1 NHMRC-ARC Dementia Research Development Fellow, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia.
2 Research Fellow, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia.
J Health Serv Res Policy. 2018 Jul;23(3):176-184. doi: 10.1177/1355819618764223. Epub 2018 Mar 9.
Objectives Health services worldwide are increasingly adopting consumer directed care approaches. Traditionally, consumer directed care models have been implemented in home care services and there is little guidance as to how to implement them in residential care. This study used a citizens' jury to elicit views of members of the public regarding consumer directed care in residential care. Methods A citizens' jury involving 12 members of the public was held over two days in July 2016, exploring the question: For people with dementia living in residential care facilities, how do we enable increased personal decision making to ensure that care is based on their needs and preferences? Jury members were recruited through a market research company and selected to be broadly representative of the general public. Results The jury believed that person-centred care should be the foundation of care for all older people. They recommended that each person's funding be split between core services (to ensure basic health, nutrition and hygiene needs are met) and discretionary services. Systems needed to be put into place to enable the transition to consumer directed care including care coordinators to assist in eliciting resident preferences, supports for proxy decision makers, and accreditation processes and risk management strategies to ensure that residents with significant cognitive impairment are not taken advantage of by goods and service providers. Transparency should be increased (perhaps using technologies) so that both the resident and nominated family members can be sure that the person is receiving what they have paid for. Conclusions The views of the jury (as representatives of the public) were that people in residential care should have more say regarding the way in which their care is provided and that a model of consumer directed care should be introduced. Policy makers should consider implementation of consumer directed care models that are economically viable and are associated with high levels of satisfaction among users.
全球卫生服务机构越来越多地采用以消费者为导向的护理方法。传统上，消费者导向的护理模式已在家庭护理服务中实施，但对于如何在住宿护理中实施这些模式，几乎没有指导。本研究使用公民陪审团来征求公众对住宿护理中消费者导向护理的看法。
2016 年 7 月，为期两天的公民陪审团由 12 名公众成员参加，探讨了以下问题：对于居住在住宿护理设施中的痴呆症患者，我们如何增加个人决策，以确保护理基于他们的需求和偏好？陪审团成员通过市场研究公司招募，并选择广泛代表公众。
陪审团认为以患者为中心的护理应该是所有老年人护理的基础。他们建议每个人的资金分为核心服务（以确保满足基本健康、营养和卫生需求）和可自由支配的服务。需要建立系统，使向以消费者为导向的护理过渡，包括护理协调员协助确定患者偏好、为代理决策者提供支持，以及认证程序和风险管理策略，以确保认知障碍严重的患者不会受到商品和服务提供商的利用。应该增加透明度（也许使用技术），以便居民和指定的家庭成员都可以确信他们已经支付了所得到的服务。
陪审团（作为公众代表）的意见是，居住在住宿护理中的人应该对提供护理的方式有更多的发言权，应该引入以消费者为导向的护理模式。政策制定者应考虑实施经济可行且与用户满意度高相关的以消费者为导向的护理模式。
