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.
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.
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.