Less than 60 per cent of the 25,700 new clients approved for home care last financial year took up their care package within three months, a new report has found, raising fresh concerns about extended waiting lists for community care services.
According to the Productivity Commission report released this week only 7.9 per cent of clients began receiving their home care package within a week of an ACAT assessment and 30 per cent within a month.
Significantly, 14 per cent of assessed clients had not received a care package within nine months of an ACAT approval, the report found. Concerns over the timeliness of care were also greater for level 3 and 4 packages.
The performance of the states varied, with Tasmania having the highest number of clients waiting to receive a package after nine months and South Australia the lowest.
The median elapsed time between an ACAT approval and taking up a package has also worsened over time, jumping from 39 days in 2006-07 to 52 days in 2012-13.
While the reasons for the lengthy delays are not recorded in the data, significant unmet demand for packaged care has been a long-standing concern within the sector.
In 2012, the former Department of Health and Ageing estimated unmet demand to be between 30,000 – 50,000 packages.
While the Federal Government is increasing the number of home care packages from around 66,000 to 100,000 places by 2017 as part of the aged care reforms, stakeholders have called for the Federal Government to abandon the rationing of places and move to an entitlement system.
Industry and consumer peak bodies say that an insufficient supply of home care packages places additional pressure on hospitals and informal carers, and contributes to system inefficiencies.
A Queensland study published last year in the Australasian Journal on Ageing reported cases of home care clients waiting more than 12 months to receive a home care package after they were first approved for care.
As Australian Ageing Agenda reported at the time, the research by Dr Paul Goldstraw from The Townsville Hospital and the Aged Care Assessment Team at Townsville Health Service District, said that in the absence of an available package that matched their assessed need, clients were being provided with a lower level service as a stopgap.
Residential care
In the latest report, the Productivity Commission also reported on significant delayed entry within residential aged care sector.
Nationally, 19 per cent of high care residents were admitted into a facility within a week of an ACAT approval, 47 per cent within a month and 69 per cent within three months.
However, 15 per cent of high care residents did not access a bed within nine months of being assessed, despite having a recommendation for high care.
The report said that multiple factors could explain the elapsed time and the measure did not indicate consumer wait times.
It is not clear from the data what proportion of older people were genuinely waiting for an available bed and those who did not move into care due to personal choice or changed circumstances.
The data did not capture the number of care placements rejected by consumers and why, or the influence of alternative services or variations in care fees on consumer decisions.
Dana Sawyer, director of Millennium Aged Care Placement Consultants told AAA that delays, especially in accessing home care packages, was a significant issue facing consumers. However, the length of the waiting periods was variable between jurisdictions.
She said residential aged care clients assessed as requiring high care sometimes had to consider relocating to a new area away from family or a short-term care option in order to access timely care services.
“Very rarely if someone needs high care can they go home to access the services they require. They will need to keep looking until they find a high care bed or short-term option because of the urgency of the situation,” she said.
Mismatched services
Rachel Lane, principal of Aged Care Gurus, said a mismatch between demand and supply in particular regions was a significant issue, with some areas having too few care packages and others too many.
“In some locations I’ve heard reports of up to 120 applications for one home care package and in other states providers have the home care packages allocated but they can’t find the clients to deliver the care services to. Clearly, the distribution of packages is not going where the care is needed and that’s a big problem,” Ms Lane told AAA.
She said some consumers could also be choosing to opt out of the aged care system altogether in favour of informal care and the cost of services may also be an influencing factor as to why an approval for a service was not taken up immediately. She said since the 1 July reforms, higher consumer co-contributions to care have created a bias to home care services over moving into residential care in some cases.
The Productivity Commission report on Government Services said it was investigating improving its data collection to better measure and monitor timely access to aged care services.
There is a long wait for care, but no official waitlist. We found in our CENSUS study that clients approved by ACAT did not realise that they may have to wait, or have any idea how long the wait may be. Further they had their names on lists with different providers, but didn’t know whether some providers had longer/shorter lists. We need myagedcare gateway to hold a centralised waitlist, and for clients to know what the typical wait in their region is.
This study does not capture the true nature of home care, and the reasons for the lengthy waitlist times. Yes, providers have wait lists, and yes, often consumers have to wait to access care. However, a great deal of that wait list is taken by consumers who do not actually want a home care package. They get assessed by ACAT “just in case” and therefore, opt to remain on a wait list for when their needs increase. The same applies for residential, all our home care consumers are approved for residential care, but they’re approved just in case, not because they actually require residential care.
The other issue is the enormous amount of paperwork involved, and the income & assessment applications. Consumers can be often hesitant to take up a package until they know exactly how much their ITF cost will be.
If a consumer is in desperate need of a home care package, we move mountains to make it happen. We don’t just put them on the bottom of a wait list and forget about them for 9 months.
This report needs to be redone and consumers & providers asked why it took so long.
This is one of the great tragedies of community care.
Families are usually dealing with some degree of crisis when the decision is made to enter the aged care system – whether it’s community care in their own home or full residential care in an aged care facility. The current wait times just to get an appointment with the ACAT system varies from region to region and state to state. The availability of the myriad of services and levels also varies in the same way.
When families face the challenging decision about their elderly relatives needing whatever amount of help has been determined, the last thing they want to think about and contemplate is a delay – a wait for an ACAT assessment and then a wait to access whatever service is deemed appropriate for their relative. It’s no wonder people get frustrated when their expectations are that they’ve been assessed and under CDC the money is theirs to spend as they need.
It just doesn’t work that way and anecdotal evidences continues to suggest that the MyAgedCare consultants are still not clarifying this crucial aspect with consumers and their carers and families.
It is good to see solid evidence from quality research backing up the stories we’re all hearing from our clients.
The PC report above did not fully analyse the critical issues. The report indicates that, because only 30% of ACAT assessments for home care are used within a month, then many or all of the other 70% can’t find an available package and are “missing out”. In fact, utilisation rates of home care have never been lower. The 2014 Report on the Operation of the Aged Care Act 1997 from DSS at Table 17 on page 27 shows utilisation rates for all four types of home care. Utilisation in 2013/14 is 88.4%, down from 92.2% in 2009/10. There are vacant Level 2 packages today across the country. There were a lot of empty packages in all states in 2013/14.
Introduction of Income-tested fees has then decimated waiting lists since 1 July 2014 in all capital cities as part-pensioners and self-funded retirees turn their noses up at what has become an overpriced 3.5hrs/wk of assistance. (Prior to the new system beginning, self-funded retirees were in fact over-represented as users of Level 2 packages.)
So, why are there so many persons with ACAT approvals who don’t take up a package? A significant reason is the number who seek an approval now, just in case. Because getting assessed from home can take 10+ weeks in many areas, persons seek the approvals so they can get the package should they need it! And then don’t use it. Or go to residential care. Or pass away. How to fix this? Shorten the turn-around times by doing a one-off “surge” in ACAT staff numbers, region by region. Get out and do every single assessment in a region and then make a promise that anyone who needs an assessment can be guaranteed to get it in 3 working days. So, why then go to the hassle of getting an ACAT “just in case” when you know you can get one when you really need it and it will be the one applicable to your needs then – not getting a Low Care home care ACAT approval now when you will actually commence using home care needing high care ten months hence? This should reduce the ACAT’s workload permanently.
Cheers and I’ll take my soapbox away today. Keep up the good work on the articles that promote discussion like this one and the good comments already listed above.