Conference Paper

The challenges in developing a seamless model of aged and disability community care in Australia within a mixed economy of service providers

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Community Care in Australia is provided by a range of service providers including, government agencies, not for profit agencies and for profit agencies. Such a broad range of service providers presents a significant and complex challenge in the development of common and coherent Information and Communication Technology (ICT) systems. These challenges include; limited interoperability, complex and differing work practices, conflicting data and reporting requirements, lack of agreement on common work processes across the sector, lack of skills, ad-hoc ICT funding and support. The authors of this paper argue that while policy and practice development in Community Care within Australia has emphasised person centred service delivery, localism, community engagement to enhance coordination and collaboration. Unfortunately the development and implementation of effective ICT practices across the sector have not matched this policy intention. The implementation of ICT has more often than not been technologically deterministic relying on off the shelf software and technology solutions that have reinforced significant interoperability issues, inflexible work processes and practices. Future ICT implementations would be more effective if it addressed the actual needs of service users, staff and enabled policy reforms to occur. Such reforms must also be accompanied by, effective change management, training, benefits realisation and support local information requirements.

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... Responsibilities for this provision fall to Commonwealth, State and Territory, and Local Governments, private funding agreements, and community (not-for-profit) organisations, all offering care to people suffering chronic illnesses, disability, or physical and cognitive decline. This fragmented allocation of services lends itself to problematic regulation and coordination (Clark & Lewis, 2012). Across all systems, however, the home care sector is one of Australia's largest employing industries (Australian Institute of Health and Welfare [AIHW], 2013). ...
Many kinds of workers need to both work and learn in socially isolated circumstances (i.e. in the absence of others who can provide guidance and support). Such circumstances require particular kinds of agency and agentic action by these worker-learners, and they might be described as requiring particularly agentic personal epistemologies. These epistemologies are essential for workers such as home care workers (HCWs), who, after a perfunctory classroom training, are expected to work alone in clients’ homes providing a range of support, such as mobility and hygiene assistance. This chapter draws on a recent investigation into the work and learning of a small cohort of such HCWs and maps how they exercise agency in their work practice, work-related learning and development. These workers deployed, in different ways, their past personal experiences (e.g. work, life, education), the classroom training provided, opportunities to engage with other HCWs and support from other informed sources in learning the requirements for their role. Moreover, these workers exercised agentic action by “personalising” their scaffolding or learning supports. That is, they constructed, engaged with and subsequently relinquished scaffolding as personally necessitated, rather than relying on “experts” to decide how and when these forms of learning support should be enacted and withdrawn. What is important here is how these workers’ subjectivities are found to include actions and monitoring of performance, not just ideas and dispositions. Through an account of how this particular cohort exercised agentic action, some conclusions are drawn and recommendations made for the best ways of progressing the learning and development of such socially isolated workers.
Mobile technologies confer mobility and autonomy on patients with the advantage of access to home care and health care services on demand. However, these benefits impose challenges to the future health care services. For instance, computation capacity of a conventional smartphone provides applications and services with sufficient power of calculation and automation to assist in daily life activities and medical purposes. Combined with a user-friendly interface, mobile technologies can be an easy and efficient manner to help people who are in a condition of cognitive deterioration or have a chronic disease which demands a close connection to near family members and/or to health care services.
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Access to community care services for older people and younger people with disabilities is based on the assessed needs of individuals seeking assistance to remain at home in the community. This paper reviews literature related to use of assessment tools in community care in the context of findings from a Victorian study that focussed upon initial needs assessment processes in home and community care. The trend toward more formalised (and potentially standardised) assessment tools in community care assessment may give rise to unintended tensions that potentially undermine the critical thinking and flexibility required to assess need across diverse populations. Training and professional development for community care assessment, where the focus is on critical thinking, rather than on the use of assessment tools alone is suggested.
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Personal Health Record (PHR) enables patients to access their health information and improves care quality by supporting self-care. The purpose of this study is to provide a comparative analysis of the concept of PHRs in selected countries and Iran in order to investigate the gaps between Iran and more advanced countries in terms of PHRs. The study was carried out in 2008-2009 using a descriptive-comparative method in Australia, the United States, England and Iran. Data was gathered from articles, books, journals and reputed websites in English and Persian published between 1995 and September 2009. After collecting the data, both advantages and disadvantages of each of concepts were analyzed. In the three countries considered in the present study the concepts of PHR, extracted from the literature, are that; a)patient/person be recognized as the owner of PHR; b)information be disclosed only to those authorized by the patient; c) and that PHR is created upon request and consent of the individual involved. Before PHRs can be profitably used in the health administration of a (developing) country, the necessary knowledge, infrastructures, and rules need to be developed.
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The National Home and Community Care (HACC) Dependency Data Items Project was established to recommend, for national use, validated and reliable instruments for measuring the dependency of people eligible for HACC services. In Stage 2 of the project - reported here - a screening tool and assessment instruments selected in Stage 1 of the project were field-tested in a range of HACC agencies. The performance of the screen and the associated assessments was evaluated, as was their acceptability to HACC staff and clients. The results suggest that all of the five instruments are suitable for the target population of HACC services and they can be used effectively across a broad range of service types and by providers of diverse professional backgrounds.
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The aim of the project was to recommend, for national use, validated and reliable instruments for measuring the dependency of people eligible for Australian Home and Community Care (HACC) services. The project was split into two stages. Stage 1-reported here-reviewed the suitability of existing instruments and scales to measure levels of dependency within the target group and made recommendations on a set of measures for national field testing in Stage 2. The review covered four domains of function (domestic or instrumental, self-care, challenging behaviour, and cognitive) and recommended an instrument for each domain. A two-tier assessment system was developed. The first tier consists of a simple nine-item functional screen. It consists of seven items from the OARS instrument (Fillenbaum & Smyer, 1981) and two additional items to cover cognitive and behavioural functioning. The second tier consists of five functional assessment instruments, used only with those triggered for an assessment from the first tier assessment. The five instruments are the Barthel Index (Collin, Wade, Davies, & Home, 1988) or the Functional Independence Measure (FIM, Granger et al., 1993) to assess self-care; the Lawton's Instrumental Activities of Daily Living (IADL) Scale, with modifications to make it suitable for the HACC program, to assess domestic functioning; the Australian Resident Classification Scale (RCS), with modifications to make it suitable for the HACC program, to assess behaviour; and the Folstein Mini-Mental State Examination (MMSE [30-point]) to assess cognition. The selected instruments were, on the weight of the available evidence, those that best met our criteria in terms of validity, reliability and acceptability. The performance of the instruments with a representative sample of HACC clients and services forms Stage 2 of the research; this empirical evidence is reported elsewhere in this Journal.
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This paper, which is an additional nosokinetics paper to accompany those presented in Aust Health Rev 31(1), reports on priority rating through a standardised community care assessment system, based on screening for functional abilities and incorporating additional indicators of need and risk. Routinely collected measures used to generate a priority rating have proven useful in clinical decision making and active demand management at the service entry point. Priority rating is a step towards a more equitable and efficient assessment system. Three examples of priority rating systems are described. The first is a generalist application now implemented in routine practice across multiple service types in the Queensland community care and community health system. The second, narrower in scope, was designed for the NSW Home Care Service, and is also being routinely collected. The third was pilot tested in a state-wide program to supply aids and appliances to disabled people and introduced the additional concept of "capacity to benefit". The case studies show how a technical and data-driven approach can be useful in guiding policy in a complex health care sector.
Case studies of a wide variety of state and local job related education and training programs revealed enough about the range of coordination activities nationally to permit generalizations about the current state of coordination. In a 2-year effort to examine the coordination of vocational education and Job Training Partnership Act (JTPA) programs, little evidence of duplication was found. Some isolated instances of destructive competition, primarily caused by local interest group politics, were found, but evidence of substantial destructive competition in the job training system was not found. Coordination can improve program effectiveness by ensuring that contracts are awarded to the most competent providers; that resources are allocated to the most appropriate education, training, and other job-related services; or by making possible a related set of services that are more effective than their individual components. It was found that collaborative service delivery, rather than collaborative planning, was emphasized, and that collaborative planning does not necessarily lead to the development of more effective programs through the coordination of resources. The emerging role of welfare-to-work programs in the education and training system is discussed and alternatives for federal policy and emerging issues in the "system" of work-related education and training are presented. A 29-item reference list is included. (CML)
Boundaries have long played a central role in American public administration. In part, this is because boundaries are central to the administrative process, as they define what organizations are responsible for doing and what powers and functions lie elsewhere. It is also because of the nation’s political culture and unusual system of federalism, in which boundaries have always been the focus of conflict. Five boundaries have historically been important in the American administrative system: mission, resources, capacity, responsibility, and accountability. New forces make managing these boundaries increasingly difficult: political processes that complicate administrative responses, indirect administrative tactics, and wicked problems that levy enormous costs when solutions fail. Working effectively at these boundaries requires new strategies of collaboration and new skills for public managers. Failure to develop these strategies—or an instinct to approach boundaries primarily as political symbolism—worsens the performance of the administrative system.
Very little systematic research has focused on applying the concept of intellectual capital (IC) within the nonprofit context; particularly in the highly competitive nonprofit environment. Based on a review of the existing literature, this paper firstly contributes to filling this gap by building an argument that IC can be utilised as a competitive tool in nonprofit organisations (NPOs). Secondly, an IC conceptual framework is proposed that explicitly links the attainment of competitive advantage with positive outcomes for NPOs. Finally, the paper discusses how the IC conceptual framework can be effectively utilised to foster competitive advantage in the nonprofit sector. Copyright
Partnerships represent a prescriptive form of network governance, based on the idea of cooperation. This article has four aims. The first is to describe why network governance and partnerships are important now, and what one particular example - Primary Care Partnerships - is addressing. The second is to analyse the network structure of two of these partnerships, and the third is to examine network dynamics. The fourth aim is to explore relationships and sustainability over the longer term. Two government-funded and steered partnerships, which were established to increase coordination between primary care services in Victoria, Australia, were examined. Annual interviews at three points in time between 2002 and 2005 were used to explore relationships between organizations within these two partnerships. The structure of two different communication networks, based on contacts for work and contacts for strategic information, were examined using social network analysis. Tracing network structures over time highlighted partnership dynamics. The network structures changed over the three years of the study, but an important constant was the continuing centrality of the independent staff employed to manage the partnerships. Over the longer term, it seems to be more important to fund independent partnership staff, rather than people who connect partnerships to the funding agency. If partnerships are seen as valuable in improving service coordination and health outcomes, then long term rather than just start-up funding support is required.
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