Top Menu

Royal commission weighs case for independent navigators


A system navigator independent of providers should be available as soon as people enter the aged care system, the Royal Commission into Aged Care Quality and Safety has heard.

A series of expert panels gave evidence in Adelaide this week on potential new models of service delivery at the point of entry, based on a consultation paper released by the royal commission in December.

The paper proposes basic screening for entry level support and comprehensive assessment for higher needs, with care finders available at a local level to help find services and oversee care plans.

It would replace the current system where people are assigned a level of assistance by an ACAT or RAS assessment and then directed to the My Aged Care portal where they are expected to more or less fend for themselves.

Block-funded independent role ‘fundamental’

Professor Mike Woods from the Centre of Health Economics at UTS said a block-funded face-to-face navigation role separate from providers was “absolutely fundamental” to prevent older people getting lost in the system and dropping out.

Profressor Woods (left) and Ian Yates at Monday’s hearing of the aged care royal commission.

However, he warned there was a risk of “over-servicing” under a block grant model, and efficiency principles should be maintained.

Aged Care Sector Committee Independent Chair David Tune also raised concerns about the limitations of block funding.

“You need to make sure government funding is sufficient to meet the demand,” he told the royal commission on Monday.

Nicholas Hartland from the health department acknowledged there was a need for a bigger face-to-face presence in the aged care system.

But the navigator model shouldn’t simply add another step in an already complicated process where someone was “referred to assessment, to going to a GP, getting referred to a central point and then getting referred to navigation and getting referred to other services”, he said.

Rather, navigation needed to be embedded in existing structures, Dr Hartland said.

Don’t overlook role of providers, says peak

COTA CEO Ian Yates said COTA believes the role should combine care-finding and case management, and should be linked with assessment.

“We’ve suggested that when people are assessed, they are assigned someone who … can navigate, who knows where services are available, who can work with the person about making decisions about what’s best for them.”

A navigator role would be particularly valuable for people with dementia who often found themselves in a “post diagnosis vacuum”, Alzheimer’s Disease International Chair Glen Rees told the commission.

“In the case of people with dementia you do need a structure that takes them from the point of diagnosis to a navigator who can help plan and direct the services,” he said.

However ACSA CEO Pat Sparrow warned that providers shouldn’t be overlooked in the process, as they played key a role in care management after referral.

“Providers see people every day, they see the changes, they know the changes and they get to know the person really well,” she said.

“I think again there’s a balance and there’s a point at which you need both, keeping some independence, but also making sure that those people who are dealing on a day-to-day basis and can provide valuable insights are part of that process.”

New three-stream model

The royal commission consultation paper proposes replacing the current system of home care with three discreelty funded streams – an “entry” (or basic services) stream; a mid-level “investment” stream focused on reablement; and a higher-level “care and health” stream.

GPs and other health and community services would potentially be able to make referrals to entry level services, which could include services like gardening and cleaning, and social activities.

“We want a system that would allow older people to enter any stream and be supported to build their own bundle of supports and care,” the paper proposes.

The proposed new model from the Royal Commission’s consultation paper.

 

Professor Woods told the commission the idea of having basic screening versus comprehensive assessment was well placed, as it provided a “soft entry” for people requiring basic services.

Aged Care Sector independent chair David Tune said he supported health services being a point of assessment but added there was also a need for an independent assessment process for eligibility, particularly if there was a move towards an uncapped system.

Subscribe to Community Care Review

Tags: , , , , , , , , ,



, , , , , , , , ,

7 Responses to Royal commission weighs case for independent navigators

  1. Sebastian February 13, 2020 at 12:13 pm #

    Same people driving the redesign as those involved in the original design of the current mess!
    I was optimistic by the royal commission but this is waning quickly.

  2. Michael February 13, 2020 at 10:14 pm #

    Sad to see this. Agree with Sebastion. Like every previous ‘reform’, the RC are setting out what they would like without first addressing The reasons for failure. These will persist.

    It’s still under The control of the family so we are likely to be back here in a few more years. Very depressing.

  3. Sofia Mercer February 13, 2020 at 11:18 pm #

    I would agree Sebastian. in my experience the Provider was no more than a recipient of the HCP package funding. they availed themselves to some $800 monthly fees for admin and care management. the person supposedly assessed as Level 4 was only receiving 5-6 hours personal care a week. on any level this did not bother the provider they kept getting funding or $4000.00 a month which they invested so they could make more money. No one from the Government or the Provider who was the recipient of HCP funds queried this situation. HCP person had to rely on family members and could not employ any ironing or cleaning or carer unless they entered into an agreement with the Provider who received the package funding at cost of $300 for agreement and an ironing lady or a cleaner or carer had to have an ABN. the ABN ,should be looked at it , the Royal District Nursing model in my view is the system to be considered for home care package recipients
    Also provider required their preferred “providers” other agencies to provide the home care and I believe they did not release funds to these agencies monthly and they also receive some percentage from their “preferred Providers” This situation would not occur under a Royal District Nursing model where skilled and domestic help were employees on weekly or part time wages.

  4. Terry Kelly February 14, 2020 at 3:03 pm #

    Agree with Sebastian. Sigh.

  5. Janet Castle February 14, 2020 at 4:30 pm #

    As one who set up a private practice as a navigator/case manager, I fell foul of being unable to put my details on My Aged Care site so RAS assessors/ ACATs could not refer. Additionally, while many would have benefited from navigation/case management, few were willing to direct funds towards it. Needs to be specifically funded (for for profit or not for profit providers of navigation) and possible to be on My Aged Care site.

  6. Gabriele February 20, 2020 at 2:34 pm #

    Those discussing the Navigator services seem to turn a blind eye to what is already a successful navigator program in Victoria called Access and Support. This initiative has been in place for the past eight years and has provided with pre and post MAC navigation across the state.

    The Access and Support Program needs a review and sound engineering on how to apply it nationally.

  7. Deidre March 13, 2020 at 1:06 pm #

    Assessors do have ability to link clients to services under My Aged Care the problem being the lack of time and having to meet existing KPI”s initiated by someone sitting behind a desk in government with no idea of time involved trying to find services especially in regional areas. The other problem is that assessors are unable to send referrals for services to providers if the providers have closed their portal due to no funding from the Federal Government. I doubt a Navigation system would help clients to find non existing services.

Leave a Reply