Aged care chief challenges CDC ‘wisdom’
The head of ECH, a large community aged care provider in South Australia, has delivered a damning critique of the pursuit of consumer-driven, market-based models in aged care.
The head of ECH, a large community aged care provider in South Australia, has delivered a damning critique of the pursuit of consumer-driven, market-based models in aged care.
Speaking at the Aged and Community Services Australia (ACSA) national summit on Wednesday afternoon, David Panter said there was limited evidence to show that consumer-directed care approaches delivered better outcomes for older people.
While Mr Panter said he supported giving clients choice, he remained unconvinced CDC delivered this to consumers.
He said the vast majority of older people were “poor shoppers” who did not have the knowledge or capacity to navigate the home care market and nominate a preferred provider.
“The majority of consumers have no idea how to evaluate what is a good offer or bad offer or what it is they are looking for,” he told the Cairns audience.
Poor digital access, the absence of advocates and a lack of easy-to-understand and comparable information acted as significant barriers to older people exercising greater choice and control.
He said it was critical for Australia to closely evaluate the outcomes of CDC for older people and learn the lessons from the international experience of market-based care systems.
Case management, which has been undervalued in the NDIS, also needed to be protected in a CDC environment, he said.
“There is a great danger within the CDC model for aged care services that we will see the erosion of the care management element and reduced funding for this service.”
Increasing Choice in Home Care changes
Reflecting on the implementation of the February home care reforms, Mr Panter said a key issue to emerge was the increased pressure on the Commonwealth Home Support Program while consumers waited on the new national queue for a home care package.
“We have seen a dramatic increase in the number of people who have been approved for a package in the queue but are being diverted into CHSP services,” said Mr Panter, who is a former health executive both in South Australia and the UK.
A number of clients were being supported with six to eight CHSP services a week as an interim measure, which meant people requiring low-level home support were missing out, he said.
As Community Care Review reported, industry peak body Leading Age Services Australia also recently raised this issue with the Federal Government as part of its home care issues paper. (Read that story here)
Further investing in home care
Mr Panter told the conference the Federal Government must deliver on its rhetoric to reorient the system in favour of home-based care.
Despite the government’s talk of a shift to supporting people at home, new residential places still dominated the aged care provision ratio, he said.
The government’s existing target ratio, set under the Living Longer Living Better reforms, will fund 78 residential places and 45 home care packages per 1,000 people over 70 by June 2022.
“We need to look at a different set of incentives for how the system operates. If our intention is to enable more people to stay at home, then we need to seriously address that imbalance between the resourcing that goes into home care compared with residential care.”
Appropriate community care must also ensure access to home-based palliative care services, he said. ECH is currently undertaking a research project to determine the cost of delivering palliative care in the home, with early indications suggesting it is between the subsidy for a Level 4 home care package and the annual cost of residential care, said Mr Panter.
Elsewhere during the session, conference delegates also raised the distress caused to clients over the incorrect issuing of package withdrawal letters under the new system.
I think Mr Panter may be right. There needs to be more assistance for people receiving funds so that they get the most appropriate and needed services.
The industry has told the government since the first day this was proposed that it wouldn’t work. However, with the new private companies who are will to meet the CDC outcomes it working and very well, its only with those companies used to the old ways and funding that are very slow to change and probably wont end up changing. Perhaps the issue is the unwillingness of older companies to change with the times.
There is now a backlog of processing at the dept of those who have taken up a HCP with their chosen their provider. Every single person is now receiving a letter from the department incorrectly advising them that their package has been withdrawn. Causing uncertainty and distress for frail vulnerable older people and their families. Not to mention service providers left with having to explain the error. I AM BEGGING THE DEPT TO STOP SENDING OUT WITHDRAWAL LETTERS UNTIL THIS IS SORTED!
I think Mr Panter has highlighted some of the main issues, My aged care is really a good
approach, but some important steps should be done before going ahead with the project:
-preparing lists with all clients who have priorities
Preparing lists with expected number to apply according to the
statistics of every local council Clients over ( 65 )
– for example we have clients who are over 93 years old who are told the waiting list is
6 months – 12 months
While HCPs are a good option, I do agree that the wait and CDC doesn’t necessarily work for some people at the intersections e.g. critical health issues, no family or friend networks, public housing, mental illness, addiction, etc. How does one deliver a CDC approach to a person with serious mental health issues and long term addiction? How can the market ever respond to someone living in squalor when their single most important service is getting to a specific service that makes their week?
The experience in a HCP environment has brought to light for me the seriousness of some older adults living in home where support (without the push for goals or CDC) is critical. It is time that different voices are heard in relation to CDC. Ask – you’ll get a diversity of answers from people willing to make the system better and who are vested in care because it impacts on their future and that of others.