Paralysed by choice: on tofu and aged care

I do the grocery shopping in our family. It’s not easy:  sometimes I can be found in a supermarket aisle confronted by the sheer choice in front of me. 

For example, take tofu (for my daughter). Which tofu? Organic? Silky? Chilli, teriyaki or plain? I am paralysed by choice, a situation often resolved by taking home different varieties.

Being paralysed by choice isn’t just a situation confronting fathers shopping for tofu. It also seems to be the plight of many older Australians who are needing home care.

This February marks 12 months since the federal government gave older Australians the choice of provider and complete portability of their government-subsidised “package” of care.  

The philosophy is a great one: let older consumers choose what services they need and from whom. Let them change providers if they are not happy. The government has responded to the growing demand for home care by releasing 6000 more “higher care” packages. 

And, yet, the queue of people waiting for home care is growing (more than 100,000 in September 2017).

But ironically, the number of Australians actually receiving home care packages declined in the first months of the new My Aged Care system. 

Hang on: more supply but longer queues and fewer people receiving care! How?

The answer lies in the tyranny of choice: older Australians are being assessed for home care in record numbers, but left on their own to choose where and how to access that care.

That might be great for the well-educated and those who can self-advocate. But pity the older Australians living on their own who have dementia! They receive a snail mail letter telling them they have 56 days to decide on a provider.  Best of luck and have a nice day.

Our research shows almost half of those who had been allocated a home care package whom we contacted had not decided on a provider. Why?

Were they merely carefully weighing up their options, not realising that if they didn’t choose within 56 days they would need to re-join the queue?

Barry Schwartz, in The Paradox of Choice, found while we think that more choice is going to produce greater well-being, often the opposite occurs. Rather, confronted by an array of options, consumers decide not to decide.

This resonates with UK research which found that “the choice discourse”, while resonating with contemporary neo-liberal thinking, often became decreasingly appropriate as people’s agency and capacity declined.

So, what should we do for the ever-growing queue of people who have been allocated a home care package but, for whatever reason, haven’t been able to decide on a provider?

Some consumer groups advocate that there should be “navigators” to help older Australians get through the system. A good idea, but with 100,000 people in the queue these navigators will be quickly overwhelmed. 

A simpler solution is how our superannuation system works: we are free to choose our provider but, if we don’t we have a fund allocated by our employer. Moreover, we can change funds at any time.

The same can work for older Australians allocated a home care package. Confident and capable consumers can make their own choice. However, those who have failed to elect a provider within eight weeks would have their need for service provision referred to all accredited providers in the consumer’s location. 

If consumers are unhappy with their initial provider they can always change providers. 

After all, providing people with the home care they need shouldn’t be as hard as shopping for a daughter’s tofu.

Dr Stephen Judd is chief executive of HammondCare, an independent Christian charity specialising in health and aged care.