The conditions for radical reform of aged care are now present, NSW Ageing and Disability Commissioner Robert Fiztgerald has told a key aged care  conference.

“The moment is with us, the politics are right,” Mr Fitzgerald told the ACSA National Summit in Canberra on Wednesday.

“There are two ways public policy occurs. Either because there are bright, intelligent people capable of leading that reform, the second is crisis.

 “You’ve got all the elements, you’ve got all the evidence, you’ve got the insights of royal commissions and other inquiries. You’ve got your own intelligence. We’ve been through a pandemic, which has focused these issues, and the politics are right.

“So if I’m any strategist at all, your moment has come.”

Commissioner Fitzgerald said the two biggest barriers to meaningful reform included workforce issues and financing.

“Those issues remain exceptionally perplexing, and those two issues are really, really significant,” he said.

Learn from the NDIS

Commissioner Fitzgerald said in designing the new Care at Home System it was important to learn from the failures of the NDIS model, which was based on providing blocks of service for a fee.

Robert Fitzgerald

“One of the tragedies of the NDIS is that it’s transactional,” he said.

“You need to create a system that is relational, not transactional. If we don’t the home care system will fail, it will be flawed like the NDIS.

“It is incomplete if we simply have a model that has turned every aspect of a person’s life into two hour blocks for which there is a particular fee.”

The provider market

There should be a range of providers under the new system, Commissioner Fitzgerald said – including for-profit, not for profit, mutual and government.

“This notion that we can simply open up a market, and let it rip, has been shown to be fundamentally flawed, and governments need to reassess in the light of overwhelming evidence that that does not deliver for the wellbeing of the group as a whole,” he said.

“If we want a quality system in which the values and the incentives that operate within the system are aligned, you need that mixture.”

However the market-based approach would not work for some people and shouldn’t be required in all cases, including First Nation’s people, older people experiencing homelessness and mental illness, and thin markets.

Common funding approach

Commissioner Fitzgerald acknowledged the push from the Support at Home Alliance for a common funding approach across residential and home care.

He said he supported this in some areas but would be concerned if social support, including respite, equipment, community transport and general care, were included.

“There is actually no reason to put them in at this point in time,” he said.

“It will over complicate the system. My advice is you do not have to put everything into the marketised model to start with. Learn the lesson of NDIS.”

This story originally appeared on Community Care Review

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3 Comments

  1. My concern about the aged care sector is that it excludes conversations with some groups of people e.g. counsellors and their peaks who could be important to supporting the mental health of older people.
    The marketisation of disability care is flawed, from my perspective, where it’s allowed unregistered providers to charge the maximum fee from the price guide. There’s not enough incentive to be a registered NDIS provider (other than access to NDIA managed clients) but I constantly argue for registration as it affords some protection to those most vulnerable.
    My hope is that there’s a similar price guide but that sole traders (currently excluded) are deemed registered professionals and afforded some recognition in the aged care space without multiple registration costs. We need a system that’s flexible and offers a mix of quality options.

  2. “You need to create a system that is relational, not transactional”. Says it all. This is actually how HCP and HACC used to be before the Federal Governemtn messed with it. It was all based on relationships & support via engagement(with people, not a funding balance). Even the language of the new model is heralding little change-“services” rather than “support”.
    The sad part is so many good, well skilled, committed workers from all levels have been driven out of the sector.

  3. “, Learn the lesson of NDIS” just about says all that’s needed. Absolutely flawed in outcomes and horrendously expensive. Another government flawed plan that doesn’t deliver and completely unsustainable! So what will the government and the would be do gooders do about it? Throw more good money after bad I’d reckon.
    Pathetic.

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