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NARI calls for huge home care reform

The home care system needs systemic reform to ensure it is sustainable and effective for older Australians into the future, says a recent report from the National Ageing Research Institute (NARI).

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A Position Paper from the National Ageing Research Institute is advocating for a systemic change in the home care sector to better support older Australians in the future. [Source: Shutterstock]

Yesterday, (NARI) released a Position Paper, Transforming the system of home care for older Australians, which analysed the Federal Government's responses to key home care recommendations from the Royal Commission into Aged Care Quality and Safety and what more needs to be done to ensure a secure and safe system for older people.

Director of Clinical Gerontology at NARI, Associate Professor Frances Batchelor, says the NARI research found that the home care system should be needs-based and not rationed, similar to how the healthcare system currently works.

"The Royal Commission highlighted that older Australians want to remain at home, but the current aged care system is not providing adequate access to services and supports to help them remain at home," says Assoc. Prof. Batchelor.

"While the Federal Government has committed to providing additional home care packages and other incremental reform, this will only provide temporary relief. Without substantial change to the ration-based system, the waitlist will only build up again as more and more people require aged care at home into the future.

"Funding should be linked to individual needs and care planning. Under the current model, bundled funding is allocated to a limited number of older people in need. This model lacks flexibility and is not truly tied to the unique needs of each older person.

"Funding needs to be better distributed so it is allocated in a more cost-effective way, to ensure every person in need of care at home is able to receive it, when they need it."

The Federal Government is committing $7.5 billion to support older Australians to remain living at home for longer, including $6.5 billion to provide an additional 80,000 Home Care Packages by 2023.

In the recommendations from the Royal Commission, it suggested a needs-based approach to home care, however, the Federal Government did not make any commitment to address this suggestion.

While NARI appreciates that the Government is making positive changes in the sector, they don't believe the current system will be able to handle a growth in the number of people who need to access home care services.

NARI would support a reformed home care system that is more streamlined, effective and flexible when undertaking a needs assessment, which would improve the overall experience for older people and their families when accessing aged care services.

Assos. Prof. Batchelor says that one of the problems with home care is that the process of assessing the needs of older people is currently constrained by resourcing issues and that doesn't allow for the provision of services and supports that would align with the actual care and support requirements of an older person.

He adds that there is a particular need for flexible assessment processes and funding allocation based on individual needs.

NARI says only systemic change in the home care system will work, not incremental reform, as previous reform history in the aged care sector has shown that it doesn't work well.

Suggested systemic changes in home care include:

  • A transition to a needs-based system of funding and delivering home care services in a timely manner so older people don't have to wait to access care

  • Personalised and flexible funding that incorporates the individual needs of an older person, in a model that takes the form of individualised budgets or case-mix classification

  • An introduction of streamlined and flexible needs assessment processes that would improve the experience of older people accessing home care services

  • More mechanisms to assist older people in navigating and accessing home care and to make informed choices, like the introduction of a care finders network and improved quality regulation measures such as Star Ratings

Assoc. Prof. Batchelor says, "We welcome the Government’s funding of 80,000 additional Home Care Packages over the next two years, however, for as long as current model stays in place, older Australians will continue to wait long periods of time to access home care."

Industry peak body, Leading Age Services Australia (LASA), has been working with the Department of Health on home care reform since the start of this year.

Chief Executive Officer (CEO) of LASA, Sean Rooney, says that a number of concerns have been raised by LASA Members about the direction of reform and the consultation process with the Government.

"Consultation with LASA Members has identified critical elements of home care reform that we need to get right," explains Mr Rooney.

"...So far we have no insight into the [assessment] instruments that will be used and how their accuracy is being assessed.

"...We can’t have a system where the focus is only on price but that is what we fear the system may be heading towards."

The current concerns from LASA members include:

  • Assessment - The assessment tool used needs to accurately capture needs, the governance of the assessment process needs to be independent and objective, and people need the right to review.

  • Care-recipient experiences and outcomes - There needs to be actual measurement of customer satisfaction and care outcomes rather than a focus on price.

  • Case management - This needs to be provided in the new home care system and noting a variability of care management support needs from moment to moment.

  • Flexibility and choice - Tailored funding is a good idea but should not result in people requiring regular reassessments when conditions change. Additionally, LASA believes the system is moving towards subsidies based on units of service, but this cannot be allowed to limit choice.

  • Transition and consultation - Reform to the sector needs to include genuine consultation and a clear timetable. The rush to achieve dates was recently experienced by the sector through the "Improved Payment Arrangements" changes which resulted in an additional cost to providers.

To view the National Ageing Research Institute Position Paper, head to their website.

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