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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 12 November 2015Brisbane, Australia
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Introduction • ‘Personalisation’ of Aged Care
– Narratives and Research– Perspectives of different stakeholders and actors
• Challenges & Opportunities– Seven Key Steps
• Adaptive Leadership Framework
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About Carrie Hayter Consulting
1 May 2023
Transforming Social Care – Public Speaking – Research & Evaluation – A Handbook for community care services, Empowering People, enhancing
independence, enriching lives with Alt Beatty Consulting for NSW Government
– Education & Training – Service Providers – Implementing Wellness and Reablement in Community Aged Care (managers
and support workers)– Implementing Consumer Directed Care (Managers and Support Workers)– Ageing and Sexuality (managers and front-line workers)– Service Users – Living Life my Way (Service Users)
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Shifting Policy Landscape –Personalisation
Passive Clients
Active Citizens
Block funding Individualised
funding
Rigid inflexible, bureaucratic
services
Flexible responsive services
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Personhood ‘Consumer’ as
Purchaser Citizen
Social and political rightsEconomic
purchasing power
Relationship between client and
professional
Client Citizen – Consumer
Agency
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)
Hybrid Choice and
voice mechanisms
Step One – Start a conversation and get everyone on the same page
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Wellness Reablement Restorative Consumer Directed Care
Building on the strengths • Right balance
between ‘doing with’ rather than ‘doing for’
• Builds community connections
• Identifies what a person can do and wants to do in the future
• Time –limited targeted interventions to regain function, confidence or capacity
• 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.
• Giving more power to people to determine the who, what, why and how supports are provided
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Source: Adapted from Australian Government Department of Social Services (2015) Living Well at Home: CHSP Good Practice Guide,
Step Two – Critically read research and practice guides and share it with your
team
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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)• Australian changes
– Outcomes and benefits
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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).
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Step Three – Engage Older People - Nothing about me without me
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Important to Important for
WWhat else do we need to learn or know?
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).
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
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Coercing
Educating
Informing
Consulting
Engaging
Co-designing
Co-Producing
Co-delivery
Co-Ownership
Ladder of Participation – Choice and Voice?
Doing for
Doing to
Doing With
Doing for themselves
Adapted form Think Public, 2015
User Rights Strategies for older people in the mid
1990’s
Consumer Directed Care?
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www.wavertonhub.com.auwww.mychoicematters.org.au
Co-Ownership and Co-Delivery in Australia
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30 Day Challenge
Getting Traction and Translating into Practice
Your Organisation/ Team
Shared understanding and conversations
Where are we at?
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Step Four – Empower your staff
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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)
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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)
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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’?
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Step Five – Connect people into community
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Orchestrate the Conflict
1. Create a holding environment2. Control the temperature, raise the heat or lower the temperature3. Pace the work4. Show people the future
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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 organisations on their journey?
What might be the losses or casualties?
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Step Six – Form Partnerships
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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 outcomes?
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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
Who are your confidants? How can they support you?
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Step Seven - Be curious and test ideas Be Curious
I have no special talents.
I am only PASSIONATELY
CURIOUS
ALBERT EINSTEIN
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Conclusion
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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/
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References and Resources 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/sites/default/files/documents/06_2015/good_practice_guide_version_web_accessible_pdf.pdf
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.
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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
References and Resources
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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
References and Resources
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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
References and Resources
More Information
Download the seven key steps to implement wellness, restorative and enablement
approaches www.carriehayter.com
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