Enhancing Independence and Person Centred Practice – A Pathway to Implementing Consumer Directed Care

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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

Nothing about me without me www.carriehayter.com

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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

© Carrie Hayter ConsultingNothing about me without me www.carriehayter.com

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

8Nothing about me without me www.carriehayter.com

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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


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).


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?


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’?


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?

© Carrie Hayter Consulting

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?

How do you look after yourself?Nothing about me without me www.carriehayter.com

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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



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




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.


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


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

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Enhancing Independence and Person Centred Practice – A Pathway to Implementing Consumer Directed Care