of health interventions including adolescent vaccination programs [19], surgical management of obesity [20], emergency department treatment [21] and taxing of soft drinks [22]. With respect to care for older people, a citizens' jury conducted in the UK examined priorities for development of dementia care services [23] and another examined introduction of consumer directed care in residential care in Australia [24].…”