1. Consumer Directed Care Would you like fries with that? Angie Robinson September 2014

2. Aim: -Raise awareness of the importance of cultural change, infrastructure, systems, and staff skill sets -Provide insight from a case manager and consumers perspective -Share learning's

4. Placing people at the centre of decision making Individualised funding Strengthening community connections Building workforce capacity Understanding organisational culture Operating in a competitive market Being effective and accountable Pressure Points for Providers

5. So what does this all mean for our consumers and case managers? This hasn’t been an inherent part of our practice A consumer directed framework versus individualised budgets - are they one and the same?

6. So what does this all mean for our consumers and case managers? Ethical decision making – who is making the decisions? Have you had the conversation yet? Understanding the cultural change required in practice

7. Concepts of:- - Choice "Is it that easy to translate into practice and isn’t it interesting how it has become such a challenge?” -Choice -Control -Balanced Relationships (power) -Citizenship -Focus on strengths -Transparency

8. When we first started to have the conversation – What are the first responses do you think I received from staff?

10. Staying true to the intent of consumer choice and control? The right to be a citizen The right to be independent The right to a quality of life – purpose and meaning Human rights approach

11. Understanding our own value base:- Am I making decisions FOR the consumer? When do I transfer my values and judgement ? Am I listening to the consumer or someone else? What is ethical for the consumer?

13. Case Study : " Arnold is a 71 yo man living in a rural and remote town. He was born in the former republic of Yugoslavia and migrated in 1970. Arnold and his carer Ellen (wife) declined a package in 2011 as they felt it wasn’t flexible enough to meet their needs.

14. Case Study : " As a result of the initial discussion and understanding what Arnold and Ellen’s goals were, the CM was able to use the individualised budget tool to demonstrate costs of services and how their funding could be used in different ways – flexibility was the key for Arnold and Ellen. They were also surprised that they could have input into staff they could have, which

15. Case Study : " …meant they could have someone they could trust. The other area of importance for them was being able to make decisions regarding when the service could commence and what time – Ellen asked if they could start next Wednesday at 10am and would that suit us – the CM replied it is your package it needs to suit you.

16. Case Study : " …The flexibility has allowed Arnold and Ellen to bank hours to assist with a specialist appointments in a town a considerable distance from their home."

17. Case Manager reflections? Not being limited by a standard menu The need to be creative to meet consumer goals that doesn’t impact on their budget Planning ahead for increasing needs including equipment and small capital costs Impact of travel and rostering practices on the budget

18. Case Manager reflections? Flexibility and also level of accountability Importance of consumers participating in the decision making process and how empowered they have been Understanding assumptions Challenge of asking the right questions

19. Case Manager reflections? Being able to discuss what is important to the consumer The significance of the change in practice – we didn’t realise how different it was really going to be as we thought we were practicing a consumer focused approach Realisation of how much cross subsidisation we actually did and what that means

20. Case Manager reflections? Understanding our own assumptions and value base around decision making and control Consumers have taken time to “speak up and say what is really important to them” How the budget facilitates consumers using their funding that fits with their lifestyle

21. “ I was really challenged about the concept of individualised funding and how I was going to be able to advocate for consumer needs and what I found was they were able to do it themselves by understanding the cost of their service and making decisions on how they wanted to use it…” Case Manager

22. What has worked? Development of tools to support conversations Training in how to have crucial conversations Understanding of the true intent of a consumer directed care Asking the right questions and having the right conversation – "the craft of the ask"

23. Shared Learnings? Have the conversation early Start planning and understand a true consumer driven environment– talk to others Understand that the approach doesn't equal individualised budgeting only – it is a tool! Understand your own organisational true costs

24. Shared Learnings? Understand where you are currently cross subsidising and prepare for the transition Don’t underestimate the cultural change and time involved for the whole of organisation and not just Case Managers Recognise that what you think you might know and what you have planned will always change along the way

25. “We have to remember & renew our capacity to support & invite the resourcefulness of families, & individuals. This means overcoming the patterns that encourage families and people to delegate their well being to the service system. It means intentionally attuning ourselves to the gift economy as well as functioning competently in the world that commodifies “care”.” John Obrien 2014

26. How do we do this across all settings?

28. “ A mind that is stretched by a new experience can never go back to its old dimensions” Oliver Wendell Holmes Jnr

29. Service Menu – ‘do you want fries with that’

30. Design your menu, your way

31. Thank you arobinson@integratedliving.org.au