Providers should start preparing for a future where the traditional boundaries between home and residential care collapse and new models of care and accommodation emerge, sector leaders say.
The chair of the Aged Care Sector Committee, David Tune said that the key long-term direction of the recently released Aged Care Roadmap was to create a single aged care system.
“The differences between home care and residential care should merge over time. It doesn’t mean that they will totally merge, but it will mean moving towards one system of aged care rather than two separate systems,” he told the Strategic Thinking for Choice and Control conference last week.
Nick Mersiades, director of aged care with Catholic Health Australia, said home care and residential care were terms that were “dreamt up in Canberra” but in 10 years’ time wouldn’t exist.
“It’ll just be places that you go to receive care,” Mr Mersiades told the event hosted by COTA Australia and Criterion.
Services provided where the client wants
The Aged Care Roadmap proposed that a person’s assessed aged care entitlements would be “service agnostic” and would be delivered in the setting of a person’s choosing. To facilitate this choice, a consumer would receive the same government contribution regardless of whether they were receiving care and support in their home or in a residential facility.
Mr Mersiades said these arrangements would create significant opportunities for innovation in service delivery and a shift away from a siloed approach to aged care.
Ian Yates, chief executive of COTA Australia, told the Sydney audience the separation of care and accommodation would open up a wide range of aged care housing options that would challenge traditional models of residential care.
Mr Tune said an integrated system would also create flexibility for consumers to move more seamlessly between services.
Mr Tune said the directions outlined in the roadmap, which moved aged care towards a market-based, demand-driven system, were a “radical” set of changes and the risks to providers, consumers and government would need to be carefully managed.
Proposals such as the uncapping of aged care places and the freeing up of pricing would require detailed modelling of the impacts and careful consideration about the pace and sequencing of the changes.
While the market should be allowed to determine the “nature, location and quantity of services provided”, government would need to provide extra assistance “through higher subsidies or block funding for areas or groups where the market is unable to offer the required services,” Mr Tune said.
He said reablement also needed to be fostered as a service type and would be an important part of a more flexible aged care system.
Mr Mersiades said there was a risk that aged care reform would stall at the point of funding being held by consumers and government would not agree to end the rationing of places. However, he warned this would fall significantly short of achieving the goal of delivering consumers choice and control.
He said there were strong arguments in favour of removing rationing in home care first, before proceeding with residential care as part of the phased removal of supply caps.
Increasing user pays
Just as the sector built public acceptance for bonds in high care, Mr Mersiades said a similar exercise would need to take place on the role of user contributions in contributing to a sustainable aged care system.
“There will need to be a convincing case made to the community that there is a grand bargain between consumers and what they contribute; for increased contributions you get choice and control over services, that has to be part of the deal.”
Mr Yates said relying on consumer co-contributions for those with capacity as an increasing source of funding would ensure that older people with the least ability to pay would continue to be supported.
He said the changed political environment where funding will follow the consumer in home care from 2017 will put pressure on government to uncap supply. “Consumer ownership of places is going to start to focus attention on unmet need.”
Mr Mersiades said one of the most challenging areas in the roadmap was ensuring that consumers have the capacity to exercise informed choice so that the system could respond to their needs and preferences.
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