industry & reform
Funding falling behind
Funding for CHSP services has not
kept pace with the rise in demand.
By Michael Fine
P
erhaps the most damaging side
effect of the Royal Commission into
Aged Care Quality and Safety is that
instead of dealing with the problems of
the aged care system, we have a de facto
policy of ‘wait and see’. Actions and policy
initiatives we know are urgent are simply
not happening.
In the meantime, although politicians
often remind us that throwing money at
a problem is no solution, that’s what they
try to do.
The recent call from Commonwealth
Home Support Programme providers for
growth funding is a glaring case in point.
After years of facing the chop, CHSP
services are now expected to take up some
of the growing queue for national Home
Care Packages – at least until 2022 when
their funding is again scheduled to be
terminated.
In a gesture that is supposed to ease the
problems of providers, CHSP providers
were informed in September that they
can apply for additional funding from a
$150 million funding pool the government
says will provide support to 18,000 people
over the next 12 months. Applicants in
areas where there is high demand, it is said,
will be given priority. But in the era of CDC,
doesn’t each individual count? Isn’t every
person who misses out or who is forced to
wait for a vacancy a high-demand case?
Of course providers welcome the
chance for extra funding. However, even
the ACSA has described the package as a
‘drip feed’ that will do little to tackle the
waiting list problem in the Home Care
Packages Program. Nor will it make up
the funds CHSP services have previously
missed out on.
Funding for CHSP services has clearly
not kept pace with growth in demand
over the past five years. In 2017–18, total
government expenditure per client was
just $2762 a year, about $55 a week down
from the previous year.
As important as funding is, other
approaches to policy design are also
required. We need to think about
innovative new approaches to service
delivery and opportunities for real
serviced innovation, better pay, as well
as educational and career opportunities
for staff and more security for their
employment into the future. And I
could go on.
But what do we get? A new home
care assessment system, introduced
without serious field trials and that seems
designed to fail, frustrate and confuse.
It makes simple access to basic services
complicated. It focuses on eligibility
at entry but ignores the importance of
regular, ongoing reassessments.
The outcomes of assessments were
always likely to be somewhat cautionary
and uncertain in many, if not all cases.
Where a need for support is assessed but
there is doubt about what level of service
might be required, the result is likely to be a
‘safe’ one, a decision-making process that
was always likely to lead to an increased
number of recommendations for access
to a more comprehensive Home Care
Package rather than a more specific and
limited CHSP intervention.
Whatever the cause, the new assessment
policies for Home Care and the CHSP have
effectively funnelled an additional 800,000
consumers who use CHSP services each
year into an assessment program that
seems to have been designed for 90,000–
100,000 Home Care users per year.
Bottlenecks should have been expected.
Perhaps even more troubling, the
emphasis placed on assessment at the
point and time of admission to services
is misplaced. Because the care needs of
individual consumers change over time,
regular, periodic follow-up reassessment is
at least as important as assessment at the
point of entry.
In many cases, the care needs for those
at home may reduce over time as a result
of reablement programs or recovery and
recuperation following discharge from
hospital admissions.
Reassessment is also important from
a service provision perspective. Without
the capacity to reassess consumer needs
over time, turnover rates are minimal and
services fill and lack capacity to accept
new applicants.
Can it be left to consumer choice?
When it is your turn, what would you
choose? Under the existing system there
is the possibility you might get what you
need. But it’s also possible that you might
miss out. Perhaps worst of all, you might
actually be assessed and found eligible,
only to have to wait a year or more. Who
knows when a place will come free?
Do you need to wait for someone else to
die before you can take their place?
In the name of flexibility and competition,
it seems we’ve gone from a search for
security to the guarantee of an offer of
precarious care in late old age.
In the 21st century, that seems to be what
they call progress. ■
Michael Fine is an honorary professor of
sociology at Macquarie University.
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