Enhancing independence and person centred practice - A Pathway to implementing Consumer Directed...

Enhancing Independence and Person Centred Practice –

A Pathway to Implementing Consumer Directed Care

Better Practice Conference Australian Aged Care Quality Agency

Carrie Hayter, Managing Director

Carrie Hayter Consulting 27 August 2015, Sydney, Australia

28 August 2015 © Carrie Hayter Consulting 1

About Carrie Hayter Consulting

28 August 2015

Nothing about me without me

Personalising Care – Translating Research into Practice – A Handbook for community care services , Empowering People, enhancing

independence, enriching lives with Alt Beatty Consulting for NSW Government

– Strategic Planning, Research and Evaluation – Education, coaching and mentoring – Person Centred Practice and Thinking (managers and support workers)

– Cultural Diversity and Cultural Competence

– Ageing and Sexuality (managers)

– Ageing and Sexuality (frontline workers)

– Implementing Consumer Directed Care (Managers and Support Workers)

– Living Life my Way (Service Users)

© Carrie Hayter Consulting 2

Presentation Outline

• Personalisation

– Narratives and Research

• Challenges & Opportunities

– Moving from person-centred to ‘consumer’ directed or person directed supports

– Adaptive Leadership Framework

• Questions and Practical Steps


Source: downloaded from http://lwdp.org.uk/more_info.asp?current_id=296

28/08/2015 Surviving or Thriving in a Consumer

Directed World? © Carrie Hayter Consulting 4

Shifting Policy Landscape – Personalisation

Passive Clients

Participants or ‘consumers’

Block funding

Individualised funding or fee

for service

Monopoly Providers

‘Market of Care’


The rise of the ‘Consumer’

Consumer as Purchaser

Citizen

Social and political rights Economic

purchasing power

Relationship between client and

professional

Client Citizen – Consumer

Active or passive

subjects?

Mechanisms for enacting ‘choice’ and ‘voice’ Mechanisms for enacting ‘choice’ and ‘voice’

Market mechanisms via competition (LeGrand, 2007)

Managing self interest

(LeGrand, 2007) and voice mechanisms

Enable ‘choice’ through ‘voice’

mechanisms (Simmons et al 2011)

Diversity of policy

mechanisms


10 28 August 2015 © Carrie Hayter Consulting


Wellness Reablement Restorative

• Building on the

strengths • Outcomes for people –

outcome or goal focused

• Right balance between ‘doing with’ rather than ‘doing for’

• Looks at appropriateness of services

• Identifies what a person can do and wants to do in the future

• Time – limited

targeted interventions to regain function, confidence or capacity to resume activities

• Evidence-based

interventions led by allied health workers that allow a person to make a functional gain or improvement after a setback, or in order to avoid a preventable injury.

Wellness, Reablement and Restorative Approaches

Source: Australian Government Department of Social Services (2015) Living Well at Home: CHSP Good Practice Guide, pg 11-13

Why reablement and wellness?

• Research - UK, Australia and New Zealand – Improved health and welling for older people (Lewin at al,

2013, Parsons et al, 2013, Parsons et al, 2014) – Reduces people’s dependence on paid supports (King &

Parsons, et al 2012, Lewin & Alfonso 2013, Lewin & De San Miguel, 2013)

– Role of assessment is critical (Department of Family and Community Services, Ageing, Disability and Home Care, 2012)

• Further research – People with dementia (Alzheimer’s Australia NSW, 2014) – Engaging carers and service users in their reablement and

wellness (Wilde & Glendenning, 2012)


Personalisation Narratives

• Personalisation works, transforming people’s lives for the better.

• Personalisation saves money.

• Person- centred approaches reflect the way that people live their lives.

• Personalisation is applicable to everyone.

• People are the experts in their own lives (Needham, 2011: pg 7).


Personalisation and Carers

• Formal care system would not exist without informal carers • Access to personalised budgets

– Conservatism of carers and the risks of personalisation (Needham, 2011)

– The traditional model gives them security and comfort

• Choice and comfort for service users may not necessarily bring choice and comfort for carers

• Voices of carers not being recognised and heard (Carers NSW, 2014)

• Mainstreaming of carer support funding – Access to appropriate support? – Block funded rather than individualised funding


28 August 2015

Models of Consumer Directed Care

Support Facilitation &

Brokerage

Individualised Budgets

Cash for Care

Self Managed

Home Care Packages

National Disability Insurance Scheme

Level of Service User control


Carers Payment

Individualised Budgets


Expressing choices Person centred planning

Self Directed with Community and Family

Using formal and informal supports

Managing money Resources Staff Outside of service system

Co-participant in Support Facilitation

Person Centred

Person and Family Directed –

Self Managed

Wellness

Personalisation for Organisations


28 August 2015

Service Users Service Users Practice Practice

Staff & Volunteers

Staff & Volunteers

Costs Costs

Direct & Indirect Direct & Indirect

Carers Carers Life story Life story

Overheads Overheads

Training & Support

Training & Support

Education & Support Education & Support

Goals and Vision

Goals and Vision

Creative Culture Creative Culture

Person Centred Thinking and Management

Consumer Directed Care

or Person – Directed Support

Bu

ildin

g B

lock

s


Person Centred Thinking and Management

Important to Important for

• What is important for people are the things that help people become or stay healthy and safe, whether it is important to them or not


• What is important to a person is what they say through their own words and behaviours about what really matters to them (eg comfort, happiness).

Source: http://www.helensandersonassociates.co.uk/reading-room/how/person-centred-thinking/person-centred-thinking-tools/sorting-important-tofor.aspx

http://www.helensandersonassociates.co.uk/reading-room/how/person-centred-thinking/person-centred-thinking-tools/sorting-important-tofor.aspx



















Must haves Love to haves

What is stopping the person from having more of the ‘love to haves’ in their life?

Good Day and Bad Day

Good Day Bad Day

What does a bad day look like?


What does a good day look like?

What needs to happen to have more good days rather than bad days?

Source: Helen Sandersonson and Associates http://www.helensandersonassociates.co.uk/reading-room/how/person-centred-thinking/person-centred-thinking-tools.aspx

Differences between Technical Problems and Adaptive leadership

Technical problems are well defined.

Their solutions are known and those with adequate expertise and organisational capacity can solve them.

(Heifetz & Linksy, 2002)

Adaptive leadership challenges are entirely different.

The challenge is complex and not so well defined; and the answers are not known in advance

Problems that require us to learn new ways (Heifetz & Linksy, 2002)


Get on the Balcony

Give the work Back

Think Politically

Orchestrate the conflict

Manage your hungers

Anchor Yourself

What’s on the line

Hold Steady

Adaptive Leadership Elements

Source: Heifetz & Linsky (2002)


Picture downloaded from: https://janeaustensworld.wordpress.com/category/regency-etiquette/page/2/

Getting on the Balcony

Picture downloaded from: https://www.youtube.com/watch?v=qSvyDLTdlyU

What is your team saying about their role? What do older people and their allies say about your

organisation? What is the ‘song beneath the words’?

28 August 2015 © Carrie Hayter Consulting

24

Picture downloaded from: https://janeaustensworld.wordpress.com/category/regency-etiquette/page/2/

Getting on the Balcony

Picture downloaded from: https://www.youtube.com/watch?v=qSvyDLTdlyU

How does management get behind the front-line? How are older people involved and active participants in the

design and delivery of our services? How can we enable service users to make active choices? What skills do service users need? Who can provide these

skills?

28 August 2015 © Carrie Hayter Consulting

25

Think Politically 1. Find Partners

2. Keep the Opposition Close

3. Accept Responsibility for your piece of the mess

4. Acknowledge their losses and accept casualties

5. Model the behaviour (Heifetz & Linksy, 2002)

Picture downloaded from: www.twitter.com

What can we learn from other people or oganisations on their journey?

What might be the losses or casualties? How does our organisation support people across the care

system?



Orchestrate the Conflict

1. Create a holding environment

2. Control the temperature, raise the heat or lower the temperature

3. Pace the work

4. Show people the future


Orchestrate the Conflict

• Co-production or Co-design

• Working with people for planning and designing or co-producing services

– Challenging how staff work and governance structures

– http://www.ndti.org.uk/uploads/files/Personalisation_-_dont_just_do_it_coproduce_it.pd

– http://homecaretoday.org.au/

http://www.ndti.org.uk/uploads/files/Personalisation_-_dont_just_do_it_coproduce_it.pd




http://homecaretoday.org.au/

http://homecaretoday.org.au/

Give the Work Back

• Solutions are achieved when “the people with the problem” go through a process together to become “the people with the solution”.

• Take the work off your shoulders….place it where it can be addressed by the relevant parties.

Who do you need to engage in the solutions? How can we work with older people and their allies to co-

produce solutions and outcomes? What structures do we need ?


Anchor Yourself • Don’t confuse one’s self

with one’s professional role

• Identify a truly trustworthy confidant who can really tell you what you NEED to hear

• Find a sanctuary for retreat, rejuvenation and personal reflection

30

Who are your confidants? How can they support you?

How do you look after yourself? 28 August 2015 © Carrie Hayter Consulting

People Leading the Way

Village to Village Network Boston Beacon Hill Village • Grass roots movement created by

older for older people • Member based http://www.beaconhillvillage.org Village to Village Network http://www.vtvnetwork.org/ • Australia -Waverton http://wavertonhub.com.au/

My Choice Matters

• Workshops, resources for people to have more voice, choice and control

• Run my projects

• Become a leader

http://www.mychoicematters.org.au/

• Community Disability Alliance Hunter – Planning Cafes

31 28 August 2015 © Carrie Hayter Consulting

http://www.beaconhillvillage.org/

http://www.beaconhillvillage.org/

http://www.vtvnetwork.org/

http://www.vtvnetwork.org/




A Call to Action


Nothing about me without me • Planning • Delivery • Design of Supports All people have some capacity for self-direction Engaging informal networks and community to support the person

References and Resources

Leadership

• Heifetz, R., & Linksy, M., (2002) Leadership on the Line: Staying Alive through the Dangers of Leading, Harvard Business Review Press, Boston Massachusetts

• Heifetz, R., Grashow, A., & Linksy, M., (2009) The Practice of Adaptive Leadership – Tools and Tactics for Changing your Organisation and the World, Harvard Business Review Press, Boston Massachusetts

• Goleman, D. (1998). Working with Emotional Intelligence London Bloomsbury.

• Covey, R., (1996) The 7 Habits of Highly Effective People, Simon and Shuster, New York – https://www.stephencovey.com/7habits/7habits.php

• Cambridge Leadership Associates – http://cambridge-leadership.com/


https://www.stephencovey.com/7habits/7habits.php




Reablement and Wellness

Alzheimer's Australia NSW. (2014) The Benefits of Physical Activity for People living with Dementia, Sydney , Alzheimer's Australia NSW downloaded from https://nsw.fightdementia.org.au/nsw/news/the-benefits-of-physical-activity-and-exercise-for-people-living-with-dementia Australian Government Department of Social Services (2015) Living Well at Home: CHSP Good Practice Guide, pg 11-13, downloaded from https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/commonwealth-home-support-programme/living-well-at-home-chsp-good-practice-guide Glendinning, C. (2012). Home care in England: markets in the context of under-funding. Health & Social Care in the Community, 20(3), 292-299. doi: 10.1111/j.1365-2524.2012.01059.x King, A., M. Parsons, et al. (2012). "Assessing the impact of a restorative home care service in New Zealand: A cluster randomised controlled trial." Health and Social Care in the Community 20(4): 365-374. Lewin, G., & Vandermeulen, S. (2010). A non-randomised controlled trial of the Home Independence Program (HIP): an Australian restorative programme for older home-care clients. Health & Social Care in the Community, 18(1), 91-99. doi: 10.1111/j.1365-2524.2009.00878.x Lewin, G. F., H. S. Alfonso, et al. (2013). "Evidence for the long term cost effectiveness of home care reablement programs." Clinical interventions in Aging 8: 1273-1281. Lewin, G., K. De San Miguel, et al. (2013). "A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults." Health & Social Care in the Community 21(1): 69-78.


https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/commonwealth-home-support-programme/living-well-at-home-chsp-good-practice-guide


































Reablement and Wellness (Cont)

Parsons, J. G. M., N. Sheridan, et al. (2013). "A Randomized Controlled Trial to Determine the Effect of a Model of Restorative Home Care on Physical Function and Social Support Among Older People." Archives of Physical Medicine and Rehabilitation 94(6): 1015-1022. Ryburn, B., Wells, Y., & Foreman, P., (2009) Enabling Independence: Restorative Approaches to Home Care Provision for Frail Older Adults, Health and Social Care in the Community, Volume 17 (3), pp 225- 234, see pg 22 Senior, H. E. J., M. Parsons, et al. (2014). "Promoting independence in frail older people: A randomised controlled trial of a restorative care service in New Zealand." Age and Ageing 43(3): 418-424. Wilde, A., & Glendinning, C. (2012). ‘If they’re helping me then how can I be independent?’ The perceptions and experience of users of home-care re-ablement services. Health & Social Care in the Community, no-no. doi: 10.1111/j.1365-2524.2012.01072.x



Needham, C. (2011). Personalising Public Services Understanding the Personalisation Narrative Bristol, UK Policy Press

Simmons, R. (2011). Leadership and Listening: The Reception of User Voice in Today's Public Services. Social Policy & Administration, 45(5), 539-568. doi: 10.1111/j.1467-9515.2011.00790.x

Moran, N., Glendinning, C., Wilberforce, M., Stevens, M., Nettens, N., Jones, K., Manthorpe, J., Knapp, M., Fernandez, J., Challis, D., & Jacobs, S. (2013) Older people’s experience of cash-for-care schemes: evidence from the English Individual Budget pilot projects, Ageing and Society 33, pp 826-851

Needham, C. (2011). Personalising Public Services Understanding the Personalisation Narrative Bristol, UK Policy Press

Simmons, R. (2011). Leadership and Listening: The Reception of User Voice in Today's Public Services. Social Policy & Administration, 45(5), 539-568. doi: 10.1111/j.1467-9515.2011.00790.x

Simmons, R., Birchall, J., & Prout, A. (2011). User Involvement in Public Services: ‘Choice about Voice’. Public Policy and Administration, 27(1), 3-29. doi: 10.1177/0952076710384903

Williams, R., & Sanderson, H., (2005) What are we learning about person centred organisations?, downloaded from Home Care today www.homecaretoday.org.au



More Information Carrie Hayter

Email: [email protected]

Twitter@carriehayter

Slideshare: Carrie Hayter

www.carriehayter.com

Linked in http://au.linkedin.com/pub/carrie-hayter/34/536/517/


mailto:[email protected]

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