Nursing Review Issue 3 May-June 2022 - Page 12

industry & reform
industry & reform

More trouble brewing ?

The looming dispute over the Support at Home Program .
By Michael Fine

A

number of reports and planning documents released without fanfare by the Commonwealth Department of Health in January and February this year spell out the direction that the Federal Government seeks to take the proposed new Support at Home ( SAH ) program .
Scheduled to begin operation in mid- 2023 , the plans spell out some of the crucial details of a scheme that would radically change the existing system of community-based and home care in this country , converting it to something that seems to closely resemble the NDIS .
But the department ’ s plans for the SAH do not look like they will receive the smooth ride that the senior public servants responsible for their implementation seem to think . They are facing scrutiny and criticism , with opposition led by a number of senior industry figures and alliances .
Foremost among the other voices is the Support at Home Alliance , which includes ACSA , the Ethnic Communities ’ Council of NSW and a range of more specialised peak organisations from the CHSP , including
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Community Transport ( NSW ), Home Modifications Australia , Meals on Wheels Australia and the NSW Neighbour Aid & Social Support Association .
Their campaign is a national one , with detailed arguments set out in a discussion paper released in December 2021 entitled Seamless Aged Care : How to set up ‘ SUPPORT AT HOME ’ Right , the first time . It certainly raises some very fundamental concerns about the Federal Government ’ s plans which have national implications .
The central idea behind the SAH program is that of reducing complexity by integrating a number of existing programs into a single , much larger one . Hence , from July next year it is proposed that the Commonwealth Home Support Programme ( CHSP ) will be amalgamated with the Home Care Packages ( HCP ) Program and the ( little known ) Short Term Restorative Care ( STRC ) Programme to form the SAH Program .
It will certainly help overcome the spelling inconsistencies that have crept into our programs . Or is that programmes ? Gone , too , is that sensitive word ‘ care ’. It will now be replaced by the less intense and personal form of assistance referred to as ‘ support ’. As those skilled in manipulating them will confirm , words matter .
So too does funding , eligibility and entitlement categories . The SAH plans are to replace the complexity of the existing funding schemes for the CHSP , based on ending annual block funding grants , despite the clear call from the Royal Commission to continue this form of broad investment in service development . Similarly , the four levels of funding for home care packages are to be abolished , replaced by what sounds like a single mechanism – the ‘ point-of-delivery payment ’. This is what we all know in health care as the fee-for-service system .
Before it is destroyed , it is worth stopping for a moment to think about the relative merits of what is being replaced . The CHSP operates as a block-funded system of support , paid for by Federal and State governments to provide an alternative to reliance on institutional facilities . It provides basic home support services such as prepared meals , day care , home nursing , community transport , as well as social and home support which may include cleaning , showering , help with dressing and so on . It supports over 800,000 people annually : by far the largest number of them being aged care consumers . Importantly , this care can keep people more active and independent and defer the time when they may have