The much-anticipated independent review of the Living Longer Living Better reforms has handed down a series of recommendations for the home care system designed to change the mix of packages, add flexibility to the aged care ratio and increase the collection of consumer contributions.
The Minister for Aged Care, Ken Wyatt, tabled the independent review undertaken by David Tune in parliament last week, which included 38 recommendations to government for further reform across both residential and community aged care.
While the report recognised it would be “desirable” for aged care supply caps to be removed, Mr Tune said there was significant work to do before this could be considered.
In addition to re-balancing the current mix of home care packages to better match demand, Mr Tune proposed temporarily re-allocating unused residential places to high level home care packages.
“Permanently re-balancing the ratio is unlikely to assist in increasing the supply of home care. However, creating greater flexibility within the ratio between the use of home care and residential care places may be a more productive approach,” he found.
To increase the options available to older people to stay at home for longer, the Tune Review recommended the introduction of a level 5 home care package for people with high care needs, which would be equivalent to the average cost of residential care (currently $63,000).
This proposal could have the effect of further blunting demand for residential care and meet consumer preferences to be cared for at home.
The Department of Health’s recent discussion paper on the second stage of home care reform also canvassed the sector’s views on a new higher-level package and how they would be funded.
Aged & Community Services Australia questioned the need for a new package level, which it said would create additional complexity, and recommended the subsidy of existing high-level packages should be increased instead.
Leading Age Services Australia has said a cost of care study would be required to determine the appropriate level of funding for a higher package, including delivery of palliative and complex care in the home.
The Tune report also said the number of package levels and subsidy amounts should be reviewed as part of the planned integration of the home support and home care programs.
Other significant recommendations included introducing mandatory consumer fees in the Commonwealth Home Support Program and removing the discretion of providers to waive consumer fees in home care packages.
As CCR previously reported, a survey by the Aged Care Financing Authority found most providers were not charging the full basic daily fee and nearly one-quarter were waiving the fee altogether.
The survey also found 17 per cent of providers were not collecting the income-tested care fee from clients.
Mr Tune said the basic fee should be considered “a minimum consumer payment to access the government-subsidised home care system” and those unable to afford the amount could apply for financial hardship assistance.
A CCR reader poll of 141 participants, found support for compulsory home care fees was mixed, with 41 per cent of respondents rejecting the proposal and 28 per cent in favour. Respondents were also more likely to support making the income-tested fee compulsory over the basic daily fee.
ACSA said it had some concerns about making the basic fee compulsory, which removed the ability for consumers and providers to negotiate fees on the basis of individual circumstances.
CCR understands some sector stakeholders hold significant concerns about the adequacy of existing financial hardship provisions and the impact of mandatory contributions on the take up of necessary services.
Addressing a longstanding concern in the sector, the review also proposed making the basic care fee proportionate to the value of the package subsidy.
“It is likely that the relatively high proportion of the basic daily fee in lower-level packages is contributing to the lack of uptake of those packages,” the review said.
Increased consumer information and supports
Responding to ongoing concerns over a lack of consumer supports, Mr Tune recommended introducing an aged care system navigator and outreach service to assist those struggling to engage with the system.
Mr Tune said the independent service would be funded by government and provide support to “the small but significant group” of consumers and carers requiring help.
The role would involve talking to consumers about their needs, bringing them into contact with My Aged Care and helping them to navigate the system and complete paperwork.
The sector should also move to ensure comparability of home care pricing for consumers, the report said.
For those seeking short-term single services such as meals or community transport, the Tune Review recommended trialling a simplified My Aged Care assessment process.
Related coverage: Tune recommends wide-ranging changes to further reform
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