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Home care reforms leaving most vulnerable behind


More vulnerable people are experiencing difficulty accessing home care since the introduction two years ago of the Increasing Choice reforms, research suggests.

Dr Mikaela Jorgensen

Dr Mikaela Jorgensen and a research team from the Aged Care Evaluation and Research unit at Macquarie University have been examining the impact of the 2017 Increasing Choice in Home Care reforms, which assigned home care packages to individuals rather than providers.

The reforms were intended to improve the way home care services were delivered after a 2011 Productivity Commission inquiry that found key weaknesses in the aged care system, including limited consumer choice.

However, the researchers found that while there had been an increase in the number of people getting home care before the reforms, this dropped off after they were introduced. Also, those accessing home care were younger and less likely to have a partner after the reforms, and fewer were entering home care after coming out of hospital.

“This starts to suggest that more vulnerable older Australians may experience difficulty accessing the services that they need under the new system,” Dr Jorgensen told the Australian Association of Gerontology (AAG) conference this month.

“A truly consumer directed system would ensure that people who have been assessed for care have the potential to actually access home care, and that is not the case at the moment.”

The reforms created more steps before receiving a home car package, saw the establishment of the national priority queue and left many older Australians unclear about what they were meant to do once they had been approved for a package, she said.

Health department research conducted at the time found 45 per cent of recipients were unsure of what to do after getting their approval letter, Dr Jorgensen said.

Scant research into to impact of reforms

“We don’t really know what’s going on since 2017 reforms,” Dr Jorgensen told the conference.

To glean some more information, Dr Jorgensen and her colleagues analysed data on 40,000 people receiving community care from a “large and representative” ACT/NSW provider over a period encompassing 12 months before the reforms and 12 months after.

They found that before the reforms, the number of new home care clients had been increasing but after the reforms there was a big drop in the number of home care clients. There was no real change in relation to clients leaving the provider.

The data also showed that before the reforms, 64.6 per cent of home care recipients were 80 years and over, but after the reforms 59.7  per cent were 80 and over.

It also revealed that prior to the reforms 42 per cent of home care recipients had a partner, compared to 50.6 per cent after the reforms.

“From this single large provider we can see that people are having trouble getting into the new home care packages and the people who are getting through are more likely to be younger and have a current partner,” Dr Jorgensen said.

She also noted that while fewer people coming straight from hospital, where they may have been treated for a fall, there had been no national increase in transition care or shorter term reablement packages over that time.

There was a need to expand the research by evaluating the impact of the reforms at a national level, she said.

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3 Responses to Home care reforms leaving most vulnerable behind

  1. Community Nurse November 14, 2019 at 1:26 pm #

    This is what we who work in the community with older Australians warned would happen, but we were over ruled by people who work in nice offices in capital cities.

    The people most at risk, the frail, socially isolated and cognitively impaired were not part of focus groups or responded to on line surveys. The groups who claim to speak for older members of the community don’t engage with this group.

    The frail, socially isolated and cognitively impaired are the Invisible Australians who get ignored and left behind in this modern age of consumer directed care. These people often don’t have a family member or a friend to act on their behalf and so the services they would benefit from are never implemented.
    These are the people we have told for years Beware of Telemarketers and so when the My Aged Care call centre or ACAS phone they hang up on them resulting in “Assessment Declined”, or when the letter offering an Aged Care Package arrives it gets filed with the junk mail as its not one of their usual letters.

    I have worked in the community for over 20 years and have found there is a large group of Older Australians who need to deal with someone face to face and be given an opportunity to develop a relationship with that person. They trust people from the local hospital, community health centre and their GP clinic but not people who represent organisations or services they are unfamiliar with.

  2. Angus Kerr November 18, 2019 at 1:44 pm #

    I would love to see some data/research into the number of assigned home care packages that are not taken up because of the reasons sited by Dr Mikaela Jorgensen and
    Community Nurse. Just from a functionaily perspective, if this number is significant, the fact that a HCP assignement sits there for 56 days with the high chance of not being engaged, must have affect the funcionaility of the national queue and further increase wait times?

    The amount of older people I work with who don’t fit into the catagory of ‘vulnerable’ but who require support to understand and navigate the community care sector especially post receiving correspondence from My Aged Care regarding approval and/or assignment of Home Care Packages is staggering. So the mind boggles about the truely vulnerable who are not engaging the supports they have been assessed for. ACAT teams have the capacity to identify ‘vulnerable’ clients but probably do don’t have the capacity to assist these people to understand and ultimately engage the supports they have approval for.

    The role that Access and Support workers (CHSP funded) play in Victoria is filling this gap to a degree but this is not offered in other states and it is unclear of its future beyond 2022? It is an area which I was hoping to see explored further by the System Navigation pilots on a national level. Although System Navigator pilots are trialling x6 specialist support workers across the country, my understanding is that these roles are restricted to working with people who have yet to engage with My Aged Care. As this research highlights there are significant numbers of people who have been through the My Aged Care system but still need support to understand their options, navigate the market and engage their approved supports under both HCP or CHSP.

  3. Daniella Occupational Therapist November 20, 2019 at 2:53 pm #

    I totally agree with the comments made by my colleagues above and would like to add the NESB vulnerable/isolated/cognitively impaired as being even more disadvantaged. I am a therapist working within aged care and supporting aged care package participants however did not realise the extent of the barriers with the NESB population until I had first-hand experience, which I will recount for anyone who may be interested;
    We have a ‘nearly 98-year-old’ family friend, with no immediate or extended family in Australia. He is part of our family as he was my late grandfather’s best friend and the two of them travelled by boat to Australia from Europe in the mid-late 50’s with their wives following 9 months after. He was gainfully employed from the time he landed (36 years of age) to retirement age. He has been diagnosed with prostate cancer and spinal mets and has been declining steadily over the years both physically and cognitively. With much encouragement and persuasion, he agreed to me referring him to MAC for home care support and minor modification support.
    The individual at MAC, tasked with contacting him, tried on 2 occasions and when he did not answer the phone (he is terribly deaf and attends a day centre 3 days per week for lunch) I was contacted and a voice message was left on my phone advising that MAC had tried to contact him, they had not been successful and could I please have the gentleman (that I had referred) call them back on a 1300 number and quote a 10-digit reference number. Needless to say, that there is no way our friend was going to be able to manage this given his hearing and NESB status. Not to be dissuaded and as my retired mother (69 years of age) has more time on her hands and is our elderly friends’ executor, I asked that she follow this up. The issues we had moving forward were jaw dropping.
    My mother (who was fully educated in Australia and does not identify as a NESB) struggled to navigate the system herself. First, to overcome the complications of requiring formal documentation to “act on our friend’s behalf” given that she was not a blood relative; then to routinely attend his home to review his post to ensure that any MAC communique was not discarded mistakenly and; finally, to work out what to do and who to contact when a package was finally allocated. The responsibility of explaining the process to our friend fell to my mother, with whatever additional assistance I could provide with the limited knowledge I had. At more than one point, our dear friend suggested that we just “forget it” because it was so complicated and he could not understand the system and processes (e.g. the MAC assessment made promises then no action – because he was on the waiting list) and was fearful when receiving official looking post as he assumed this was negative. Further to this, being asked to “pay into” the package was not clearly explained and we had a hard time explaining the reasoning behind this as well as reassuring him that the government was not using the package as a rouse to access his bank account and take his money.
    We have other family friends in this cultural group and none of them are receiving packages as they do not know these exist and if they do, the response has been it is too hard to navigate. Like I said, I am a clinician working in aged care, however my role is usually about providing support after a client has a package, so this experience has been a real eye-opener. As a result, I have serious concerns about how packages are being administered and fundamentally, that there are disadvantaged client groups out there missing out, and, dare I say it, a degree of unintentional discrimination occurring due to poor processes and system failures.

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