There is currently no accurate way of estimating demand for home care in Australia and this has created huge gaps in what we know about the impact of the aged care reforms sweeping through the industry, an issues paper says.
The wide-ranging Deeble Institute issues brief, released this month, pools existing government and non-government research.
It concludes there’s a need for more comprehensive data to understand the effect of the overhaul on an “under pressure” home care workforce and those receiving, or waiting for home care.
The paper says “there is currently no accurate estimate of unmet demand for home care in the wider community” and proposes that “adding questions about needs for formal aged care services to an existing population survey, such as the Australian Bureau of Statistics’ Survey of Disability, Ageing and Carers, is one potential way to collect these data”.
The paper’s author says to date there have only been small and limited qualitative studies, but large-scale government-commissioned independent research is needed to look at home care and the implementation of CDC, particularly for people with cognitive problems and those from diverse backgrounds.
“There are big gaps in what know, particularly about how consumer directed care is going and looking at the outcomes of the home care reforms,” Macquarie University researcher Dr Mikaela Jorgensen told Community Care Review.
“There’s a lot of potential with the reforms but there needs to be a lot more work looking at what’s actually going on and who’s benefiting.”
Waiting list blowout
The paper says despite “clear demand” there’s been a reduction in the growth of people getting home care over the last year.
Increased assessments “due to mass provider advertising to attract clients under the new system” could be a potential driver for the blowout in the waiting list.
It highlights concern about the impact this is having on informal carers and the entry into aged care for people on interim packages.
Is choice really choice?
The paper says although the aged care reforms emphasise increased choice and control for consumers, there is little public information about provider quality that consumers can use to inform those choices, with the government failing to collect data on administrative fees for home care packages.
“Requiring providers to disclose their administrative fees on My Aged Care, as they are currently required to do for maximum exit amounts, would be a first step towards monitoring this information,” it says.
The paper notes there’s been an increase in complaints about home packages, with official figures showing 12 per cent of all aged care complaints in 2015-16 were about home care packages, compared to 15 per cent in 2016-17.
The most common complaints were about fees and charges (31 per cent) followed by lack of consultation and communication (21 per cent) and lack of communication about fees and charges (12 per cent).
“The nature of these complaints indicate that the communication and budget components of consumer directed care are not always being implemented adequately,” it says.
The brief says a market-based system has the potential to exacerbate inequalities for those who lack the necessary knowledge, skills and abilities to navigate the process.
Carers, volunteers and the aged care workforce
The cost-effectiveness of reforms that aim to keep people at home for longer need to take into account the impact they are having on informal carers and the expenses associated with informal caregiving, the paper says.
It also notes that despite an increasing number of approved providers, the sector is experiencing an ongoing shortage of aged care workers, with a decrease in the proportion of the direct home care workforce who are registered or enrolled nurses and a decrease in the proportion of non-direct care workers who are care managers/coordinators.
“This means that there are fewer skilled workers to care for the growing number of people with complex needs at home.”
It warns that the willingness of volunteers to engage with the home care sector may be further comprised as the reforms drive the sector towards a competitive profit-driven market.
You can read the issues paper here.