CHAPTER 3 : THE RELEVANCE OF INTER-ORGANIZATIONAL CO-ORDINATION
In this section I would like to analyze the findings of my research by linking to the framework of the study and literature review. Firstly, in ﾔDecentralizationﾕ I will apply Smithﾕs concept of decentralization in terms of local democracy which has positive benefits to the local community including political equality, accountability and liberty and responsiveness to people. I will also examine Waldfogelﾕs concept of locality to assessment and planning services in relation with the findings of the research. Furthermore, the role of local government will be discussed in term of the co-ordination of community care services for elderly people. Secondly, I will analyze the finding of my research through these conceptual frameworks of IOC such as Mulford and Rogers, Warren et al. and Alexanderﾕs. Also, I will discuss some other features of IOC such as informal links and centralizing authority. Finally, I will examine the characteristics of well co-ordinated services in the two LGAs which I discussed in literature review, which include a single point of co-ordination, equality of access, continuity of staffing and volunteers, adequate resources and funding and open-line communication between service providers.
Decentralization
As I discussed in the literature review, the level of decentralization in Australia is low in legal and financial terms compared with other federal countries. However, the high level of decentralization in the law and financial sense does not necessarily mean the co-ordination system of community services for elderly people is more decentralized in planning and assessment of services. According to Smithﾕs (1985) concept, decentralization to local government will develop local democracy and bring benefit in both national and local level. In terms of the co-ordination of community care services for elderly people, the level of decentralization should be measured in relation to the level of local democracy.
The legal and financial power of the two local governments, North Sydney and Leichhardt, for the co-ordination of community care services for elderly people is weak like other local governments in NSW. However, in terms of in planning and assessment of the services, the area of the service provision and co-ordination is based on the local government area although the local council does not always take the initiative. In this sense, the co-ordination of community care services for elderly people in NSW is considerably decentralized not systematically but practically. Therefore, the finding of the research shows a extensive difference and contrast between North Sydney LGA and Leichhardt LGA in both the co-ordination style and the level of local governmentﾕs attitude to the community care services for elderly people. As a case study, I will use the examples especially from North Sydney Community Services and Victoria Alice Lamkin Centre.
The concept of local democracy in terms of decentralization
Smith (1985) argued the development of local democracy and the increase of opportunities for local people for the participation would enhance political equality. Local democracy also prevents the gap between administration and local community. The finding of my research show that there is a difference in the provision of opportunities for local people to participate in the policy-making process in terms of the development of local democracy. One of the biggest reasons for the difference in the opportunities for local people between the two community service providers, North Sydney Community Services and Victoria Alice Lamkin Centre is the difference of the management style. In North Sydney Community Services, the organization is managed by a community based Board of Directors. The Board of Directors includes councillors and community members. The management of the organization is run by the local people themselves. More importantly, the daily service provision of this organization heavily involves volunteers in the community. This close relationship between the organization, local community and volunteers promotes the participation of community members in policy making and the reflection of voices from community members. Also, a focus group meeting among volunteers has a very important function to bring opinions of volunteers into the policy process directly.
On the other hand, in Victoria Alice Lamkin Centre, the management of the service provision is run by Leichhardt Council. Although community members can suggest ideas through council meetings, they can not participate in the policy making process in this organization directly. Volunteers possibly might express their opinions to the staff during volunteer works. However, these informal opinions will not strongly influence the policy making process of the service provision in this organization.
Smith also states that local democracy will improve clientsﾕ satisfaction. There is also a difference in the attitude to the collection of consumer opinions between two organizations. Firstly, in North Sydney Community Services, the opinions from clients are listened to because the Board of Directors is made up of retired people mainly. In Victoria Alice Lamkin Centre there is no direct communication between clients and the organization except for some surveys about the service quality. Secondly, North Sydney Community Services optimises use of Meals On Wheels (MOW) volunteers to watch and listen to clientsﾕ changes in demand and anticipate future changes in the whole community. This communication system will work out because the MOW volunteers have enough time to go into clientsﾕ house. Although MOW volunteers in Victoria Alice Lamkin Centre have some responsibilities to inform staff if the clients are not at their home, there is not enough time for volunteers to fulfill the function of checking clientsﾕ conditions and changes of needs. Staff also do not expect volunteers to check the clientsﾕ condition carefully because Victoria Alice Lamkin Centre does not have the function to co-ordinate other community services as a formal policy.
These differences between North Sydney Community Services and Victoria Alice Lamkin Centre discussed above explain why the level of decentralization in term of the co-ordination of community care services in North Sydney Community Services is higher than that of Victoria Alice Lamkin Centre. As a result, the lack of local democracy in Victoria Alice Lamkin Centre decreases the benefits which Smith states for service provision and co-ordination. North Sydney Community Services is more likely to make use of local democracy such as the political equality, accountability and liberty, responsiveness to people to maintain more stable service provisions. Hokenstad (1982) also states that clientsﾕ participation in policy making will have a positive influence to service co-ordination. In North Sydney Community Services the benefits of local democracy increase the number of volunteers and improve the co-ordination of the services. In addition, clientsﾕ needs are likely to be reflected in policy making for the service co-ordination.
There are some common problems in both organizations in terms of decentralization. Although I did not discuss decentralization as legal and financial terms in this section, the weak financial power very much influences the service provision of community services in both organizations. The large part of funding of the service provision in both organizations depends on NSW government and Commonwealth government funded HACC programs. They can not take a strong initiative to make flexible programs for the service provision and co-ordination. According to the interview results, these pressures from the lack of funding bring about the lower satisfaction of the staff and volunteers and are likely to cause a decreasing level of quality of the services.
The role of local government for service co-ordination
In terms of decentralization, the role of local government in co-ordination of community care services for elderly people is discussed. Waldfogel states assessment and planning should be done by locality because local actors better identify needs of clients for service co-ordination with a high degree of flexibility and autonomy. In my hypothesis I assume in the framework of study that local government will take more active role in the co-ordination of community services for elderly people because it has a closer relationship and easier access with local community, as Bowman (1987) claims that local governments should be the main organization for co-ordination of a range of front-line services and local integration. However, the findings of this research show that the local government is not necessarily a main and proper organization for the co-ordination and the provision of community care services for elderly people. For example, Victoria Alice Lamkin Centre does not succeed to make use of the feature of the local council as the closest organization to the community and build the local democracy in the process of the service provision and co-ordination. Also, the role of the council in Leichhardt LGA becomes vague in terms of the co-ordination of community care services for elderly people because there is no clear policy direction and consensus among staff. On the other hand, North Sydney Community Services utilises its special position as a non-profit community organization for the service provision and co-ordination and creates the close relationship with both the local community and the local council. This is because North Sydney Community Services understands their role of co-ordinator and service provider, North Sydney council clearly recognizes its role in social planning in North Sydney LGA and concentrates on it.
It will be hard for me to conclude that the local government should take all responsibilities in the co-ordination and the service provision in all LGAs in NSW. However, local government should make more effort to fulfill local democracy in each LGA because the benefits from the development of local democracy manage a stable service provision and improve the co-ordination of community care services for elderly people. More importantly, the staff of the local government should make sure which role the local government must take in each local LGA without being vague about it. It is also essential for the local government to promote local democracy in order to enhance volunteer activities and citizen participation in community care services for elderly people. The local government can take the initiative to utilize social human resources such as volunteers and local people because it is one of the closest public organizations to the local community.
Inter-Organizational Co-ordination (IOC)
Mulford and Rogers (1982) state the increase in complex needs of clients promotes the specification of the provision for community care services for elderly people. At the same time, IOC becomes essential for the co-ordination of the services. As discussed in the framework of study, there is the level of IOC in various contexts in terms of service provision and co-ordination. Mulford and Rogers (1982)ﾕs definition regards IOC as a process. On the other hand, Warren et al.(1974) quoted by Mulford and Rogers (1982) and Alexander (1995) discusses IOC as a process or structure. Alexander (1995) also stresses informal links as a style of IOC. Finally, Mott (1968) quoted by Rogers and Mulford (1982) uses the concept of difficulty of centralizing authority for IOC. In relation to these concepts of IOC, I would like to examine the level of IOC in both LGAs by focusing on North Sydney Community Services and Victoria Alice Lamkin Centre as a case study.
IOC as process and structure
Considering Mulford and Rogersﾕs (1982) definition of IOC as a process, IOC is to make a joint decision between organizations and establish the importance of shared task environment. Firstly, the level of IOC will be shown in whether the decisions about the service co-ordination of community services for elderly people in the LGA are created jointly between organizations. In the meaning of IOC as a process, the finding of the research shows a contrast between North Sydney LGA and Leichhardt LGA. In terms of joint decision makings, North Sydney LGA has a Service Co-Ordinating Team (SCOT) meeting once a month at North Sydney Community Services. This case meeting creates a joint decision making systematically between all co-ordinating organizations and providing organizations and prevents misco-ordination of the services. On the other hand, Leichhardt LGA does not hold any case meetings between co-ordination organizations and service providers including the council. According to Schermerhonﾕs (1975) literature cited by Mulford and Rogers (1982) about the difference between co-ordination and co-operation, although there are weekly case meetings between ACAT, Community Options, Home nursing and between ACAT and hospitals, it would be difficult to call this meeting an IOC process because these case meetings among some co-ordinating organizations and health sectors are held to achieve their respective individual goals rather than to find one solution in Leichhardt LGA. Therefore, it will be suitable to call this meeting a cooperation process.
Mulford and Rogers (1982) also explain the importance of a shared task environment as a process of IOC in service co-ordination. North Sydney LGA introduced recently the community information assessment referral system which shares a same file of each client among co-ordinating and providing organizations in North Sydney LGA. This filing system will effectively promote IOC as one of task shared environment among different co-ordinating and providing organizations, and is likely to reduce the duplication of assessments and co-ordination of the community care services for elderly people in North Sydney LGA. Leichhardt LGA does not have a comprehensive task sharing system for service co-ordination. Even within Leichhardt Council, Victoria Alice Lamkin Centre has different files of clients from other providing organizations such as Rozelle Neighbourhood Aid Centre.
Both Warren et al. (1974) quoted by Mulford and Rogers (1982) and Alexander (1995) regard IOC not only as a process but also as a structure. Warren et al. (1974) argue that IOC is to identify the relationships between the participants. In terms of co-ordination of community care services for elderly people, IOC will be the structure which can recognize the role of the organization between participating organizations. Alexander (1995) explains the importance of interdependence and mutual interest between the co-ordinating and providing organizations. IOC will be effective as a structure only if the interdependence exists. In North Sydney LGA, IOC as a structure is working well because the role of council and North Sydney Community Services is clearly divided as planner and provider/co-ordinator separately. In addition, North Sydney Community Services does not feel any pressures from North Sydney Council although the council subsidizes the many programs of North Sydney Community Services. Each organization is independent yet interdependent in some levels in North Sydney LGA.
In Leichhardt LGA, the role of the council and other providing organizations which are run by the council are ambiguous because the recognition and understanding about the role of the council and the importance of interdependence between Victoria Alice Lamkin Centre and other co-ordinating organizations is lacking among staff. Firstly, the interviews with the staff in Victoria Alice Lamkin Centre show that they do not realize the importance of the co-ordination and co-operation with Rozelle Neighbourhood Aid Centre which provides some community services in Leichhardt LGA. Secondly, there is no strong interdependence between ACAT and Victoria Alice Lamkin Centre in terms of service co-ordination. ACAT in Leichhardt does not recognize Meals on Wheels services as an important function to get the daily information from clients, as in North Sydney LGA. Also, there seems to be a big gap in the understanding about the role of the organization between administrative staff and part-time staff who directly work with clients and volunteers in Leichhardt Council.
In addition to IOC as the formal structure, Alexander (1995) considers that there are many informal channels between different units in one organization and between different organizations. In terms of the co-ordination of community services for elderly people in both LGAs, IOC as a informal linkage is significant for the effective service co-ordination. In both North Sydney Community Services and Victoria Alice Lamkin Centre informal links are likely to supplement formal IOC structure and process. However, there are slight differences in the quality and quantity of informal links between the two organizations. Firstly, most staff in North Sydney Community Services very much depend on informal meetings and conversations between staff to solve the daily problems. On the other hand, part-time staff in Victoria Alice Lamkin Centre do not find enough time to discuss the daily issues informally because they are too busy managing services and volunteers. Secondly, although there are administrative staff of Leichhardt Council and front-line part-time staff in the same office, the research shows that there are few informal meetings and conversations about the management of the service provision and the daily problems between them. This communication gap will strongly influence and decrease the level of IOC in the service provision in Leichhardt LGA. In contrast, the better relationship between North Sydney Council and North Sydney Community Services appears to be maintained by frequent informal links such as informal meetings and information exchanges although each office is located in a different place.
The concept of centralizing authority
Mottﾕs (1968) concept quoted by Rogers and Mulford (1982) explains that the more centralizing to one position or vertical an inter-organizational system is, the less public support individual agencies will get. The development level of IOC will be shown in the level of centralizing power of the service co-ordination and provision system. The findings of my research show that there is a strong tendency of centralizing authority in the relationship between organizations which are run by Leichhardt Council. In Victoria Alice Lamkin Centre the authority is completely held by an administrative staff. The decision style and communication pattern between the administrative staff and part-time staff is vertical and hierarchical. This centralizing power puts much pressure and frustration on part-time staff to manage the service provision and volunteers. These frustrations are shown in part-time staffsﾕ negative attitudes to the use of volunteers in service provision. Therefore, these unfavorable impressions influence the relationship between staff and volunteers. Also, the dissatisfaction about working conditions of part-time staff will give anxiety and distrust even to clients. As a result, it would be difficult for Victoria Alice Lamkin Centre to get public support and enough volunteers. In contrast, very few staff in North Sydney Community Services feel frustration and pressures from North Sydney Council. The relationship between North Sydney Community Services and North Sydney Council has a horizontal feature which is based on the partnership. The decentralization of power to front-line staff who work with clients and volunteers in North Sydney Community Services helps to give reliability and credibility to the local community and attract public support.
Type of IOC
As I discussed above, the level of IOC is quite different between the two LGAs. The findings show that the level of IOC in North Sydney LGA is higher than that of IOC in Leichhardt LGA. If you examine the level of IOC from the point of the views of Rogers and Mulford (1982), North Sydney LGA uses systematic case co-ordination (refer to diagram1 P25) which establishes agreement and activities between co-ordinating organizations and providing organizations by definite rules and procedures. It might be understood as a program co-ordination in which co-ordinations are based on joint programs. However, the service co-ordination and provision is not completely controlled and built by one core organization as a program in North Sydney LGA. Each organization attempts to recognize the specific role on its own and reduce the gaps of the service co-ordination and provision through the SCOT meeting as a system. Therefore, systematic case co-ordination will be the style of the service co-ordination of community care services for elderly people in North Sydney LGA.
On the other hand, the type of IOC which is practised in Leichhardt LGA will be ad hoc (mutual adjustment) type co-ordination (refer to diagram2 P32). For example, Victoria Alice Lamkin Centre is not included in any formal co-ordination structures in Leichhardt LGA although information exchanges or referrals of clients are proceeded with other co-ordinating and providing organizations. Alexander (1995) claims that IOC will not produce any benefits if the interdependence is weak between organizations. Since the level of interdependence between Victoria Alice Lamkin Centre and other organizations is considerably low, Victoria Alice Lamkin Centre is unlikely to receive positive effects of IOC in terms of the co-ordination of community care services for elderly people. This is contrast to the condition of North Sydney Community Services.
Characteristics of well co-ordinated services
Next, the pursuit of how much the characteristics of well co-ordinated community care services for elderly people are achieved in both organizations is discussed. The discussion will be followed by consideration of the characteristics of well co-ordinated services which include a single point or co-ordination, equality of access, continuity of staffing and volunteers, adequate resources and funding and open-line communication between service providers. These characteristics were identified in literature review and adopted as themes of the interview questions.
Before discussing these issues, I will examine the influence of demographic features in each local government area to the characteristics of well co-ordinated services, which I did not consider in the last sections. Firstly, the percentage of people over 65 years old in North Sydney LGA is higher than that of Leichhardt LGA. Also, more elderly people tend to live alone in North Sydney LGA than in Leichhardt LGA. According to these facts, North Sydney LGA will place a higher priority in policy for community services for elderly people than Leichhardt LGA. Secondly, the weekly income over 65 years old in Leichhardt is considerably lower than that in North Sydney LGA. Although it is changing, Leichhardt LGA is a residential area for working class people who have lower incomes. This low economic factor will be strong reason for heavily lacking volunteers and facilities in Leichhardt LGA. It will be extremely difficult for providing organizations in Leichhardt LGA to find volunteers especially from retired people who are the main volunteers in Australia. On the contrary, North Sydney LGA has large commercial and retail centres and industry where people who have relatively high incomes are concentrated. Therefore, it would be easier to find volunteers and receive donations for organizations compared with other LGAs. Thirdly, the greater diversity of ethnicity in Leichhardt LGA makes the co-ordination of the services difficult and complicated as well. We have to consider that these differences of demographic features between the two LGA will strongly influence the co-ordination pattern of community services for elderly people in each area.
A single point of co-ordination
In this case study, it would be difficult for me to conclude that multiple points of co-ordination should change to a single point co-ordination in the local government area. It is true that multiple co-ordinations in the local government area cause co-ordination problems such as fragmentation and duplication. However, a single point co-ordination is not necessarily the best form to solve these co-ordination problems in any local government area because each local government area has different demographic and social features. For example, in North Sydney LGA, although there are three main co-ordinating organizations such as North Sydney Community Services, ACAT, Community Options, there are fewer co-ordination problems between these organizations. In Leichhardt LGA, fragmentation and duplication often happens despite there being fewer co-ordinating organizations. Practically, ACAT has to accept almost all co-ordination of the services including minor services because there are no other co-ordinating organizations to do them. The key to solve co-ordination problems in both LGAs is whether there is a formal case meeting between co-ordinating and providing organizations or not.
On the other hand, one organization co-ordinating and providing is very effective and efficient to solve co-ordination problems. For example, in North Sydney Community Services, one organization includes the role of co-ordination and provision of the services. Because it is providing the daily base services such as Meals on Wheels, service co-ordinators can always keep in touch with clients and know the clientsﾕ condition constantly and automatically. It might be possible to combine co-ordinating organizations and other daily base service providers such as Home Care and Home Nursing. A complete independent co-ordinating organization which is separated from service provision might have difficulty to get daily information from clients.
There is no one strong consensus about the introduction of one organization co-ordinating among staff whom I interviewed. For staff in service providers one organization co-ordinating would be one of ideal form because their co-ordination tasks will become easier and simple. Also, for clients one organization co-ordinating will be more simple and understandable than multiple co-ordination. However, according to the experience as co-ordinating organization staff in an ACAT team interviewed, they are doubtful about the quality and efficiency of an independent co-ordinating body which will be introduced by NSW government . As Hokenstad (1982) claims that there are professional barriers to co-ordination in the health services system and the social service system, this doubt might indicate a professional obstacle in that co-ordinators in the ACAT team do not want a new drastic change or they have a strong confidence in traditional multiple co-ordination. However, actually the effectiveness of one organization co-ordinating has not been tested in many places in NSW. Therefore, it might be too early to make a clear answer to the effectiveness and quality of one organization co-ordinating in the LGA.
Equality of access
Obviously, inequality of access for clients to the co-ordination of community care services for elderly people is shown between the two local governments. The level of democracy in Leichhardt LGA for service co-ordination is lower than that of North Sydney LGA. This difference between the two LGAs is the main cause of inequality of clientsﾕ participation. In addition, the quality of clientsﾕ access to the service co-ordination is lacking in Leichhardt LGA because of its co-ordination style. Victoria Alice Lamkin Centre does not have the function of co-ordinating the services in Leichhardt LGA even though this centre provides every day services and can contact clients constantly. They also seldom refer clients to other services. Clients often have to contact ACAT by themselves in order to ask for the co-ordination of community services. Because of this co-ordination style, ACAT which originally accepts clients who have complex needs have to co-ordinate health and community services for all clients who need help. Then, a easy and simple access for the services co-ordination is not guaranteed. Also, as Rogers and Mulford (1982) states IOC improves the access, the fewer communication between ACAT and Victoria Alice Lamkin Centre will reduce the quality of access for clients.
On the other hand, in North Sydney LGA, clients can consult community workers in North Sydney Community Services for any minor things. One of the biggest differences from Victoria Alice Lamkin Centre is that North Sydney Community Services assesses clients at first before providing services and keeps close contacts by providing services. It is important for the closest organization to clients to attempt to look for and open up needs of clients. Finally, North Sydney Community Services refers to ACAT when clients need a greater range of services or a comprehensive assessment by the team. This co-ordination style will actually give clients very easy and simple access to the service co-ordination and a type of co-ordination which is clients needs based rather than organization centred.
The volunteer co-ordination also influences the quality of access for clients. In North Sydney Community Services, the same volunteers are likely to deliver to or help the same clients as long as possible to create a good relationship between volunteers and clients. If the volunteers and clients get to know each other, there are many advantages from it. Firstly, it will be easier for clients to inform of any problems and concerns about services or clientsﾕ condition to volunteers. Secondly, volunteers will find out any problems and changes of clients and inform them to staff smoothly. Thirdly, the service provision will become effective and efficient because volunteers become familiar with the same clients and get used to the same jobs. In Victoria Alice Lamkin Centre, it is difficult for staff to co-ordinate the same volunteers for the same clients constantly because volunteers in Leichhardt LGA often quit volunteer work. Also, staff are not necessarily concerned about the benefit of using volunteers to get clientsﾕ information.
Continuity of staffing and volunteers
My research shows that the main problem for both North Sydney Community Services and Victoria Alice Lamkin Centre is the lack of volunteers because both of them totally depend on volunteers for providing services. This lack of volunteers strongly influences the continuity of staffing. Actually, staff in both organizations often find it difficult to manage volunteers and keep the quality of service provision. They also suggest hiring more paid workers instead of depending on volunteers completely. The pressures which arise from the lack of volunteers will disturb proper working conditions for staff and link to their dissatisfaction. In Victoria Alice Lamkin Centre the pressures bring about the distrust and unfavorable feelings about volunteers among part-time staff. In North Sydney Community Services staff understand not only these disadvantages of using volunteers but also advantages, and attempt to make use of volunteers as important social resources to build community developments and local democracy. More importantly, volunteers very much care about clients and come to have a lot of commitments with clients. For many clients MOW volunteers are the only persons who visit them in the day or shopping service volunteers are only persons with whom they can go out to town in the community. Although this has not been investigated here, volunteers in the community are likely to have special positive attitudes to clients such as friendship, community spirits and consideration compared with paid-workers.
However, demographic features are related to the continuity of staffing and volunteers in significantly. reflecting the demographic reasons for discontinuity of volunteers in Leichhardt LGA, many volunteers start volunteer work because of the unemployment situation. Staff also do not have much enthusiasm to cultivate a volunteer spirit in this community but use volunteers to save costs. On the other hand, because of demographic features such as low economic factor in this area, it will be very difficult for staff to change the volunteersﾕ feature and attitude to the jobs suddenly.
Also, in terms of continuity of staffing, the satisfaction level among staff about their jobs will depend on freedom for staff and the understanding of administrative staff. The level of satisfaction among staff in the two community centres showed a contrast. The difference of the satisfaction level among staff occurs because of the difference of the management style. The findings of the research show that in Victoria Alice Lamkin Centre, a bureaucratic feature of government organizations causes lack of understanding for administrative staff and freedom for part-time staff. On the other hand, a democratic feature of non-governmental organizations improves administrative staffﾕs attitudes to front-line staff in North Sydney Community Services. Front-line part-time staff who work with clients have enough freedom and show satisfaction for the working conditions and the understandings from administrative staff. In addition, the satisfaction among staff and continuity of staffing are very important factors for the management and quality of service provisions.
Adequate resources and funding
The adequacy of financial resources and human resources and the influences the service co-ordination in the two LGAs is now examined. In terms of financial resources, both organizations feel inadequate about financial resources including grants from HACC programs and local council. However, staff in North Sydney LGA recognize the adequate provision of community care services for elderly people while staff in Leichhardt LGA notice a considerable deficit in the amount of the provision of community care services. In Victoria Alice Lamkin Centreﾕs case, there is a strong connection between inadequate funding and the quantity of volunteers. The lower funding makes the organization decrease the number of staff who organize volunteers to the minimum or reduce their working time. These reductions will cause the lack of time for staff to manage volunteer co-ordination. As a result, the organization can not find enough volunteers to provide services. On the other hand, North Sydney Community Services can solve the problem by posting a volunteer co-ordinator in this organization. Although each staff who organizes community services such as MOW, Shopping services, Linen services has to manage the time schedule or working procedures independently, they do not have to find new volunteers by themselves. A volunteer co-ordinator receives all information about volunteers at first, and arranges these volunteers to a suitable job. As for organizations which provide services by using volunteers, the position of a volunteer co-ordinator is very effective to overcome inadequate funding problem.
The findings of the research shows that the complicated provision system by many providing organizations is problematic. As Michael Fine (1993) claims, research shows that there are a lot of benefits in terms of efficiency to utilize all social resources in the LGA if each organization provides more comprehensive services, In Leichhardt LGA, two organizations, Victoria Alice Lamkin Centre and Rozelle Neighbourhood Aid Centre which are run by Leichhardt Council are located and provide community services separately. In this case, it is difficult for the two organizations to share the same volunteers in each service provision. They have to advertise and find volunteers separately. On the other hand, in North Sydney Community Services many services can share the same volunteers with each other easily and eliminate overlaps through joint working because they provide a range of services in the same building. Also, the separation of the service provision will waste time and cost for extra communication between staff.
Open-line communication between service providers
Open-line communication between service providers is one of the most important factors for the co-ordination of community care services for elderly people. Service providers in both LGAs do not have enough open-line communication as a system. It is very significant to have a good communication between service providers as well as between co-ordinating organizations and service providers because service providers have important information about clients to share with each other. If they do not have open-line communication as a formal system, the efficiency of the service co-ordination will reduce. In Leichhardt LGA, providers hardly get information about the different needs of clients from other agencies because they do not have any formal systems for open-line communications between service providers. Especially, it is very ineffective that there is no formal meetings between Victoria Alice Lamkin Centre and Rozelle Neighbourhood Aid Centre. In North Sydney LGA, the SCOT meeting is a influential formal meeting for open-line communication for service providers. Also, the fact that North Sydney Community Services provides a range of community services can eliminate the complexity and barriers for open-line communication between service providers in the LGA.
CHAPTER 4 : CONCLUSION
The future co-ordination of community care services in the local government area
As noted in my literature review, Australia will be a country ageing rapidly like other developed countries, especially with people over 75 years old increasing dramatically within 10 years. In other words, the number of people who need more complex community care services will grow. In addition, especially in Sydney metropolitan areas, demographic features will become complicated because of the diversity of ethnicity and living standards in different areas. Each Local Government Area will have more varieties of particular cultural and economic characteristics. Also, according to the trend of privatization of public services in Australia, more private companies will come into the community service provision as a future market. In the possible future trends of community services for elderly people in NSW, the influences of these changes will bring other problems and directions for the co-ordination of community care services for elderly people. In this section, two viewpoints are discussed in conclusion to my research thesis. Firstly, equality and equity will be examined in terms of community care service for elderly people in NSW. Secondly, I would like to discuss the importance for the co-ordination of community care services.
Equality and Equity of community care services for elderly people
In NSW, the demographic features of each local government will become more diverse in terms of ethnicity and economic situations. As I found that there was the difficulty in adjusting the quality and quantity of community care services for elderly people through my case study, the expansion of diversity of demographic features in NSW will increase the difficulty considerably. However, in terms of a social justice strategy which Commonwealth government introduced, the service quality and quantity should not vary markedly from one to another local government area.
Firstly, the responsibilities of federal / State government will have to be more clear and definite. The organizations of HACC programs which check and supervise the quality of services will be more important and should be more active in each local government area. Especially, HACC programs should carefully understand the future changes of demographic data and prioritize funding for staff in low economic areas to adjust the co-ordination difficulty related to the demographic features. Also, as one of the responsible governments, each local government will have to keep watching the social changes in each area and positively and actively suggest the supports for service co-ordination to upper levels of government. Local governments should not be just one of the providers but be active planners and advocates who absorb opinions and suggestions from the local community and even compare with other local governmentﾕs situation.
On the other hand, the characteristic of each local government area should be regarded as one of the most important factors for the improvement of the co-ordination system. According to the diversity of ethnicity and economic situation in the future, one standard system which federal / State government created will not necessarily apply to the co-ordination system in each local government area. The more the demographic feature should be respected in each local government area, the more the uniqueness and originality of the co-ordination system in each local government area should be stressed. In that case, local democracy will be a significant way to create new community networks and promote citizen participation in service provision and co-ordination. Local government will be the key organization to maintain local democracy to make use of the diversity of ethnicity for service co-ordination.
Also, the future increase in privatization will reduce public responsibility not only for service provision but also for assessment and co-ordination of the community care services for elderly people in NSW. However, even if privatization increases the quantity of service provision in each local government area, it will not necessarily improve the quality of the service. In my opinion, the quantity and types of the service provision in NSW are considerably adequate. The lack of service provision is likely to exist because of lack of proper co-ordination systems. If the co-ordination teams and organizations improve and the problems of the system are solved, it would be easier to meet the needs of clients in community care services for elderly people. Therefore, the co-ordination and assessment of community care services for elderly people should be managed under public responsibility.
Importance for the co-ordination of community care services
As discussed in the last section, IOC is a very important factor for the community care services for elderly people in NSW. The research shows that both the structure and process of co-ordination are the key elements for the improvement of service provision in each LGA. Even if the LGAs have similar service providers for community care services for elderly people, the quality of the service provision will show a extensive difference between LGAs without proper co-ordination systems. The co-ordination of the services and management is needed both formally and informally because informal co-ordination promotes and supplements formal co-ordination.
There are two future prospects for the co-ordination of community care service for elderly people in NSW. First, the fact that the number of people over 75 years of age will increase dramatically in a decade will place more importance on co-ordination. This is because it is obvious that people over this age barrier have more complex needs and require a range of community care services in order to help them live in their own home. In that case, the number of people who need a comprehensive co-ordination between health and social services providers will increase rapidly. On the other hand, the stable quantity of the service provision will be also needed in each service provider. Considering the fact that it is very difficult for providing organizations to receive more financial support, service providers will have to increase the effectiveness and efficiency of the service provision and co-ordination and also optimise use of volunteers and local networks in the community.
While the use of volunteers will become more important, the fact of ageing in Australia will decrease the number of volunteers in the community. The low birthrate will decrease the number of young people. In addition, the movement of women from the family to the workplace will shrink the capacity of the middle-aged women who are the majority of volunteers in the community at present. As a result, the community service providers will focus on retired people as important volunteers. However, because of their limited physical capacities, the type of volunteer work for elderly volunteers will be limited as well as they need more supports from paid workers. Therefore, an increase in paid staff will be needed for the co-ordination and provision of community care service for elderly people.
Secondly, as a result of the demographic feature in community care services for elderly people the provision and the co-ordination system will need to be more comprehensive. The level of commitment to co-ordination will need to be higher in each LGA because of the rapid increase of complex servicesﾕ needs. In order to reduce the cost and human resources for service provision in LGAs, the partnership between providing and co-ordinating organizations will need to become strong. The co-ordination style will need to change from systematic case co-ordination to joint programs and program modification between providing and co-ordinating organizations (Diagram3). With this trend, providing organizations and co-ordinating organizations are likely to become one independent co-ordinating and providing organization in the LGA, for example, North Sydney Community Services in North Sydney LGA. Leichhardt LGA is also planning to create a new building including co-ordinating and providing organizations together in the near future. I believe the planning will improve the access and quality of services and promote good and effective co-ordination in Leichhardt LGA.
Policy recommendation
The findings of this research lead to policy recommendations in relation to 1) Victoria Alice Lamkin Centre 2)North Sydney Community Services, 3) Leichhardt LGA, 4) North Sydney LGA, 5) State/federal government respectively. The problems in the two LGAs are mainly inter-organizational. It would be difficult for each organizations to implement the policy recommendations without further discussions with other relevant organizations and governments. This policy recommendation is intended for practical and effective implementation.
1) Victoria Alice Lamkin Centre
Organize policy planning meetings to improve direct participation in policy making from volunteers and community members.
: Implement surveys of clientsﾕ satisfaction including interviews and questionnaire on a regular basis.
: Attempt to put the same volunteers with the same clients and optimise use of MOW volunteers to daily check of clients.
: Increase the budget for hiring full-time staff who specialize in social work and community work.
: Develop effective advertisements and create information networks in cooperation with TV, radio company and newspaper in local and regional areas to increase the number of volunteers and understanding of that work amongst community members.
: Hold weekly staff meetings to build and share consensus and a clear vision and reduce misunderstandings between administrative staffs and part-time staffs.
: Change the decision making style from top-down into consensus style with democratic procedures for the policy making.
: Publish newsletters to give information to volunteers and community members to share the vision of the centre.
: Position a volunteer co-ordinator.
: Hold a formal/informal meeting with ACAT to increase the interdependence between Victoria Alice Lamkin Centre and ACAT.
: Share client/ volunteer information between Victoria Alice Lamkin Centre and Rozelle Neighbourhood Aid Centre
: Improve working conditions for part-time staff to increase their job satisfaction and promote continuity of staffing.
2)North Sydney Community Services
: Develop effective advertisements and create information networks in cooperation with TV, radio company and newspaper in local and regional areas to increase the number of volunteers and understanding of that work amongst community members.
: Increase the budget for hiring full-time staff who specialize in social work and community work.
: Improve working conditions for part-time staff to increase their job satisfaction and promote continuity of staffing.
3) Leichhardt LGA
: Co-operate with Victoria Alice Lamkin Centre to promote advertisements in local and regional areas and increase the number of volunteers and understanding of that work amongst community members.
: Make more efforts to create local democracy to promote volunteer activities among local people.
: Participate in regional planning for community care services not only as a provider but also as a facilitator.
: Establish a regional case meeting among all co-ordinating and providing organizations.
: Use a same referral system and share clientsﾕ information in Leichhardt LGA.
: Plan to set up joint seminars and multi- disciplinary training in Leichhardt LGA to improve partnerships and understanding of each role between providing and co-ordinating organizations.
: Give more freedom to service providers run by Council for flexible service co-ordination
: Hire staff who specialize in social work and community work as service providers and administrative staff in Council.
: Appeal strongly to HACC program to increase funding in Leichhardt LGA because of its demographic features.
4) North Sydney LGA
: Co-operate with North Sydney Community Services to promote advertisements in local and regional areas and increase the number of volunteers and understanding among community members.
: Plan to set up joint seminars and multi-disciplinary training in North Sydney LGA to improve partnerships and understanding of each role between providing and co-ordinating organizations.
5) State/federal government
: Conduct research about demographic changes and differences in each LGA.
: Check and supervise constantly the quality and quantity of community care services in each LGAs.
: Conduct direct consumer surveys about clientsﾕ satisfaction with community care services.
: Increase funding to local governments and providing / co-ordinating organizations for hiring more specialist staff.
: Hold social workersﾕ meetings to listen to opinions and recommendations from front-line workers in each area.
: Combine co-ordinating and providing organizations for effective service co-ordination (this plan will be introduced in Leichhardt LGA soon)
Limitation of this research and future research recommendation
My research has been not attempted to cover all organizations that provide and co-ordinate community care services for elderly people in NSW. I did not conduct interviews in organizations such as Community Options, Home Care of NSW, Home Nursing, etc. Some of them are very important organizations which maintain community care services. In order to discuss the characteristics of the co-ordination in community care services in the two LGAs, in the last sections I explained the functions and the roles of these organizations from indirect information through interviews in my research and document resources. Also, this research did not include the relations with most health sectors such as hospitals, nursing homes, community health, day care, respite care, etc because I concentrated on community care services in my research. However, there is a strong connection and cooperation between community service and health sectors to maintain the service co-ordination of community care service for elderly people. Moreover, it is very difficult for community service sectors to solve the policy problems discussed without cooperation with health sectors. Therefore, for a further research it would be valuable to focus on the influence of and relations with health sectors to community care services in LGAs.
As discussed above, it was difficult for me to generalize the characteristics of the co-ordination style in the LGAs in NSW. First, the diversity of demographic features made it difficult to generalize the characteristics in each LGA. Secondly, community care services were not necessarily implemented in the LGA base. Some important providing and co-ordinating organizations tend to look at the service area on a regional or multiple LGA basis. Thirdly, because of the features of the case study and the limit of sample areas, describing and analysing the whole pictures of the co-ordination system in NSW was outside the scope of this study. Future research would expand the research areas and extend to new discussion topics arising from this research. In this sense, the discussion about a single point co-ordination or multiple co-ordination would be one of the main future research topics for my research in terms of community care services for elderly people. Also, the role of local governments in community care services for elderly people is another significant topic for further research.
As an international student from Japan, I found many interesting and significant differences and similarities between Australia and Japan in terms of policy problems for community care services for elderly people. The topics include the role of local government, family values, volunteer spirit, multiculturalism, clientsﾕ attitudes and consciousness to ageing and well-being. Particularly, I was quite surprised and impressed by the strong spirits of elderly people for self-help and well-being in Australia. Through 10 monthsﾕ of volunteer activity in North Sydney and Leichhardt, I visited and talked with many elderly people who live alone as users of community care services. Although they seem to totally depend on a range of public services and people in the community, most of them try very hard to manage their life independently even though they have disabilities and, more importantly, they also believe in trying to fulfill and enjoy their life. Also, it is said in Japan that volunteer and community spirit are decreasing in the city area because of urbanisation. However, I was able to see and experience a strong volunteer spirit and community ties irrespective of national origin and ethnicity in Australia. Although I helped elderly people as a volunteer, I was always cheered up and inspired by their kindness, affectionate consideration and smiles. I hope I shall be able to make the best use of these experiences for another comparative study of community care services for elderly people in Japan and Australia.
