Reforms to in-home care: what providers need to know

Proposed changes to in-home care are supposed to make things simpler for older Australians, but providers say legislative delays are making it difficult for them to plan ahead, writes DENISE CULLEN.

Liesel Wett OAM, Chair of Goodwin Aged Care Services, which provides in-home care services to 1000 people across the greater Canberra region, said the lack of detail about policy direction and the recently announced delay in releasing the draft new Aged Care Act is stymying efforts.

“All the uncertainty is a problem,” she said.

Changes to in-home care are just one of a raft of measures proposed in the wake of the Royal Commission into Aged Care, which delivered a scathing report detailing neglect, abuse and below-average care for nursing home residents.

In all, it delivered 148 recommendations, including the development of a new in-home aged care program which rolled existing programs into one, and introduced a common set of eligibility criteria, a single assessment process, certainty of funding and genuine choice and flexibility for users of aged care services.

The need for greater independence

Speaking in a briefing that remains available on the federal Department of Health and Aged Care website, Nick Morgan, Assistant Secretary of the Support at Home Reform Branch, said the new arrangements sought to help older people stay independent in their homes for longer.

The changes would be implemented in two stages to create a single in-home aged care program that brought together the existing Commonwealth Home Support Program, Home Care Packages and Short-Term Restorative Care.

“We want to have a greater emphasis on independence through upfront supports like handrails and allied health to keep people active,” he said.

The single assessment system was scheduled to commence from July 2024.

A trial undertaken in 2023 using the new one-size-fits-all assessment tool collected data that is currently being used to determine the final classifications funding levels under the new Support at Home program.

From July 2025, Support at Home was due to commence by replacing the Home Care Packages and Short-Term Restorative Care Programs. The Commonwealth Home Support Program would then transition to the new program no earlier than July 2027.

This staging reflected feedback from peak bodies and providers that more time was needed for these providers to adjust “to mitigate the risk of provider exits or failures associated with the changes”.

What do providers need to know about the changes?

According to Patricia Sparrow, CEO of COTA Australia, the proposed in-home care reforms were significant and went beyond combining existing programs.

“It’s crucial that the design process centres the needs and preferences of older Australians, particularly over their desire to self-manage their care,” she explained.

“Boards and directors will need to make sure they have the right systems and processes in place to support this.

“Delays to these important reforms will only keep the current system in place, hindering efforts to boost access, cut wait times and ultimately limit older Australians’ ability to self-manage their care and live independently in their homes for as long as possible.”

Wett also signalled support for the shift towards greater consumer-directed care. A single set of rules and entry point for consumers to access the services they needed “makes perfect sense”, she added.

Yet aged care providers needed more information to firm up their workforce, technological and other plans.

“If there needs to be a major shift in how services are delivered, or what services are delivered, we need to know what they are,” she said.

For example, significant changes to the types of services an in-home carer could provide — such as domestic help or gardening services — might mean that parts of a provider’s workforce could no longer be deployed.

“When you’re running a company, you want certainty in policy direction, so you know where to invest your resources to best meet your client base,” Wett said.

“If we don’t know what those levers might be, we can’t plan for it (and) the people that suffer are patients, consumers or, in this case, older Australians.”

Questions surrounding budget allocations

Another upcoming change to in-home care concerns how client budgets are allocated. Morgan noted that budgets were previously reset each quarter so unspent funds did not accumulate.

“We’re now proposing that people be able to retain savings of (up to) $1000 for unexpected expenditure if they don’t fully expend their budgets,” he added.

“In the past we had put forward a concept of providers having access to a flexible pool of funds to support people as their needs change.

“This is no longer part of the program design given both the ability to save funds and the proposal to allow budget pooling to provide additional flexibility.”

Wett pointed out that “those resources belong to the client, not to the provider” and again called for further details on the way ahead.

Goodwin Aged Care Services is forging ahead with its planning process even in the absence of firm guidelines.

“For organisations like mine, that support a large number of Canberrans and South Coast people, we need to be able to tell our consumers what (the future) looks like and how we can help them live their best lives,” Wett said.

Denise Cullen is a Brisbane-based journalist and psychologist who writes on a diverse range of issues, including mental health, criminology, safety and aged care.

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