Home Care reform: hits and misses
1st May 2018
Published in the Autumn 2018 edition of Community Care Review
It’s a year on since the Federal Government introduced the Increasing Choice in Home Care (ICHC) reforms to improve the way home care services are delivered to older Australians. As the name suggests, the changes were designed to enhance consumer choice through the introduction of funding following the consumer, package portability, and more timely access to care.
Ultimately, the reforms sought to progress long-term policy directions proposed by the Productivity Commission in 2011 and subsequently advanced through various elements of the 2012 Living Longer Living Better reforms. It is timely now to reflect on the extent to which ICHC is achieving its intended outcomes.
Portability of packages has been effective, with ample anecdotal evidence of consumers electing to transfer from one provider to another. There is no data on the full extent of portability movements, but for Benetas, portability has been a relatively small proportion of overall movements.
As might be expected, consumers opting to switch providers peaked in the months after the changes commenced and subsequently slowed. Importantly, it’s there and working for consumers, so a win for the program. Of interest are the drivers of client movements. They are a mixed bag and include dissatisfaction with existing arrangements, pursuit of a better deal (fees particularly), relocation to another area, and convenience (for example, couples consolidating care to a single provider). An interesting consequence is client transfer to newly approved providers that had previously been an informal partner (retirement living is a prime example).
There is no doubt funding is following consumers. Packages are now assigned to consumers who subsequently select a provider. Another win for the ICHC reforms. Underlying this, however, are some unexpected outcomes. Enhancements to the My Aged Care (MAC) service finder aimed to give older people more information, including details of fees and charges, service availability and specialisations. However, it is very evident choice remains a challenge for many consumers. A significant proportion of home care clients don’t know how to respond following assignment of a Home Care Package by MAC, and many wait until the close of the 56-day acceptance period to act.
An unfortunate consequence of this has been the withdrawal of packages, and the subsequent anxiety arising for both consumers and providers, especially when wait times have been lengthy. What best guides consumer choice remains a complex matter and perhaps one of the reform’s grey areas. The Tune Review zeroed in on this and referred to the need for “a system navigator and outreach services”.
The recommendation has merit and can be implemented in a number of ways, extending beyond the independent service proposed by David Tune. More consumers are contacting Benetas’ customer centre prior to engaging with the aged care system, and ahead of being assigned a package, to make enquiries and shop around. Our responses to enquiries are now more timely and purposeful, consistent with system navigation concepts and customer support principles.
There is an equally strong focus on the service offer of other providers, with competitor analysis and mystery shopping initiatives being undertaken by providers. In this sense, the Productivity Commission’s want for increased competition and a more market-based sector is beginning to play out. Reform will claim this as a win.
ENHANCING CONSUMER SUPPORT
Without question, the most significant outcome of ICHC to date has been the increased visibility of the number of consumers awaiting care and the wait times for care. Contrary to favourable satisfaction levels recently reported by market research firm AMR, consumers supported by Benetas express significant concern about wait times whether this be for assessment, approval or assignment of care.
The extent of unmet need is now well-documented and has attracted volumes of comment. Given the gap between supply and demand, and considering package turnover rates, without a substantial increase in the total number of packages available, wait times can only blow out. A large and growing number of wait-listed consumers are in receipt of an interim package, receiving some care but less than their assessed entitlement demands, and at the expense of consumers assessed for a lower level of care.
This is a further expression of the supply and demand shortfall. The total amount of care available remains a challenge for government but there is opportunity to maximise take up of the care that is currently available. We should look to what can be done to enable the earliest commencement of care, post assignment of a package.
On the surface, the allowable 56-day acceptance period (with a 28-day extension) provides time for consumers to make important decisions about providers once a package has been assigned, but it also arguably delays starting care where the full 56 or 84 days
Consumers are usually waitlisted for extended periods of time prior to package assignment, and there is opportunity to utilise wait times by introducing requirements for consumers to nominate a preferred provider ahead of being assigned a package.The introduction of a letter to provide advance notice to consumers of forthcoming package assignments is a positive move.
This could go a step further asking consumers to advise MAC of their preferred provider ahead of assignment. For consumers, what needs to be worked through does not change, however their readiness to accept an assigned package quickly is accelerated. For providers, early engagement with consumers and a role in system navigation would be universally welcomed. This seems like an easy win for the ICHC changes.
We shouldn’t lose sight of the need to use available funds as well as possible. The level of home care package underspend is not reported and may be unknown, but anecdotally providers speak of substantial and increasing funds held in surplus.
There are many ways of assessing the cause and consequence of unspent funds, but in any sense unspent funding is a lost opportunity to meet care needs. As the ICHC measures didn’t set out to address this, it is a call to action for the Australian Government if the full intent of aged care reform is to be realised.
There are a number of considerations for the Commonwealth such as whether it needs to look at a different funding model, rethink
how people are assessed, what to do with surplus amounts, and address the client mentality of “saving for a rainy day”.
BUDGET MUST DELIVER
The extent to which access to care has changed is a moot point. More consumers engaged with the aged care system, assessment for a specific level of care, visibility of wait times, service finder enhancements, and genuine choice of preferred provider are positive changes to the system. These achievements, however, are compromised by the growing demand for care. We look to the May Federal Budget for a response to the Tune Review, as well as a significant boost in package numbers to ease the bottleneck of more than 100,000 older Australians waiting for care at the level they need.