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In-home aged care services support nearly a million senior Australians. Research indicates that many seniors prefer to stay at home for as long as possible before moving to a residential aged care facility.
Improving home support can prevent seniors from moving into residential aged care prematurely or against their wishes. With better support, some might never need to enter residential aged care at all. Seniors would manage risks associated with staying at home, and the assessment process would ensure that those needing to relocate to residential aged care can do so appropriately.
Currently, in-home aged care comprises various programs with different approaches to assessment, eligibility, service providers, funding, and fees. This can result in inequitable outcomes, with seniors receiving different levels of support for similar needs, and insufficient funding being allocated to direct care. Consequently, the system is complex and confusing for seniors and their families.
The Home Care Packages (HCP) Program has faced long wait times, high overhead costs from some providers, and high levels of unspent funds. The Commonwealth Home Support Programme (CHSP) has varying service availability depending on the location.
In response to the Royal Commission, the Australian Government committed to creating a new Support at Home Program, developed in consultation with seniors and community stakeholders. This program aims to implement several recommendations from the Royal Commission, enhancing support for seniors to remain independent and at home for longer.
How Would the Proposed Support at Home Program Improve Services?
The new Support at Home Program would reform in-home aged care delivery, including assessment, reablement and restorative care, individualised support plans, service inclusion clarity, provider funding, and market regulation. Seniors would receive service approvals based on their assessed needs and circumstances, rather than being placed into one of the four broad home care package levels.
Seniors would access goods, equipment, assistive technologies, and home modifications needed for safe and independent living without needing to save up package funds. A new funding model would support point-of-delivery payments for service providers, reducing their reporting burden and enhancing transparency for seniors while lowering fees and administrative costs.
Support at Home assessments would focus on promoting independence and providing guidance and support to delay functional decline. Seniors would have greater choice among providers for their care. A risk-proportionate regulation model would support care businesses and workers in delivering safe and high-quality aged care services at home.
Consistent Assessment and Better Service Recommendations
Currently, aged care assessments are conducted by Regional Assessment Services (RAS) and Aged Care Assessment Teams (ACATs) using the National Screening and Assessment Form (NSAF). A new Integrated Assessment Tool, to be introduced in July 2023, would better match services to a person’s aged care needs. It would assess eligibility for all aged care programs, covering various domains like general health, functional decline, cognition, behaviour, psychological condition, community engagement, medical conditions, home and personal safety, and carer support.
The tool will have four levels of assessment, using trigger points to guide assessors to the appropriate level for each person. It will identify the best care setting for seniors and provide funding approval as part of the assessment outcome.
Individualised Assessment Outcomes
After assessment, seniors would receive an Individualised Support Plan, outlining their eligible service types, frequency, and duration. The plan would be adjusted in collaboration with the senior and assessor to reflect their support needs, circumstances, and preferences within their assessed class.
Example:
A Service List for Clarity and Efficiency
The new program would include a Service List, providing clarity on available services and costs, subsidised by the Commonwealth Government. Providers may offer additional, non-subsidised services at the senior’s own cost. Services would be grouped into categories, allowing seniors to swap approved services within the same category, and enabling providers to adjust support plans as needs change.
Subsidies Set by Service Type
Under a fee-for-service funding model, a price schedule developed by the Government, with support from the Independent Hospital and Aged Care Pricing Authority, would set service prices. This schedule would include the government subsidy reflecting the cost of service delivery, including administrative overheads.
Care Management
Care management would be included as a service type for seniors with complex needs requiring oversight and coordination. Funding for care management would be restricted and not interchangeable with other services. The department will consult with stakeholders to define care managers' roles, accountability, client information sharing, engagement with other actors, and regulatory representation.
Access to Goods, Equipment, Assistive Technologies, and Home Modifications
The new program would ensure seniors have access to essential supports like handrails, home monitoring devices, and shower chairs without needing to save funds. The assessment process would consider needs for goods, equipment, and home modifications, with co-design activities continuing to refine this approach.
Supporting Self-Management of Care
The new regulatory model would allow seniors to self-manage their care, including using multiple service providers. An ICT payments platform would enable seniors and providers to view entitlements, book, and pay for services at the point of delivery.
Consistent Funding Arrangements
Support at Home would bring all in-home aged care providers under one funding model, moving to a fee-for-service basis. Payments would be based on agreed prices for services delivered, with no accrual of unspent funds.
Supporting Providers in Thin Markets
To ensure service availability for all seniors, a grant program would support providers in regional, rural, and remote areas, or those serving small cohorts with unique needs.
Better Support for All Seniors, Including Specific Cohorts
The program would integrate short-term reablement services, support seniors with dementia and their carers, and provide a new national support service for senior Aboriginal and Torres Strait Islander people, offering intensive face-to-face support and guidance for providers on cultural safety.
Next Steps
The department will consult with various stakeholders, including seniors, their families, carers, aged care providers, professionals, assessors, peak bodies, the general public, and experts. Consultation will involve workshops, focus group sessions, and bilateral discussions to inform the Support at Home Program's design.
Do you believe the upcoming changes to the Home Care sector are for the better or worse?
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