industry & reform
The first of the five pillars
Analysing the government ’ s plans to improve the provision of aged care .
By Michael Fine
Now that the Royal Commission has finished and the worst of the pandemic and vaccination problems seem to be over , we can all take a deep breath and think again about the changes to the aged care system planned over the next few years .
Since May 2021 , the path of development for the aged care system has been reset . There is less concern about how to get to the destination and more of a focus on the specific changes being planned . We no longer have a roadmap to indicate where we ’ re going . So , you may ask , what are these changes ?
The changes planned by the government are succinctly summarised in a plan with a grand title : Five pillars over five years . Although not written on stone tablets like the ten commandments , the classical , quasi-biblical references are hard to miss .
The first of these pillars concerns ‘ Home Care ’. No wonder . Although care at home is often ignored in the media and in political discussions and receives far less funding than residential care , home remains the place in which the overwhelming majority of aged care residents are to be found .
In the no-man ’ s land between the recommendations of the Royal
Commission and the responses by the government lie at least two proposals that are exciting , yet also so risky as to be dangerous . It is time for those who currently work in community support and home care ( or hope to do so in future ), as well as those who are counting on it to help remain at home in their hour of need , to get engaged . There is much to lose .
Unpaid carers , family and friends remain the real unsung and increasingly forgotten heroes of aged care in Australia . Alongside them , at present , there are two relatively poorly funded systems of formal care services responsible for the delivery of formal care at home . For years it has been planned to integrate the two approaches , but this was never finalised . In practice it seemed to mean that we would have just one system , which sounds sensible , but it would have been at the cost of the least expensive yet highly effective lower tier of support .
Home Care Packages , the more costly , complex and higher level of service for those at home , provide funding budgets at four different levels to individual consumers . This is the form of care for which waiting lists have been increasing massively over recent years . The May federal budget pledged to fund an additional 40,000 care places over the next year , with further expansion pledged for future years .
Although there has been much demand for additional high-level places , provision has not kept up with demand . According to auditor ’ s reports , while funding has increased the budget management practices associated with the way care is arranged for each individual have actually seen a reduction in the hours of care per week . There has also been an accumulation of considerable amounts of unspent funds . This suggests that more attention needs to be paid to this funding model .
The Commonwealth Home Support Programme is less costly but it serves almost four times the number of consumers . Typically based on local , community organisations , these services are less focused on individualised funding than on community sharing . To date , funding has been what the Royal Commission described as grant-based .
The ambitious but risky plans of the government are first : the development of a new aged care program , with a single assessment process and care finders ; and second , the commitment to develop and extend a system of locally coordinated social supports to reduce and prevent social isolation . Does this sit alongside the new program or is it another component of it ? Or worse , is it just another marketing trick ?
The funding mechanism is an apparently subtle and so far little discussed area of conflict in the Royal Commission ’ s recommendations and the government ’ s response . The Commissioners recommended the clear reinstatement of grant funding . The government has responded not with a promise , but a process measure they term ‘ Home Care – Future design and funding ’. The design of a new support at home program will be finalised following sector consultation and further development of the model , but a key feature has already been decided – funding ahead of spending will cease and is instead to be paid in arrears .
In November , a national conference is planned for the CHSP program . These providers have lacked a strong collective voice in national discussions to date . Might there finally be a move to develop one ? Let ’ s not wait any longer or the chariots , slaves , priests and philosophers who can help shape a new future will have moved on to other pillars . ■
Michael Fine is an honorary professor in the School of Social Sciences at Macquarie University .
10 agedcareinsite . com . au