CHAPTER 1
CO-ORDINATION IN COMMUNITY CARE
Research problem
The aim of this research essay is to identify characteristics of co-ordinated services in community care for elderly people through analysis of the services provision in two local government areas of NSW with different demographic compositions. This research will also contribute to a better understanding of the effect of co-ordination on community based services for elderly people.
In 1985 the Australian Labour Party introduced the Commonwealth-State joint Home and Community Care Program (HACC)ﾕ as a part of National Aged Care Reform Strategy to make the shift from an emphasis on residential services to community care, which allows elderly people to remain in their own home and improves the quality of life for elderly people and their carers. However, despite the increasing trend of community service provision in ten years, this complicated service provision program has caused four main problems in terms of co-ordination (Healy 1990).
Firstly, co-ordination from multiple entry points potentially causes communication problems between co-ordinators/service providers and clients/carers. In the HACC program the co-ordination for elderly people is implemented by different organizations such as the local doctor, Aged Care Assessment Team (ACAT), Community Options, Local Government, Community Information Services, and the relevant State department.
Secondly, there is a problem where access at a multiple entry points is likely to cause the fragmentation and poor co-ordination of the community care services. This is because the services in HACC are provided in complicated ways by regionally based voluntary agencies, State Government agencies, locally based community organizations and local governments though the main assistance in community care is provided by informal care givers such as family members, friends and neighborhoods.
Thirdly, the complexity of the funding system is likely to restrict service providers' ability to gain adequate funding for elderly people and carers. These formal service providers are funded by either Commonwealth or State Government through grants or contracts. The complication might also cause managerial problems within providing organizations and disturb their autonomy.
Finally, the co-ordination problems in service delivery in HACC program may possibly disturb the programs of the social justice strategy such as equity, equality of rights, fair and equal access, participation. This is because the different and complicated co-ordination system in each area will potentially restrict service providers' ability to meet consumers' complex needs with inequitable outcomes. Also, the present co-ordination system lacks the opportunity for direct consumersﾕ participation in policy-making.
This research topic is worthwhile because the co-ordination of community care services for elderly people is important for not only service providers and administrators in governments but directly for consumers and their carers in relation to social justice outcomes of social service provision. It is expected that major problems in community care services about funding, administration, management of provision and social justice are likely to have a strong connection with the co-ordination pattern and system. It is also important to note that there are increasing trends towards the co-ordination of community care services for elderly people by local governments in other developed countries though the social services for elderly people are provided by different kinds of organizations in each country.