Study finds increased choice and control when self-managing Home Care Packages

Commissioned by carer platform, Mable, the independent report, Self-managed home care packages: How Mable is improving the quality of life for older people, was produced by Sarah Russell, aged care advocate and principal researcher at Research Matters.

The aim of the study was to investigate how participants felt self-managing their care using Mable, and the pros and cons of self-management through Mable from consumers and their families, compared to their experiences not self-managing their supports in their Home Care Package.

Participants described feeling “much better”, finding self-management “much easier” and found the experience “less stressful”.

Additionally, participants felt that their provider-managed package left them with no choice over their support workers or any control over the time of day that support workers would visit.

Dr Russell says the findings in this study were consistent with the national study she undertook in 2019, Older people living well with in-home support, which found that participants who had provider-managed home care had high case management fees and excessive hourly rates for support workers when using these services.

“Participants described Mable as giving them genuine choice and control about who worked in their home, when they worked, what they did and how much they were paid. They said it had improved their quality of life primarily because they felt empowered,” explains Dr Russell.

“Not only were they able to get more hours of support with self-management than when it was provider-managed, they really valued their relationships with their support workers and their ability to communicate directly with them, to negotiate rates and flexible times, and to easily make changes if needed.

“It is paramount that home care incorporates both medical and social models of care, both are equally relevant to living a good life. Finding people living locally to them was another of the benefits most valued by participants in the study.”

Participants found that rather than having one support worker who did numerous tasks, they could engage support workers for other services, like cleaners, gardeners, qualified carers, or experienced cooks, who were compatible with themselves, who spoke their language and had similar interests.

Recent research from the Grattan Institute and the National Ageing Research Institute (NARI) found that older people don’t feel like they have choice and recommended that the aged care system needs to be changed so that consumers feel more empowered.

The Royal Commission into Aged Care Quality and Safety also recommended a bunch of changes to the aged care system that allows for consumer choice and control.

Co-founder and Chief Executive Officer (CEO) of Mable, Peter Scutt, says the results of this independent research were consistent with the organisation’s own internal consumer research.

Mr Scutt believes that the findings support the principles of self-management which starts with the assumption that the older person has the right to self-determination and is in the best position to know what they need, want and like.

“These consistent themes shouldn’t be a surprise to anyone who has ever assisted a family member or has really tried to put themselves in the shoes of someone seeking in-home support,” says Mr Scutt.

“Indeed, it is my own story and personal experience with my parents that became my driver for developing the Mable platform. Older adults have spent decades making decisions and many have experience with complex negotiations. Sometimes they make decisions with input and advice from trusted friends and family, which is also normal throughout life.

“We seek and accept guidance from experts but we know our minds, we always have, and we don’t like our choices and concerns being ignored or dismissed. And as adults, we certainly don’t want to be made to feel like children because of automatic ageist and paternalistic judgements about our capacity.”

Research participants expressed positive feelings towards the safeguarding measures in place on the Mable platform, including work experience checks on carers.

Mr Scutt says that often people feel like they are losing choice and control over their lives, as well as a loss of dignity, which is why they don’t like to reach out of support. This problem is increased when they have to consider the aged care system.

But if people develop consistent relationships with their chosen carers, they have a higher level of confidence and security.

“Sadly, many respondents reported that, prior to finding Mable (which was often by accident) they were unaware of their right to self-management in a consumer-directed care framework. They talked about the need for greater communication and promotion of their rights and choices,” explained Mr Scutt.

“We need to focus more on rights and choices. As individuals, we have these rights and we are entitled to choice and control over our lives, regardless of our age or health status.

“This research demonstrates that for many people, self-management of their home care package is a very important expression of those rights; one that I hope the Aged Care Royal Commission will seek to reinforce.”

Around 30 people were included in the research project and the participants were subject to an hour-long interview around their experiences accessing home care support.

To access the research on self-management, head to the Mable website.