Pressure mounts to review home care supplement

The government’s Dementia and Cognition Supplement aims to support seniors living at home with dementia – but just a third of the expected recipients are getting it, raising questions about barriers to access. Linda Belardi reports.

The take-up of the Dementia and Cognition Supplement in home care continues to track significantly below the government’s estimates and budgeted expenditure, which is prompting calls for a comprehensive review of the initiative and any barriers to claiming.

Figures obtained by Community Care Review show that after two years of operation, just one-third of the home care consumers who the government estimated would need the additional funding have received it, while actual expenditure on the supplement is at 50 per cent of forecasts.

The funding supplement, which provides an additional 10 per cent on top of the basic home care subsidy for all package levels, was designed to recognise the extra costs of dementia care and the fact that people receiving any level of a home care package can have cognitive impairment.

The Living Longer, Living Better reforms, which allocated $123 million over five years to the measure, noted additional assistance for dementia support was only being provided to home care clients at the highest level (EACH-D packages) and the new supplement would make extra funding available to individuals at all four home care package levels.

The LLLB document from April 2012 stated:

“More than half of all aged care recipients have some form of dementia. However, of the 50,656 older Australians who were receiving care through Home Care packages on 30 June 2011, only 2,935, or 5.8 per cent, were eligible for additional funding in recognition of the additional costs of meeting their care needs due to their dementia (those in receipt of Extended Aged at Home – Dementia packages)…”

“A new Dementia Supplement will provide additional assistance to all Home Care package providers, to assist them to deliver more appropriate care to people with dementia.”

The announcement said it expected about 26 per cent of home care recipients would qualify for the higher level of funding.

To fund the majority of the cost of the new supplement, the government reduced the basic subsidy rate for home care packages in August 2013 by 1.5 per cent, which was redirected to the measure.

This means that home care subsidies were reduced on the basis that a significant percentage of home care clients would be captured by the new dementia supplement.

According to data supplied by the Department of Health, 5,390 recipients (full-time equivalent) claimed the supplement in the 2013-14 financial year and 5,941 (FTE) recipients in 2014-15 financial year. Over 83, 000 people accessed a home care package in 2014-2015.

Approximately 65 per cent of providers were claiming the supplement in the first quarter of 2015.

Barriers to take-up

Illana Halliday, CEO of Aged and Community Services NSW & ACT, says the low take-up of the supplement is concerning and the reasons for this should be investigated.

“It’s disappointing to see that the proportion of consumers who were estimated to benefit from this measure haven’t been able to,” Halliday tells Community Care Review.

“The government should determine why this measure is not reaching the increased number of home care packaged consumers with dementia that the policy was intended to support.”

Halliday says there has been a range of feedback from providers about the effectiveness of the assessment tools that are used and the challenges around the availability of registered nurses or medical practitioners to conduct the assessment, especially in rural and remote areas.

“Aged Care Assessment Teams (ACATs) do not routinely use the tools which determine eligibility for the supplement meaning potential consumers have to undergo yet another assessment.”

Under consumer directed care, the costs of carrying out the assessment need to be factored into a person’s individual budget, which may also be acting as a disincentive for consumers, Halliday says.

CCR has been told that a number of consumers are declining to undertake the assessment because of the cost and effort involved, which is seen as outweighing the benefit of the 10 per cent increase in funding.

Feedback from providers also suggests the Psychogeriatric Assessment Scale (PAS) tool may not be appropriate for people with frontal lobe dementia.

The government’s commissioned evaluation of Home Care Packages program completed last year also reported similar concerns regarding barriers to utilising the supplement.

Alzheimer’s Australia agrees the requirement to undergo an additional assessment may be a deterrent for some consumers. Low levels of awareness may also be playing a part, according to the consumer peak.

Deborah Smith, executive manager of policy, programs and research at Alzheimer’s Australia, says a diagnosis of dementia and approval for a home care package should be sufficient to qualify for the supplement.

“The key issue we would like to see addressed is for the supplement to be made available to anyone with a diagnosis of dementia that is eligible for a home care package,” she tells CCR.

“Why add an additional layer of assessment when a person with dementia has both a diagnosis and an assessment as needing home care support? This adds cost, red tape and is an additional burden on both people with dementia and their carers. We need to be removing barriers to accessing care, not creating them, as we try to improve support,” says Smith

Responding to questions from CCR, a spokeswoman for the Department of Health says there is no information to indicate the supplement is not working as intended and estimated uptake “will not always match the uptake rates in practice once a measure is introduced.”

Read an extended version of this article in the February edition of Community Care Review available now.

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