Home' Australian Ageing Agenda : AAA Jul-Aug 2013 Contents what challenges they have in achieving
their goals on a day-to-day basis," she says.
Having an individual's needs assessed
by the right people and developing
solutions with input from the consumer
are important next steps, Pross says.
There is an inherent contradiction on
the surface between the philosophy of
choice and control and enablement, which
means providers must also take on the
role of educator, she says.
For example, to give an older person the
basic choice between having their cleaning
done, or undertaking an exercise program to
be able to do it themselves is not a sensible
one, she says. "Focusing on healthy living and
options that can maximise wellbeing will have
a flow on effect to basic tasks of daily living."
An enablement approach, like CDC, is more
sophisticated than a traditional service
delivery model and requires training,
managerial leadership and consideration
from boards about how to support staff to
think outside the square, Pross says.
"Care workers need much more
expertise, systems and motivational
language. Changing the service culture,
language and philosophy of care is key."
Four years since transitioning to an
enablement approach CCNB is just starting
to see change. "We have started to shift the
underpinning philosophy of care on every
level, from service design, assessment,
provision and management. People have
started to know the difference. Workers
have started challenging each other about
whether they are realising enablement
potential with their clients," Pross says.
While there is the chance of conflict
between CDC and enablement, if it is done
well within a culture where independence
and choice is advocated, it has great
potential to improve older peoples' lives,
Pross says. "Ninety per cent of getting it
right is a cultural shift."
And so all agree organisational-wide
cultural change is the crux for CDC success.
To better understand this process of
organisational change, Helping Hand has
been developing case studies involving
consumers and advocates talking to staff
about their experience of the pilots.
Ian Hardy's advice for implementing
CDC is to identify "an internal champion,
mentor, or 'go to person' who really
understands the vision for consumer choice
and empowerment and can help their
colleagues adjust to a new way of thinking."
Similarly Jane Mussared says unless
agencies achieve the cultural shift, it is
very difficult to do the rest. She suggests
helping staff understand about where
control with the customer and broker sits
and what that means.
"There is a fundamental cultural shift
between the old style and CDC. It's as
important to understand why the shift is
necessary as what the shift is. Unless they
embrace and understand and support 'the
why', it's almost impossible to pick up 'the
what'," Mussared says.
Financial transparency is the other
important element to get right from the
start, she says, because it will open up the
way for valuable conversations about what
packages can and can't include.
"If you do that immediately you will get
people who will ask questions." And while
those questions will likely be difficult
ones, service providers shouldn't be
frightened of the conversation, she says.
"I think we'll be delighted along the way
with the probing and questions."
Mussared likened the situation to the
provider and the consumer learning and
walking the CDC road together. Ian Yates
agrees with this and says the most important
thing for providers to get right from day one
is to see the consumer as a partner.
"It is not all about we will give you
more choices. It is about how we can work
together to design the best package of
support for you." n
can't wait for CDC, Hardy says. "It is an
exciting thing to help people make choices
for themselves." However, the journey is
not without its challenges, he adds.
For care workers, and especially
registered nurses who have a strong feeling
of needing to protect the client to ensure
the best health outcome, it is a whole new
way of thinking and working, he says.
"Letting go of that is going to be a big
challenge for everyone in the field. But as
people, we make choices every day and
they are not always good choices. If that
option is extended into our older years,
clients will sometimes make choices that
are not good for them," Hardy says.
"The challenge is at all levels but we
need to acknowledge the right to express
choice and the right to make a mistake.
It's something we need to get used to."
This highlights a conundrum of CDC
where a consumer's decision might
conflict with the requirement of providers
to emphasise wellness, reablement and
Eliza Pross is Director of Strategy
with Community Care Northern Beaches
(CCNB), an organisation that provides
22 independent ageing and disability
programs across northern Sydney using
the enablement approach.
Enablement is focused on working
with an individual to identify the things
most important to them, and supporting
them to maximise their independence at
home, Pross says. "Choosing enablement
over more passive care options is not
necessarily a choice older people will make
without the right information and support
from service providers."
CCNB's services involve coordination,
resourcing and flexible brokerage. A model
very much compatible with CDC, Pross says.
"An enablement approach starts with
understanding what a 'great day' or a 'great
life' might look like for the consumer.
From there, we aim to understand what
strengths and attributes a person has to
realise their potential, and specifically,
Mr Mussry, Community Care Northern Beaches enablement consumer, and Alexander Roach,
Conducive Exercise Physician
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