Introduction Older peoples’ role in Australia’s community aged care system is changing as part of ‘personalisation’. Personalisation is the process of modifying public services to meet the needs of people who use public services and may include person centred planning, self -directed supports and individualised budgets (Needham, 2011).

The issue of choice and voice for people who use services are key parts of the personalisation agenda. On the one hand, proponents of personalisation argue that it provides more choice and control for older people. Critics contend that too much ‘choice’ can challenge decision making processes for people who use users (Schwartz, 2004) and lead to the marketization of public services (Clarke, Newman, Smith, Vidler, & Westermarland, 2007) (Cortis, Meagher, Chan, Davidson, & Fattore, 2013). Some contend that what older people want is not ‘choice’ but more voice in the delivery of support (Barnes & Bennett, 1998).

Research Questions

What are the risks of mechanisms that promote choice for older people who use community aged care services in Australia?

What are the risks of mechanisms that promote the voice of older people who use community aged care services in Australia?

Methodology

This research paper is based on a literature review completed as part of a PhD project undertaken at the University of Sydney in Australia in 2012/13.

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Key Findings

Australia’s Aged Care System Australia’s aged care system is a mixed economy of care including residential and community care funded by the Federal Government. Reflecting international trends, the Australian Government mandated the implementation of individualised budgets in Home Care Packages (HCP) for older people from 1 July 2015 (Department of Health and Ageing, 2013).HCP’s provide in-home and community supports for older people to live in the community. In 2015 approximately $1.27 billion was allocated to HCPs which reflects a tripling of expenditure on this program since 2005 (Productivity Commission, 2005, 2015).

Choice – A Political and Contested Concept?

The concept of what choice means for service users is debated. Some contend that because of the power differentials between service users and service providers it is very difficult for service users to have real ‘choice’(Beresford, 2009). The lack of alternative options combined with the vulnerability of people who use public services is such that people really don’t have much choice (Barnes, 2009).This lack of power for people who use public services can also be reinforced by class, gender, race and ageism (Glendinning, 2009).

The policy mechanisms implemented by government in the guise of choice are not politically neutral and can have a profound impact on the people who use services (Clarke, Newman, & Westmarland, 2008). Figure One shows that the positioning of people who use services in policy debates may effect the use of voice or choice mechanisms.

Figure One – Choice, Voice and the rise of the ‘consumer’

Hayter, Carrie, Managing Director, Carrie Hayter Consulting Sydney, Australia

International Association of Gerontology and Geriatrics (IAGG) European Region (ER)

8th Congress, Dublin 23-26 April, 2015

Bibliography Barnes, M. (2009). Authoritative Consumers or Experts by Experience? User

Groups in Health and Social Care In R. Simmons, Powell, M., & Greener, I., (Ed.),

The Consumer in Public Services, Choice, Values and Difference, . Bristol: The

Policy Press

Barnes, M., & Bennett, G. (1998). Frail bodies, courageous voices: older people

influencing community care. Health & Social Care in the Community, 6(2), 102-

111. doi: 10.1046/j.1365-2524.1998.00105.x

Beresford, P. (2009). Differentiated Consumers? A Differentiated View from a

Service User Perspective In R. Simmons, Powell, M., & Greener, I., (Ed.), The

Consumer in Public Services, Choice, Values and Difference

Clarke, Newman, J., Smith, N., Vidler, E., & Westermarland, L. (2007). Creating

Citizen- Consumers, Changing Publics and Changing Public Services. London

Sage.

Clarke, J., Newman, J., & Westmarland, L. (2008). The Antagonisms of Choice:

New Labour and the reform of Public Services. Social Policy and Society, 7(02),

245-253. doi: doi:10.1017/S1474746407004198

Cortis, N., Meagher, G., Chan, S., Davidson, B., & Fattore, T. (2013). Building an

Industry of Choice: Service Quality, Workforce Capacity and Consumer-Centred

Funding in Disability Care. Sydney Social Policy Research Centre

Department of Health and Ageing. (2013). Home Care Packages Program

Guidelines Canberra Department of Health and Ageing

Hirschman, A. (Ed.). (1970). Exit, Voice and Loyalty Responses to the Decline in

Firms, Organisations and States Cambridge Massachusetts: Harvard University

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Glendinning. (2009). The Consumer in Social Care In R. Simmons, Powell, M., &

Greener, I., (Ed.), The Consumer in Public Services, Choice, Values and

Difference Bristol The Policy Press

Le Grand, J. (2007). The Politics of Choice and Competition The Political

Quarterly, 78(2), 207-213.

Needham, C. (2011). Personalization: From Story-line to Practice, Social Policy &

Administration, 45(1), 54–68. doi: 10.1111/j.1467-9515.2010.00753.x

Productivity Commission. (2005). Report on Government Services - Aged Care

Canberra Productivity Commission

Productivity Commission. (2015). Report on Government Services - Aged Care

Services Canberra Productivity Commission.

Schwartz, B. (2004). The Paradox of Choice - When More is Less? New York

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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

Further Research The personalisation of community aged care for older people in Australia poses many research questions. These include:

How do older people see themselves in a personalised community aged care system?

What is the impact on older people of the policy mechanisms that promote choice?

Older People and Personalisation in Australia –

More Choice or Voice?

Voice rather than Choice? Some contend that voice mechanisms for people who use services are more important than the issue of choice (Simmons, et al, 2011). Figure two highlights the range of mechanisms that promote individual and collective voice (Simmons et al, 2011). These mechanisms tend to reflect the assumption of service users as citizens with social and political rights rather than positioning people as ‘consumers’.

Figure Two – What does having a ‘voice’ mean?

Discussion Older peoples’ role in the community aged care system in Australia is changing which is reflected in the policy mechanisms to promote their choice and voice. There are questions about whether older people actually view themselves as ‘consumers’ and whether the policy mechanisms, for example through individualised budgets, will meet their expectations.

Given the historical institutional structures of the aged care system in Australia ,there needs to be more discussion about the mechanisms that promote the ‘voice’ of older people. Rather than purely focusing on the issue of choice, policy mechanisms need to also explore that the voice of older people can be heard and acted upon. Older people need choice about voice.