industry & reform
Is personalised funding working?
Can market-driven care deliver
quality?
By Beatriz Cardona
T
wo years after the introduction
of personalised funding in the
home care sector, the evidence of
its impact on increasing choice, control
and quality through competitive markets
is mixed.
Research commissioned by the
Department of Health to evaluate the
experiences and perceptions of home care
packages among consumers and service
providers since the Increasing Choice in
Home Care reforms shows that the mix
of services older people use, and the
providers delivering them, remain mostly
the same.
12 agedcareinsite.com.au
The bulk of services older people
receive are for basic support, including
domestic support, transport and personal
care. The choice of provider is greatly
determined by availability and a preference
for continuity of service.
Research on the experience of
consumers with personalised funding
conducted by the University of
Queensland in 2018 found that while
people were happy with being able to
choose providers, there was a significant
level of frustration about the lack of
flexibility once services were delivered.
This included the ability to make
changes to care plans for activities such
as providing gardening or equipment that
was not initially identified. To some extent,
there is now less ability to respond to
emergent and unassessed needs.
These issues are the unintended
consequences of personalised budgets
where the goal of care shifts from
responding to consumers’ needs to
providing care based on standardised
packages.
The study also found dissatisfaction
among consumers due to a lack of
information, poor communication,
staff inconsistency and having to wait
for services, as well confusion over the
My Aged Care website.
The current waiting list for high-level
care also tells us something about the
model. More than 95,000 people with
high needs are waiting for a Level 3 or 4
package, with almost 17,000 of these not
receiving any support at all.
With the waiting list growing by almost
4000 in just three months, the 3500 new
home care packages a year committed
in last year’s budget won’t come close to
keeping pace with demand.
The fact that people deemed eligible for
high to very high levels of support are not
receiving care, or the care does not meet
their current needs, is an indictment on
the current funding model.
Under the previous model of block
funding, older people may not have had
the ‘choice’ they have now, but they were
in their majority accessing services and
having their critical needs met.
The block funded model also allowed
service providers to spread funds to
provide additional support for people
whose care needs changed.
From a quality perspective, a key