SaH costs may push people to hospital
The government’s ageing-in-place policy aims in part to prevent older people from having to enter residential care or hospital, but changes to the fee structure in the new Support at Home program could see the opposite, warn stakeholders.
Around 300,000 Australians are currently receiving a home care package, but the new Support at Home funding model and fee structure could have unintended consequences on the very services that allow people to age at home, industry insiders have told Australian Ageing Agenda.
A no-worse-off principle will apply for people who on 12 September 2024 were either receiving a home care package, were on the National Priority System, or assessed as eligible for a package, but older people entering into the SaH program will need to make varying co-contribution payments for services.
The contribution rate will be based on:
- the type of service received, with clinical care fully funded by government for all participants but contributions for services in the independence category and everyday living services – which includes domestic assistance
- the participant’s age pension status, Commonwealth Seniors Health Card status and means.
The highest contribution rates will be for everyday living services, such as domestic assistance or gardening, which according to the indicative pricing for services released on 24 March, will see older people charged between $83 and $109 per hour for general house cleaning or accompanied shopping. The consumer contribution will range from 17.5 per cent for full pensioners to 80 per cent for self-funded retirees.
This new contribution structure being ushered in with the SaH program has some providers concerned, believing it will disincentivise older people entering from using non-clinical services – namely services like domestic assistance – despite their proven importance in preventing older people from having to enter residential care or hospital prematurely.
Some stakeholders feel more strongly about this than others, with Mark Sheldon-Stemm – who is chief executive officer of West Australian provider ValleyView and principal at aged care consultancy Research Analytics – telling Australian Ageing Agenda that he views the SaH program as the “best system for putting people into residential care.”
“Because people won’t receive a service, they’ll end up in hospital, so instead of keeping them at home, the SaH will actually in fact drive them into hospitals and into residential care instead of keeping them at home,” he explained to AAA.
Mr Sheldon-Stemm also emphasised that his modelling showed that clinical care made up less than 5 per cent of the total services, with personal care, assisted daily living, shopping and social support making up the other 95 per cent of services.
“The Department [of Health and Aged Care] knows that, they’ve got the numbers, they can see how it works,” he said. “What they’re trying to do is drive people away from those services and make them pay for it themselves.”
The need to pay for everyday living services – which might be $40 to $60 a week for full pensioners and more than four times that for self-funded retirees not eligible for a Commonwealth Seniors Health Card – means more older people will fail to seek out critical supprot as a way to avoid further financial loss, explained Mr Sheldon-Stemm.
“At the end of the day, money talks and these people don’t have the money,” he said.
Whiddon chief executive officer Chris Mamarelis agreed that non-clinical services are likely to be the first thing clients will avoid upon entering the SaH program.
“When we have increases and changes to pricing that are asking consumers to pay more, it’s obviously going to have an impact and see more people shift to the area that’s more highly subsidised, and in this case, we’re going to see more favourable pricing and subsidisation strategies focusing on care – and we’re really supportive of that, we need to do more in terms of supporting care at home and that’s positive, but it shouldn’t be at the expense of domestic assistance,” he said
“What we’re seeing is that policy makers just see domestic assistance as a very black and white service, where it only involves tasks and cleaning and providing domestic services… it’s a much richer service, and it’s much more multi-dimensional and far more important. Without undermining the need to provide domestic services, it’s far more important than just providing domestic services alone,” he told AAA.
“Specifically, what that means is that there are very important relationships formed between clients and our carers going out to people’s homes.”
Mr Mamarelis said that from his own practical experience and his experience as a chief executive officer, he has no doubt that day-to-day home care services like domestic assistance is keeping people out of residential aged care, keeping them out of hospitals, and assisting the government with their policy of keeping people in the home longer.
“I think it’s extremely important that we review the funding, that we review the policy going forward to ensure that we’re not disincentivising domestic assistance and recognise it for what it really is – which is providing care, providing these domestic services in the home, but also supporting wellbeing and these vital social connections,” he added.
Mr Mamarelis did however recognise some positives in the SaH program, including better funding and support for complex care and the ability for people to receive palliative at home.
On the other hand, StewartBrown partner David Sinclair said he thinks it unlikely the new SaH contributions will deter people from accessing domestic assistance, pointing out that the prices the department released on 24 March were the median prices currently offered – according to survey participants.
Mr Sinclair also told AAA that he disagrees with the belief the new pricing structure is too reliant on self-funded retirees, instead looking at it as an opportunity to bring them into the fold and as simply representing a more traditional service model.
“It’ll be providers providing services and they’ll have a price for a service – which is like any other sector or industry or whatever you want to call it – whereas at the moment, it was a unique situation where consumers were being charged for administration as a separate service and so forth. So I think there’s an opportunity for the sector to align itself with a more traditional service delivery model,” he told AAA.
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Thanks to Mark and Chris for bringing some home some truths about the S@H program. Home care providers have been literally canvassing the department at every opportunity to make them aware of the consequences of the S@H pricing scheme. Having been a care worker, case manager, and director of care – we can see the consequences that more older people will fail to seek out critical supports such as personal care – (a persons basic human right to have assistance to be able to shower every other day) as a way to avoid further financial loss, this in turn will drive older persons into hospital and residential care.
Totally correct. It seems the new system is aimed at discouraging people from using services, in a misguided attempt to save money.
The contrast with the NDIS, particularly for people with disabilities is appalling. The NDIS has no means test, and no fees or contributions, because it is realised that they would prevent participants from using crucial services.
In the new system, most will simply not be able to afford the everyday living services, with the disastrous consequences pointed out by the providers.
The amounts demanded are beyond the means of the frail elders who need them – they are unlikely to be enjoying highly paid employment and notoriously their incomes are very low.
Now is the time to fix it before endless misery is inflicted on people who are already struggling.