Vale HACC, 1984-2014

With legislation to repeal the Home and Community Care Act before Parliament, it is worth recalling the impact of the HACC program, and raising some issues concerning the development of the replacement scheme – the Home Support Program, writes Dr Anna Howe.

The Home and Community Care Act 1985 will be repealed with the passing of the Omnibus Repeal Day (Spring 2014) Bill 2014 introduced into Parliament on 22 October. HACC will disappear 40 years after it got underway with funding allocated in the 1984-85 budget. The passing of the HACC Act in 1985 was followed by funding increases of more than 20 per cent per year for three years, and the joint HACC Agreements committed to annual increases of 20 per cent for a further three years from 1988.

In late 1988, the first, and only, HACC Triennial Review made the notable observation that: “In a time of restraint in government spending this outcome reflects the priority which governments have given to HACC.” That review also reported growth in client numbers more than commensurate with funding increases. HACC data collections in late 1988 and early 1989 estimated some 172,000 clients aged 65 and over and another 43,000 younger clients received one or more services in an average month.

Fast forward to today.

The world of community care, and aged care overall, has changed in many ways. Some 468,000 older people received HACC services in 2012-13, and close to 50,000 received packages, just on one in every six of Australia’s 3.3 million seniors. In total, this is a three-fold increase since the late 1980s.

But funding is hardly keeping pace, and rather than standing as a high priority in the face of the impending growth of the older population, the reforms set out in Living Longer, Living Better in April 2012 are progressing very slowly. The Commonwealth took over responsibility for HACC in all states except Victoria and Western Australia in 2009, but it will be fully six years before the Home Support Program takes effect from July 2015. And this snail’s pace development is hardly leaving a trail of silver behind it.

The HSP Advisory Group and its seven sub-groups are delving into the minutiae of every type of HACC service. Thousands of pages of reports have been produced, but rather than resolving problems, contradictions are growing, especially in the relationship between HSP and packages. The Productivity Commission recommended an integrated system of continuous funding in line with clients’ assessed needs, yet the new packages are being implemented with four rigid funding levels.

It is a paradox indeed that HACC provided continuous funding, from many clients receiving limited funding to much smaller numbers receiving package equivalent funding. HSP proposes consigning all HACC clients to an as yet undefined ‘basic’ level of care, but receipt of limited funding does not necessarily mean low care needs, especially when carer roles are recognised.  For example, regular podiatry for a diabetic client is essential and skilled care. Add in nursing and personal care for such a client who lives alone, and some social support, and funding rapidly reaches package level. If just 10 per cent of existing HACC clients are at this level, close to 50,000 extra packages would be needed, right now. Yet an increase of only some 85,000 packages by 2021-22 was projected in Living Longer, Living Better. Rather than waiting for a slow process of ‘transitioning’ these clients out of HSP, the better alternative would be an immediate integration of packages into HSP with continuous funding as per HACC, with more systematic assessment and pricing of services.

Another paradox is the contrast between the rigid levels of package funding and the individualised funding being introduced in the National Disability Insurance Scheme. Funding for NDIS clients will be determined by the cost of required services, based on assessed needs, whereas the package funding will give some too much and others too little, without any of the margins for averaging individual costs within funding bands that a proper case mix system allows.

The transfer of care and support of younger people with disabilities to the NDIS is the last step on a long and winding path of separating disability and aged care in Australia. Right at the point when residential care for the two groups was separated in 1985, clients of disability programs delivered by the states, some cost shared with the Commonwealth, were brought into the HACC target population. A reportedly hasty decision to get the states on side and HACC off the ground, it created a cause for continuing debate.

The origins of the NDIS lie in the inquiry into a national compensation scheme commissioned by the Whitlam Government and led by New Zealander Justice Owen Woodhouse. The Bill that arose from that report passed the House of Representatives in late 1975 and was fatefully before the Senate on 11 November, 1975. It was 33 years before the idea of a social insurance scheme for disability care resurfaced with the setting up of the Disability Investment Group in April 2008, by Bill Shorten, then Assistant Treasurer and former Parliamentary Secretary for Disabilities and Children’s Services in the Rudd Government.

While the House of Representatives Inquiry into Accommodation and Home Care for the Aged, and its report known as the McLeay Report, provided the policy foundation for the development of HACC by the incoming Labor Government after the 1983 election, HACC’s true origins similarly lie in 1975. The Care of the Aged Report of the Social Welfare Commission recommended “The Australian Government should assume the overall direction of, and substantial financial responsibility for, implementing a Community Care Program.” Care of the aged, and especially the expansion of community care, remained unfinished business of the Whitlam Government, but as HACC took shape from the 1984-5 budget, it realised most of the objectives of the  Community Care Program spelled out in 1975.

The HACC Act may be repealed, but the lasting impact the program had on the lives of countless Australians will not be forgotten. With the ranks of community care vastly larger and much better organised than they were 40 years ago, the future of community care is in strong hands.

Dr Anna Howe is a noted gerontologist who has extensively researched the community aged care sector.