industry & policy
Tip of the Iceberg?
The neglect and abuse
seen in residential care is
simply the most visible part
of a larger problem.
By Michael Fine
T
he Royal Commission into
Aged Care needs to go beyond
the urgent problems of residential
aged care to look at the full formal system
of care and support. We need to ensure we
can increase staffing levels in residential
care and ensure a high quality of care is
available to all who need it.
To address the problems of abuse
within the aged care system in Australia
we must ensure that there are viable
alternatives to residential care for as
many people as possible. Only then can
we prevent even larger disasters that are
just around the corner.
Today the guiding strategy for aged care
is set out in the ‘Aged Care Roadmap’,
released by the Department of Health
in 2016. The roadmap directs us to a
path towards further deregulation and
competition. According to the roadmap
the destination is ‘A single aged care and
support system that is market-based and
consumer-driven, with access based on
assessed need’.
Often, experience overseas will
serve to guide the way. But in this
10 agedcareinsite.com.au
case, there are no examples overseas
where this approach has been shown
to be successful. Nor have there been
successful demonstrations of the
approach in any region of Australia.
Given what we know already about
the impact of other aged care reforms,
such as the abolition of staffing ratios
in residential care in Australia, how can
anyone be certain the proposed reforms
will work?
Many of the major moves have already
been put in place and this gives us some
insight into the potential outcome. One
of the less publicised impacts to date
has been the unintended effects of the
introduction of consumer choice principles
and new procedures for assessment.
Eligibility for all care at home, for
example, is now formally assessed.
Although it was previously possible
to simply approach a Home Support
service directly and be accepted for
care immediately, the introduction of
Consumer Directed Care (CDC) and the
new assessment procedures have come
at a huge cost.
Despite the massive expansion of
the assessment program to take on the
increased task, long waiting lists have
developed. As Aged Care Insite reported
at the time, official reports earlier this year
confirmed waiting times of a year for CDC
Home Care packages.
Instead of trying to funnel an
additional 800,000 consumers who
use CHSP (the Home Support Program,
previously called HACC) services into
a single assessment program designed
for 90,000, might it be better to think
of the CHSP as a low-cost tier of
primary care service which consumers
can approach directly, just as we do with
GPs and dentists?
Is it desirable to proceed with the
planned reforms and effectively collapse
the CHSP into the Home Care Program
to produce a single system? The move,
which will see the block funding of
CHSP services replaced by fee-for-
service payments under which they
will compete with Home Care Services,
is now scheduled to take place from
2020. It was previously scheduled for
2017 and then 2018, so perhaps there is
some trepidation about the move at the
Commonwealth level.
And what will be the impact on the
non-profit, block-funded CHSP services?
Will the volunteers continue to work
without pay when a fee-for-service
payment is in operation?
There are many other existing and
potential problems that require attention,
including the new approach that sees
carers as a consumer group, that is quite
distinct from the aged care consumers.
If we want to prevent the even larger
disasters that are just around the corner,
there are alternatives to residential
care. We must ensure these are viable,
sustainable and available to as many
people as possible.
The roadmap suggests we are
currently heading towards even greater
problems. One thing is certain: we need
the Royal Commission to go beyond the
urgent problems of residential aged care
to look at the problems of the full formal
system of care and support. ■
Michael Fine is an honorary professor
in the department of sociology at
Macquarie University.