More nuanced and tailored fee structure needed

Consumer contributions must increase for home care but eyes need to be firmly fixed on the program’s key objectives, writes Sandra Hills.

The recommendations from the recent Aged Care Taskforce report, along with the establishment of the new Support at Home program, provide the government and the sector with a fantastic opportunity to set up a fit-for-purpose program.

A program that embraces the first taskforce aged care funding principle: “the aged care system should support older people to live at home for as long as they wish and can do so safely.”  However, this transition is not for the faint-hearted as there are many challenges to overcome.

The dilemma to be solved as I see it is we have an ever increasing need for home care – evidenced by a growing waiting list, a low consumer contribution rate of around 2-3 per cent of total cost, and a growing bucket of unspent funds (currently $3.7 billion).

At the same time, we have increasing frailty and care needs of older people, a reluctance to enter residential care, a supply issue with labour, lack of long-term planning by older people and their families, and finally, inadequate funding allocated and spent on services – including wellness and reablement.

Cam Ansell – of Ansell Strategic – rightly raises a potential impact if consumers are disincentivised to participate in Support at Home services such as reablement due to costs being passed onto consumers. Mr Ansell points out this could come at a risk to the health and safety of the consumer and the unpaid carer. He also identifies the unintended consequences of increasing pressure on the wider acute and aged care sectors.

Sandra Hills

So what does the taskforce report say? It talks about establishing a fee-for-service model for Support at Home where participants pay a co-contribution for services received, based on the type of service accessed. We are already aware of the two identified service categories: short-term support – assistive technology, palliative care, restorative care – and ongoing services.

What is new from the taskforce report is the proposal that home care packages be classified into three service lists with different co-contributions allocated to each:

  • clinical supports – where government contributions would be highest and, if fully funded by government, no co-contribution
  • independence – such as personal care and part contribution by consumer
  • everyday living – for example, house cleaning, where consumer contributions would be higher.

If we return to funding principle number one and considering the issues raised by Ansell Strategic, it’s important for us to think about how we implement the changes in a way that provides a better experience for consumers.

It is acknowledged that the current cohort of older people and how they manage their health will be different from those ageing over the next decade and beyond, for example, the level of health literacy, use of assistive technology, and actively managing health conditions.

The development of a reablement and conditioning plan that gives older people the best chance to remain in their home safely should be central to the Support at Home program. Plans should outline goals and how they will be measured. These plans could be separate or incorporated into current care plans.

Transitioning to a new funding regime should be carefully thought through. Rather than solely focusing on perceived disincentives, such as an increase in what consumers pay, there could also be a focus on providing incentives for health and wellbeing goals obtained.

The government has a significant opportunity to redesign, promote and incentivise part of Support at Home. Capping the amount a customer can have as a balance would increase the number of customers receiving care packages, improving equity and access. Providers should be allowed to keep a small amount of pooled funds for customers who have additional needs.

Policy makers for some time have discussed the introduction of increasing the level of packages to cater for those with higher needs. Taking into account safety and wellbeing, if we are increasing funding levels in some packages to match frailty, it is crucial for assisted technology to be a compulsory part of a Level 5 package and above (at a cost of approximately $5,000 per year).

We have a unique opportunity to introduce a more nuanced and tailored fee structure

It is clear that the financial contributions made by those accessing Support at Home need to increase but it needs to be implemented with a central focus on the key purpose of the program.

As the needs and expectations of older people change, we have a unique opportunity to introduce a more nuanced and tailored fee structure that focuses on who pays, how much and for what services.

The core principles of equity and access for all Australians should always be at the forefront of decision-making and system design to ensure we appropriately address any potential unintended consequences fairly.

It’s essential that we take a considered and collaborative approach, and adopt a temperate pace, to implement a new fee and services structure that can sustainably support older Australians in the long term.

Sandra Hills is chief executive officer at Benetas

Comment on the story below. Do you have an opinion to share about an issue or something topical in the aged care sector? Get in touch at editorial@australianageingagenda.com.au

Tags: sandra hills, Support at Home, user-pays,

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