Human service delivery in the health sector
Science and medicine have concentrated on reason and quest for disease prevention and cure with little attention on the clients experience with illness. The argument has been that engagement in medical practice should be free of value and as neutral as possible (Pardeck, 1998). Anything less that this, the argument went, was antithetical to the objectives of professionalism, rationality and reason within the medical practice. This remained the emulated standard for research, medical, practice and service delivery until recently when the aspect of service delivery received notice due to increasing consideration for the client’s understanding and experience with illness.
Recently, reasoning and rationality has found its way in behavioral health. The consideration and management of behavioral health care is a new innovation into the field of medicine and the general policy formulation concerning both formal and informal healthcare provision. In the provision of medical care, there is a great need for reduction
in cost of service delivery and self funding of the ongoing service deliveries. There is a growth in awareness which is challenged by requirement of welfare funding and change in use of retirement income and pension funds to assist in running the programs especially associated with aged care (Phillipson, 1998).
Fine (2004) says that age care is rising with effects on both the nurses and professionals in both acute care institutions as well as the informal nursing homes. The services are transforming tremendously and there need for greater monitoring to ensure their viability. He traces transformation in human oriented service delivery to the post war error when those affected by the wars were increasingly being denied services on account of their terminal illnesses.
As a result, there was a rather haphazard cropping up of nursing homes in the 1950s and the 1960s to take care of this group of persons. The next transformation occurred during the last two decades of the 21st century. During this time, innovations in medical services saw the upsurge of the “Cinderella” kind of services especially in Australia and the New Zealand that matched and even beat human health services in other developed world, referred to by European researchers as the “cutting age of change” in the medical service provision. This
was an invention that was only challenged when the nursing homes were, as many other service delivery sectors in the post industrialization era, suffered from monetary and population pressures (Iversen, 1998). Medical staff training and by extension, service delivery was becoming inferior as an effect of profit motive and failures associated with systemic problems (Gray, 2001).
Thereafter, the third transformation was the introduction of the case management scenarios that saw partnerships between the formal and informal sectors of the medical services sector (Australian Institute of Health 2005–06)). This was based on community care philosophies as alternatives but with links with the acute formal care services.
Through specialization, the division of labor required cooperation between specialist, informal and formal caregivers through good coordination of services. This is the brain behind most innovative human service provision strategies in Australia. The Attendant Care Program of Australian health sector is one of such recent moves to introduce response into client’s understanding and participation in health care provision.
Attendant Care Program
Attendant Care Program (ACP) is one of the initiatives of the department of Ageing, Disability and Home Care. Alongside “carers”, specialist employment, home care service and profitable private agencies, attendant care program is a success story in human service delivery of the NSW. The program is funded under the state disability agreement of the commonwealth (CSDA) and is under the administration of the aging and disability department of the NSW.
The program is a service charter that identifies a group of people, usually young people; earmark them for inclusion in community participation. The idea is to un-institutionalize young people who in one way or another, due to their disabilities found themselves in these institutions. It is a form of eradicating stigma from them through the inappropriate institutionalization. The program is an extension of the family based home care services that attended to the disabled at homes but which proved difficult due to the difficulty of transportation associated with disability. In the previous scenario, there were more demerits that the merits since the clients had no choice of the attendant to see him or her. The situation was further worsened by the fact that there was very little flexibility in the kind of services provided.
The selection was done at the branch level and this meant that the room for equality was very thin. Cases more deserving for the home care program were not all ably attended to. The cross suburb movement associated with this meant that services were not as good as would have been received in ones suburb. The new dimension is more advantageous since there is a high degree of flexibility such that the client can choose for himself the best under the circumstances and this possibility of brokering ones anticipated service has an eerie of self satisfaction.
There is also increased portability since the service is concentrated. In its development, the government has had its support in allocating funs for improvement. By 1999, the number of places available for the program was 144. This increased tremendously by 24 between 1999 and 2001. The increased financing by the premier to the tune of $21.5 million saw an upsurge of service points to more than 314 by 2007 (Australian Institute of Health & Welfare, 2005–06) .
Characteristics of the program
The program was established in the context of the federal budget of 1986-87 understanding that people with disability are moved from the confines of nursing homes and placed in more accommodating community involvement. It was handed over to SDSP in 1991 and is funded under the NSW Disability Act of 1993. It operates on the guidelines of March 2007. In its inception, it necessitated the reversal of alienation of those with disability and placing them in their homes thus enabling them full participation in the community.
By removing them from the premature long-term confinements of the nursing homes, these peoples human self esteem is greatly boosted. The service is a thirty five hour per week engagement of the applicants and the service providers. The users of the service thus obtain home health care in community settings. The users are assisted in toileting training and supervision, dressing, eating, transfers, bathing, grooming and many other forms of domestic needs that are specific to a given service user. Eligibility is within the range of sixteen to sixty four years old and with physical disability (Medicare Australia, 2006–07).
This proof of disability takes into consideration those that arose from spinal cord injury, cerebral palsy, amputation, accidents and all other causes as may be deemed fit during application. The user then has an opportunity to choose a service provider who receives payment from the CDSA kitty. With the service provider, the user organizes training for attendants, administration of attendance and even programs. Those with speech difficulty may be represented in management by friends who liaise in all operations of his attendance. The attendants are recommended and referred through the ACP or the High Need Pool that is certified to oversee proper service delivery to the users of this scheme.
The logic for introducing ACP
The ACP program is one of the Australian service sectors’ initiatives to render human resource viable in policy development. It is a reaction to an acknowledgment that rationality and reasoning in the medical sector and adherence to professional ethics is not enough to tackle medical problems in the society. It is only one of the specific sector responses to factors affecting the disabled and the marginalized medically (Wien, 1999).
In acknowledging the fact that isolating the physically handicapped in institutions wear them down and wash away their morale in wanting to live, the government through the disabilities act restructured a module through which this scenario could be corrected. The argument was that taking the disabled back to their homes and even into the community realm would necessitate their appreciation of themselves. In doing so, they not only anticipated the productivity of these people to increase but also saw an eminent reduction in financial commitment to the host institutions.
This approach is supported by Fine (2007) who notes that inclusive settings have a way of turning round disabilities into assets if proper management criteria of the disabilities are enhanced. Prior to its introduction of the ACP, the home based care program which it took up from was marred by a lot of bureaucracies and poor service delivery. This necessitated the rearrangement of a possible active and efficient method of attending to the physically disabled.
The acknowledgment of positive roles played by human capital even in its deficiency as in the case of physical disability was the driving force behind this noble program. To date, the program has not only revolutionized the way the physically handicapped are treated but has also restored self esteem and self confidence in the users of the program. Not only is it an avenue of employment to a number of human capital that was previously untapped, but it has also transformed public view of disability to mean ability. The users enjoy a sense of worth and ability to make decisions and contribute to society.
Contribution of the program to national policy
The government and the NWS have previously embraced the idea that persons with disabilities have ability to transform society. Their exclusion thus meant that some aspect of community development or wholeness was lacking. The Attendant Care and Disability Unit can be seen as one of the offspring of this noble course. The national policy anticipates growth in human capital and skill. This is directly enhanced through this process. All attendants are, by default, employees who contribute to the national production through remittance (Williams, 1991). Needless to say, all the users of this service are managers in their own right. The managerial aspect of these people has indirect contribution to development of human skill.
Consultations that take place between attendants and their managers have the potential of transforming service delivery especially in the healthcare sector. Finally, and most importantly, healthcare provision has been enhanced.
This, to the government, is a great boost in provision of universal primary healthcare to all those who need it. This goes to further the policies associated with balanced human service development since healthcare affects virtually all spheres of national development. This service embraces dignity of citizens. The program has seen transformation of treatment of the physically handicapped that bestows dignity and respect for personal rights of the individual. Human dignity, in appreciation of government’s action towards persons with disability, has been enhanced.
References
Australian Institute of Health (2005–06) Health expenditure in Australia last. Web.
Australian Institute of Health & Welfare, (2005–06) Australian hospital statistics. Web.
Fine (2007)”Defining and Claiming Care”, A caring society: Care and the Dilemmas of human service in the Twenty-First Century, pg 26-51 and 199-225.
Gray (2001) ‘Aged care, ethics and public policy’, Contemporary Nurse Journal, 11(2-3): 109-115.
Iversen, (1998) ‘Care: Renewing the Social Vision’, Australian Journal of Social Issues 39 (3): 217-232.
Medicare Australia, (2006–07), GP Attendances, last. Web.
Pardeck (1998) ‘Reason and Rationality in Health and Human Services Delivery’ Binghamton, N Y: Haworth Press.
Phillipson, C. (1998). Reconstructing Old Age: New Agendas in Social Theory and Practice London: Sage.
Wien, (1999) ‘Coordinating Health, Extended Care and Community Support Services Reforming Aged Care in Australia’, Journal of Aging and Social Policy, 11 (1), (1999): 67-90.
Williams, C.J. (1991) “Growing Old in the Country: Issues and Views on the Home and Community Care Program in Rural Areas”, Regional Journal of Social Issues, No. 25.