Time for a rethink

“Awful” and “unimaginative” were adjectives used at an industry conference to describe the federal government’s proposed new model of home care – Support at Home.

Appearing on a panel discussing the future of home care in Australia at the National Home Care Conference 2024 in Melbourne late May, Professor Kathy Eagar – from the School of Clinical Medicine at UNSW – told delegates: “The best part of Support at Home is that it’s been delayed. I think it is an awful program and I think it is fantastic that [the Commonwealth Home Support Program] has been put off until 2027.”

Professor Eagar was referring to the planned amalgamation of the existing Home Care Packages program, the Short-Term Restorative Care program and the CHSP, which was due to launch as a single entity from 1 July 2025.

However, in November last year, the government announced that CHSP – by far the largest component of home care – will be included in the new Support at Home program “no earlier than 1 July 2027”.

“I have listened to CHSP providers who have advocated for more time to prepare for reforms to ensure they can transition their operations and clients smoothly,” said Minister for Aged Care Anika Wells at the time.

The reality lurking between the lines of Ms Wells’ statement is that providers and other stakeholders strongly lobbied the Albanese government for an implementation delay due to an ongoing lack of detail of exactly what the Support at Home program would embody.

A point picked up by Professor Eagar, who told the 300 delegates seated in the Marvel Stadium, and the 200 others viewing online, that the government expected the sector to “sit back and wait passively to see what the model looks like.”

Professor Eagar said, ultimately, she didn’t believe the sector should be planning for transition of the home care system at all. “Because I don’t think the case has been made for transition.”

Model lacks social contact

Also on the panel, Professor Michael Fine – honorary professor, Department of Sociology at Macquarie University. While pleased that “at least something is being done” to reform the home care sector, Professor Fine said: “But I would feel rather sad if we didn’t take the opportunity to rethink what we’re doing quite considerably.”

The existing model, he added, “is very unimaginative. It doesn’t really deliver us an interesting new-age home support system in the way that we might expect looking at overseas models for example.”

The model proposed fails to bring people together and provide social contact, said Professor Fine. “The whole idea of individualised funding and the individualisation of care under the home care program has meant that you can end up being at home, dying at home, and having seen no-one but your care staff in the last six months or year or two of your life – that’s a real quality gap.”

We should not accept that the only way to empower an older person is to give them a commercial package

Professor Kathy Eagar

Professor Eagar added that the majority of older people – given the choice – “want relationship-based care and not transaction-based care.”

She told delegates that Australia’s aged care industry is still based “on John Howard neo-liberal concepts”.

The sector, said Professor Eagar, “hasn’t actually recognised that the way to best support older people in the community is through community models and not through a private competitive market … People want to live in a community; they don’t want to live in a market.”

She added: “We should not accept that the only way to empower an older person is to give them a commercial package. People want choice but they also want engagement … It’s about the experience people have of the person who comes into their house rather than how the care is paid for.”

Key elements of a good system

When thinking of what a good aged care system encompasses, Professor Eagar – who led the design of the Australian National Aged Care Classification funding model for residential aged care and undertook research commissioned by the aged care royal commission – said it comprises of three elements.

“One is easy to access and very low cost. Also, support in the community and at home – not just at home. The second is easy access to community nursing when we need it. And the third is integrated support for carers and treating consumers and carers as a dyad, rather than two different gateways and two different Commonwealth programs.”

Professor Fine agreed. He told delegates the sector needs to think about how the varying prongs of support can be integrated.

“Integrated does not mean that they become the same,” he said. “We need to think of an integration that is inclusive integration, not placed on program boundaries that are rigid and exclusive.”

Riffing on Professor Fine’s point, Professor Eagar said the sector really needs to consider what integration is. “Integration isn’t that the Commonwealth has one tidy program. Integration is what happens on the ground. It’s how a person experiences the care system. We have to focus and remember that integration is local – it’s not what happens in Canberra.”

Joining Professor Eagar and Professor Fine for the 30-minute discussion – entitled The changing face of home care – was director of StepUp for Ageing Research at the University of Sydney Professor Yun-Hee Jeon.

Asked by conference host and aged care consultant Paul Sadler what she likes most about the Support at Home model of care, Professor Jeon replied: “I’m pleased to see that there is more emphasis on the importance of clinical care.”

She added: “But I’m also pleased that the government is taking some more time to consider other options.”

Whatever the option, Professor Jeon – a registered nurse – told delegates there needs to be a speeding up of the assessment process.

“The really important thing is that with any care – I don’t really care what model we end up with – timely service makes a huge difference,” she said. “We can’t have people having an assessment by one group of people, waiting for several months to get someone else to come and then provide the service another time.”

People are dying while waiting for community care, Professor Jeon told delegates. “The most crucial part is timely support and assessment by a healthcare professional who can plan the care with the person – that is the key point that we need to remind ourselves of,” she said.

Pointing to the many studies conducted by Professor Jeon and her team over the past two decades or more, Professor Eagar said the extensive research – which focuses on developing innovative and creative approaches to improving the health and wellbeing of older people – shows that: “When you combine what is currently CHSP with more rapid easier access and periodic community nursing as required – and put it head-to-head against what is proposed for Support at Home – it is a no-brainer. CHSP plus community nursing plus support for carers, and easy access to primary care, offers demonstrably better outcomes and is substantially cheaper.”

“There is,” Professor Eagar told delegates, “literally no evidence for Support at Home. The current design of Support at Home, she added, “is essentially all of the worst features of the [National Disability Insurance Scheme] … but with co-payments and very substantially capped budgets – which makes it substantially worse.”

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