Self-managed aged home care in Australia - Insights from older people, family carers and service providers

This paper presents findings from the evaluation of an Australian trial of self-managed home aged care. The self-management model was codesigned by advocacy organisation COTA Australia, consumers and service providers. The primary aim of the evaluation was to examine whether self-management improved consumers' perceptions of their choice, control, and wellbeing. The secondary aim was to examine whether provider prior experience with self-managed packages significantly influenced consumers' perceptions of choice, control and wellbeing, thereby confounded trial effects. A pre-test post-test quasi-experimental design and mixed-methods design were used to collect data over nine months in 2018-2019. The pre-trial methods and findings have been published. The post-trial evaluation replicated the pre-trial data collection method of an online survey (n = 60) and semi-structured telephone interviews with consumers (n = 9), family carers (n = 13), and consumers and carers jointly (n = 2), totalling 24 interviews. Semi-structured telephone interviews were also conducted with CEOs and senior managers from each of the seven providers (n = 14). Three providers had prior experience supporting self-management. Parametric and non-parametric tests examined the statistical data. Qualitative data were analysed thematically and framed according to self-determination principles and ecological systems theory. Both datasets demonstrated that consumers reported greater choice and control at post-trial than pre-trial. This finding was not affected by providers' prior experience with self-management; therefore, it was not a confounding factor. Participants reported improved wellbeing in interviews, however this was not reinforced statistically. Key desirable features of self-management included greater autonomy and control over spending, recruiting support staff and paying lower administration fees. There was no evidence of increased risks or fraud. The research limitations included a small sample size, convenience sampling with providers recruiting interview participants, no control group and differences in trial implementation. The findings support the expansion of self-management opportunities and more comprehensive evaluations that use mixed methods.