CHAPTER 2 : COMPARING CO-ORDINATION IN TWO LOCAL GOVERNMENT AREAS -THE SETTINGS-
In this section I describe the co-ordination pattern of community care services for elderly people in the two LGAs and in each organization which I choose as a case study. These descriptions will be based on the findings from structured interviews and fieldwork in each organization.
North Sydney Local Government Area (LGA)
a) North Sydney LGA (In relation to diagram1)
North Sydney Community Services is the core organization to provide / co-ordinate community care services for elderly people in North Sydney LGA. They provide the community services for elderly people especially to maintain the capacity to live in their home, such as food services, neighbour aid services, social activities. The services include the assessment of clients and the co-ordination of the services within or outside the centre. Aged and disability services in North Sydney Council accesses the needs of elderly people and people with disability in North Sydney and develop the planning and the co-ordination of HACC programs. The Council manages Kirribille Neighborhood Centre, McMahons Point Community Centre for social activities to elderly people and owns the building of Crows Nest Community Centre, which is run by North Sydney Community Services.
Community Options in the North Shore area organizes and co-ordinates a range of public and private services if the client has complex needs. ACAT assesses whether clients in North Shore area should enter nursing homes and also co-ordinates medical and community services. Both of them are the co-ordination organizations which cover the North Shore area. Also, they will accept only clients who need a range of services with a certain higher level of disability or dementia. Recently, clients tend to be in waiting lists in Community options because of lacking staffs and finances. Home care services of NSW, NSW home nursing, the day care centre in Greenwich hospital are other community care service providers for elderly people which operate in the North Shore area.
b) North Sydney Community Services
As I explained in the last section, North Sydney Community Services provide a range of community care services for elderly people as a main provider and co-ordinator in North Sydney LGA. The service is managed by a community based Board of Directors elected at an Annual General Meeting, and receives funding through the Department of Community Services HACC program and North Sydney Council.
The services in North Sydney Community Services is very various and comprehensive to assist and encourage independent living, enabling elderly people to participate to the fullest extent in their community. The available services are on the list below.
:Meals on Wheels
:Daily breakfast and lunch and activities in the Community Dining Room
:Shopping services
:Linen services
:Community Visiting
:Medical Transport
:Gardening
:Saturday Outing
:Social Activities (Movies, Cards, Bingo, Indoor Bowls, Craft, New Vogue Dancing, etc)
There are relatively many staff who organize these services in North Sydney Community Services. There are five full-time staff which include executive officer, two community workers, MOW co-ordinator, volunteer co-ordinator. Also, there are three part-time staff who co-ordinate shopping services, linen services, transport services respectively. There are several staff who engage in accounting, kitchen, dining room, etc.
Case 1: Meals on Wheels from field work notes with photographs (photograph1)
In North Sydney LGA about 150 meals are delivered by volunteers five days a week from North Sydney Community Services. Meals include main meal, soup, dessert, juice, which are specialized to each client such as diabetic, low fat meals, cold meals. About 20 volunteers with 10 teams will deliver meals with their own cars from 10:30 AM. Frozen meals for weekends are delivered on Friday. Each team usually delivers 15 meals average per day. Volunteers enter each client's house and prepare the soup. They usually ask how elderly people have been recently and have a chat for a while. There is a food manager specialized to hotel catering management, a chef, a dessert kitchen hand, other kitchen hand and volunteers in the kitchen.
In North Sydney Community Services every time clients are referred to the food co-ordination manager, she asks a community worker to visit and assess the clientﾕs condition and needs. If the community worker recognizes his or her needs for other services, she arranges other services within North Sydney Community Services or refers to other community service providers.
Volunteers are generally retired people, housewives. They work once a week on average. Some volunteers work almost everyday. Main reasons to start volunteers are that they would like to help elderly people, meet people and contribute in the community. Once volunteers start Meals on Wheels, they usually continue it for more than 6 months. Staff organize that same volunteers tend to deliver to same clients every week in order to create a strong relationship between volunteers and clients.
Case 2: Shopping services from field work notes with photographs (photograph 2)
There are three kinds of shopping services which include individual shopping by order on Monday, shopping independently on Tuesday, shopping with help by volunteers on Wednesday. On Wednesdayﾕs shopping services, a driver and a few volunteers pick up about 8~12 elderly people door to door in the morning and go to a supermarket in Neutral Bay. Some elderly people go shopping by themselves and need some help only when they get on and off the bus. Others go shopping by a wheel chairs or a special frames helped by volunteers. After shopping, elderly people and volunteers usually go to a cafe to have a chat for an hour. Then the bus returns to each clientﾕs house or apartment door to door and volunteers bring things clients bought into the kitchen.
c) Communication system between North Sydney Community Service (Crows Nest centre) and other organizations
In terms of financial and management context, major agencies that North Sydney Communities Services is related to are North Sydney Council and Department of Community Services HACC program. In terms of the co-ordination and provision of the services, major agencies include Home care service of NSW, Community Options, ACAT, North Shore Hospital, Greenwich Hospital, Home Nursing, nursing homes, local doctors. The referrals of clients usually come from these agencies and informal resources such as clients, family, relatives, neighborhoods.
North Sydney Community Services is the beginning of co-ordinating organizations in North Sydney LGA. Every client who is referred from other organizations will be assessed by a community worker in North Sydney Community Services. If the client has more complex needs than the co-ordination capacities of this organization can meet, the community worker refers to ACAT team or Community options. In order to share the information of clients who have complex needs with organizations in North Sydney LGA, there is a networking case meeting called Service Co-Ordinating Team (SCOT) meeting among service providers and co-ordinating organizations in North Sydney LGA once a month. Also, the Community information assessment referral system, which uses a same form for the same client and can be downloaded by a computer, was introduced recently. These communication systems prevent mis-coordination and fragmentation of the community services in North Sydney LGA.
The relationship between North Sydney Community Services and North Sydney Council is very good in terms of communication. It is very important that each organization clearly understands their own role in terms of the community services in North Sydney LGA. The aged and disability services in the council mainly focuses on assessing the needs of clients and planning the community development for the co-ordination of HACC programs in North Sydney LGA. North Sydney Community Services concentrates on the role of the services provisions and basic co-ordinations with the co-operation of community members in North Sydney LGA. They have many opportunities to share information formally and informally such as council meetings.
d) Continuity of staffing and volunteers
There are active 230 volunteers who actually provide services to clients. Volunteers usually work at least 6 months and some work for 35 years. However, lack of volunteers is the one of the main problems for the all services in North Sydney Community Services because the service provision depends on volunteers completely. Moreover, the community worker considerably depends on volunteers to get a daily information of clients. There is a volunteer co-ordinator who look for volunteers in the community and organize volunteers for their suitable jobs within North Sydney Community Services.
Because of its nature of volunteers, staff can not expect them too much and maintain high level of quality for the services. Staff tend to spend a lot of times not for planing the service provision but for managing volunteers. Many staff suggest that more paid-staff should be hired for keeping stable service provisions and level of the standard quality. There are many advantages of using volunteers in the service provision as well. The main advantages is that volunteers are free and good social resources which should be made use of. Compared with private paid-workers, volunteers are very friendly and care about clients very much.
Most staff have worked for more than two years in North Sydney Community Services, and are generally satisfied with their role of the job in this organization. Firstly, they like to meet people in the community, especially elderly people. Secondly, most staff feel a lot of freedom and being trusted from the higher level of administrative staff although some staff feel much pressure to manage volunteers because they do not have enough time as part-time officers.
e) Resources and funding
Most staff agree that the community services are quite enough to meet the needs of elderly people in North Sydney LGA compared with other LGAs. However, there must be more clients who do not know about the community services even though they need services to remain to live in their homes. Social isolation in the community is the biggest problem for elderly people in this area. If the number of volunteers or paid-staff can be increased with enough funding, the co-ordination of the services will be easier and more stable in this centre.
North Sydney Community Services is the biggest service provider in North Sydney LGA. Therefore, they can offer relatively comprehensive services to clients. However, some staff think multiple co-ordinating points with a few organizations in North Sydney LGA would be confusing and complicated to clients and staff. They recommends one organization co-ordinating in a LGA to optimise use of the all resources and functions of the community service providers in North Sydney LGA. On the contrary, a staff member of ACAT has doubts about one organization co-ordinating by an independent assessment body in North Sydney LGA because the new system also might be confusing for traditional co-ordinating and providing organizations which can succeed in managing the service co-ordination in North Sydney LGA considerably.
f) Communication within the centre
Formally, there is a board meeting twice a year and a staff meeting every fourth Wednesday. The board members include three councillors in North Sydney LGA and five community members. The staff meeting is held to share the information between all staff about current movements of the community and the role of each staff member. Also, a focus group meeting is held twice a year to get feedback from volunteers of North Sydney Community Services.
The meetings are likely to be held informally rather than formally every time some staff have problems to share with other staff. Especially, casework meetings are held about two or three times a week between community workers and other servicesﾕ staff when community workers have a complicated case and need to know other staffﾕs opinions.
Leichhardt LGA
a) Leichhardt LGA (In relation to diagram 2)
There is no core-service provider and co-ordinator organization in Leichhardt LGA. Two community workers engage in the aged service division of Leichhardt Council to do social planning in Leichhardt LGA. Council also manages Victoria Alice Lamkin Centre which provides Meals on Wheels, Home maintenance services, Centre based lunch, and some recreation services to elderly people and people with disabilities. Also, Rozelle Neighbourhood Aid Centre run by the council provides social activities, transport services, volunteer assistance. There are two senior citizen centres in Leichhardt LGA which provide recreation and leisure activities and bus trips. Home care services of NSW, NSW home nursing, Lilyfield Road Day Centre are other community care service providers for elderly people which are operated in Leichhardt LGA.
Community Options and ACAT in Leichhardt LGA organize and co-ordinate a range of services if the client has complex needs. Unlike in other areas ACAT in Glebe Community Care Centre which covers Leichhardt LGA will be the main co-ordinator for the community service for elderly people as well as assess whether clients should enter nursing homes. Firstly, the team has started not from hospital sectors but from community sectors. Secondly, ACAT in Leichhardt LGA has to co-ordinate even minor community services because of complicated demographic situation such as low economic status and lacking of co-ordination agencies for basic community services for clients. Community Options tends to co-ordinate health services and also accept only clients who need a range of services with a certain level of disability or dementia. Recently, clients tend to be in waiting lists in both Community options and ACAT because of the lack of staff and finances.
b) Victoria Alice Lamkin Centre
Victoria Alice Lamkin Centre (the centre temporarily has moved to Balmain hospital while constructing a new centre) provides Meals on Wheels, Home maintenance services, Centre based lunch, and some recreation services to elderly people and people with disabilities. The service is managed by Leichhardt Council, and receives funding through the Department of Community Services HACC program as well.
The services in Victoria Alice Lamkin Centre are run by two full-time community workers, three part-time Meals on Wheels staff, four home maintenance staff, one bus driver. Because Victoria Alice Lamkin Centre provides Meals on Wheels services five days a week by volunteers, this centre is likely to aware of many clients' needs and information on daily basis compared with other service providers in Leichhardt LGA.
Case 1: Meals on Wheels from field work notes with photographs (photograph 3)
In Leichhardt LGA about 150 meals are delivered by volunteers 5 days a week. Meals include main meal, dessert, juice or fruits, which are specialized to each client such as diabetic, minced. About 10 volunteers in five teams will deliver meals with their own cars from 10:30 AM. Total number of volunteers of Meals on Wheels are 27. Frozen meals for weekends are delivered on Friday. There is a chef and a kitchen hand. Volunteers usually do not enter a client's house but hand clients' meal or leave it at the door. Actually, they do not have enough time to enter because one group has to deliver more than 25 meals in 2 hours.
The majority of volunteers are retired people, unemployed people and housewives. The council pays 9 dollars for helpers and 19 dollars for drivers in every run to keep a stable number of volunteers. They work twice a week on average. Some volunteers work almost everyday. Main reasons to start volunteers are that they would like to help elderly people and use times for the community. However, a considerable number of people work for getting some money. Although some volunteers have worked more than 10 years, volunteers often have quitted the job because of personal reasons. Same volunteers do not necessarily tend to deliver to the same clients every week.
c) Communication system between Leichhardt council (Victoria Alice Lamkin Centre) and other organizations
In terms of financial and management context, major agencies that Leichhardt Council is related to is Department of Community services HACC program. In terms of the co-ordination and provision of the services, major agencies include Balmain hospital (Community options), Home care service of NSW, ACAT, Home nursing, Nursing homes and local doctors. The referrals of clients usually come from these agencies and informal sources such as clients, family, relatives and neighbourhoods.
Leichhardt Council has two roles in community services for elderly people in Leichhardt LGA. It provides some services and develops social planning. The council does not have as its function to co-ordinate the community services for clients though staff in Meals on Wheels organize some other services for clients occasionally. The staff in Meals on Wheels usually refer to ACAT or Community Option when the client has needs for service co-ordination.
The relationship between Leichhardt Council (Victoria Alice Lamkin Centre) and other providing organizations does not seem to be strong. Although each organization has its own role for providing services, it does not understand who is the main co-ordinator of the community services in Leichhardt LGA. Surprisingly, there are no formal meetings between Victoria Alice Lamkin Centre and Rozelle Neighborhood Aid Centre even though both of them are run by Leichhardt Council. Although there are weekly case meetings between ACAT, Community Options, Home nursing and between ACAT and hospitals, there are no case meetings between these co-ordination organizations and service providers including councils. Therefore, there are some duplications and fragmentations in the co-ordination and provision of community services for elderly people in this area.
d) Continuity of staffing and volunteers
There are active 27 volunteers who actually provide services to clients. In Leichhardt LGA, it seems to be very difficult to find volunteers even though the council is believed to be pay the highest money to volunteers in the Sydney Metropolitan area. In addition to lacking volunteers, lacking staff in co-ordinating volunteers and preparing Meals on Wheels influence the quality of the service provision in Victoria Alice Lamkin Centre because there is no volunteer co-ordinator who particularly works for organizing volunteers.
There are some differences of opinion about using volunteers between full-time administrative staff and part-time staff who actually work for clients with volunteers. The full-time administrative staff think there are some benefits of using volunteers for the service delivery such as saving costs and developing community spirits. On the other hand, the part-time staff do not feel any benefits for using volunteers. They think there is no control and flexibility of using volunteers and suggest paid staff should be hired for delivering meals for the greater efficiency.
The staff in Leichhardt council have worked for a relatively long period. One administrative full-time worker has worked for 10 years. Although administrative full-time workers are satisfied with their job in this organization, part-time staff who organize services and volunteers do not feel any freedom to make decisions and do not feel fulfilled by their jobs. Firstly, part-time staff feel a lack of communication and consideration between their level and administrative level. Secondly, part-time staff do not think staff in the administrative level understand the real situations of community services in Leichhardt LGA and give any trust to part-time staff.
e) Resources and funding
All staff recognize that the kinds and amount of community services are not enough to meet the needs of clients in Leichhardt LGA. Although staff know more shopping services and transport services are needed for clients according to the survey, they can not manage them because of lack of funding. Lack of volunteers is one of the main reasons that reduces the increase in service provision in this area.
As I discussed above, the community services for elderly people are provided and co-ordinated by different organizations in different locations in Leichhardt LGA. This complicated service provision and co-ordination causes confusion and lack of access for clients. A new policy from NSW Department of Aged and Disability that one independent organization assesses and co-ordinates the service provision in a LGA is intended to solve these co-ordination problems. However, a staff in ACAT opposes to this idea with several reasons. Firstly, each organization will miss a lot of relevant information about the clients because the information comes from the other organization indirectly. Secondly, many clients do not have to be fully assessed by the independent assessment body because they usually use only one communities services. Thirdly, there might be problems about skills and appropriateness of staff in the independent assessment body. Also, some staff suggest that the service provision in Leichhardt LGA should not be run by council but by community management because community based organizations would have more close contacts with clients and a better management style for using social resources in this area.
f) Communication within the centre
Formally, there used be a staff meeting regularly between administrative staff and part-time staff. However, council attempted to reduce the time for meetings. As a result, part-time staff often feel frustration in lacking information from council. Meetings are held only between administrative staff twice a week in the council.
The meetings are likely to be held more informally. However, because part-time staff are always busy managing services and volunteers, they can not find enough time to discuss any problems for clients and new planning. Moreover, decision style in Leichhardt council is top down. Part-time staff have no chance to suggest any ideas and changes of policy to administrative staff. There are few meetings for volunteers to make suggestions to council as well although there is a lunch party for volunteers twice or three times a year.
