Special report: Home care package levels missing their mark

Community care providers are struggling to fill their Level 1 home care packages while managing waiting lists in the hundreds for their high level packages, an analysis by Community Care Review shows.

Community Care Review’s analysis of HCP occupancy among seven major providers

Community care providers are struggling to fill their Level 1 home care packages while managing waiting lists in the hundreds for their high level packages, an analysis by Community Care Review shows.

Figures supplied to CCR by some of Australia’s leading community care organisations indicate that occupancy rates for Level 1 packages nationally sit at 56 per cent while occupancy for Level 4 packages is at 96 per cent.

These figures broadly align with the last official figures from the Aged Care Financing Authority, which put occupancy at 62 per cent in October 2014.

The seven major community care providers surveyed by CCR operate 410 Level 1 packages between them, representing almost 20 per cent of all packages currently in operation; they operate 2,129 Level 4s representing 15 per cent of operational packages. Collectively the providers service all of Australia except Northern Territory.

Due to the commercial nature of the information, CCR agreed not to identify the organisations that supplied us with their home care package occupancy data.

CCR does not suggest our analysis is comprehensive, but it does lend weight to the increasing and widespread anecdotal reports from providers and peak bodies of under-subscriptions to Level 1 packages and unmet demand for the Level 3 and 4 packages.

Level 1s hard to fill: providers

Several of the community care providers CCR surveyed commented on the difficulties they were experiencing in filling their Level 1 packages.

“The take up of Level 1 and Level 2 packages varies considerably,” one provider said, while another commented:

“Level 1 packages are hard to fill irrespective of the region due to the limited amount of services/funding available with them.”

The cause of the poor uptake most frequently cited by providers was a perception among consumers that Level 1s did not provide value for money, especially for those paying a co-contribution known as an income-tested care fee.

One executive told CCR:

“Part pensioners and self-funded retirees are not accepting low level packages when they learn the outcome of their income test assessment from Centrelink – they are finding alternative care, like remaining in the HACC sector or paying private fee for service.”

Another organisation said it was its experience that some Aged Care Assessment Teams (ACATs) did not see the value of the Level 1 packages or how they differed from Home and Community Care (HACC), meaning that clients might not be approved for the lower level packages. They said:

“We are hearing anecdotally that some providers and ACATs are encouraging clients to stay within the HACC program, where the fees are lower – for now – and clients are exempt from income testing.”

The provider pointed out that the average HACC client expenditure was between $1,000 and $3,000 per year, while a Level 1 package was funded at $7,600 per year. Further, a package allowed the consumer to customise their service offerings from the one provider, with a greater amount of flexibility and choice. If a HACC service type was unavailable in a region, the consumer missed out, they added.

More Level 3 and 4 packages needed

While services are reporting vacant Level 1 packages, there is a consistent message around unmet demand – and excessive waiting lists in some cases – for the high level packages.

One provider told CCR:

“The bottom line is that there needs to be a lot more funding for Level 3 and 4 packages if we are to keep people at home and out of nursing homes.”

Another organisation said it had “large waiting lists, more than 500 people, for Level 3 and Level 4 packages where we have full occupancy” while another major provider told CCR it had a wait list of 3,071 people for its Level 3 and 4 packages.

Apparent disparities in allocations

Based on the experiences being reported by providers, as well as CCR’s analysis of their occupancy rates and a review of recent Aged Care Approval Round data, the allocation of the various levels of packages appears increasingly problematic.

As one provider observed:

“Current package allocation is based on aged care planning ratios as well as evidence of local need; the current ratio is determined by number of people aged 70 plus in an aged care planning region as per ABS population  statistics. This may need to be revised when it comes to Level 3 and 4 packages as the average age of care recipients is 80 plus.”

Level 4 packages were not awarded in a number of ACAR planning regions in the 2014 round, despite the sector expressing the local demand for packages and current waitlists, the provider noted.

Indeed a review of last year’s ACAR data shows that a total of 951 Level 1 packages were released nationally – compared to just 1,007 Level 4 packages.

Lobbying for changes to levels

The push for changes to the current package levels is intensifying, with growing pressure coming from sector stakeholders – particularly aged and community care provider peak bodies and consumer representatives.

Ian Yates, the chief executive of Council on the Ageing (COTA) Australia told CCR that the Commonwealth Government  should review Level 1 packages and possibly redirect the funding to Levels 3 and 4.

“We’re hearing all the time about significant waiting lists for Level 3 and 4 and clearly that is where the need is out there in the community. Even when the Commonwealth Home Support Program (CHSP) fees come in, we don’t think there will be huge demand for Level 1 packages,” Mr Yates said.

“That’s partly because we are not convinced that the charging structure for the lower level packages is right anyway. Why should you pay 17.5 per cent of your pension [towards a basic daily fee] for a Level 1 package when that is the maximum you pay for a Level 4 package on a non-means tested basis?”

Mr Yates said there needed to be “adjustments” made to the system and COTA was making those representations to the Assistant Minister for Social Services Mitch Fifield on an ongoing basis.

Similarly, a group of 20 aged and community care CEOs raised the issue directly with politicians and MPs in Canberra in March.

The campaign, organised by Aged and Community Services Australia (ACSA), met with 50 politicians from all sides of politics to highlight the vacancies in the Level 1 packages and reported unmet demand for Level 3 and 4 packages.

Chief executive officer of ACSA Adjunct Professor John Kelly said his peak body had been “insistent and consistent” with reporting the issue as it required urgent attention. He said:

“The way the means testing is working out, with the co-contribution, people are voting with their feet and we’re seeing vacancies in Levels 1 and 2. Our concern is that if they don’t receive the care they need they might end up in acute care at $1,500 a day. So there are some real consequences that need to be examined.”

Dr Kelly said that while the government had not shown the peak body its latest data on the uptake of packages, ACSA members nationally were reporting vacancies in Level 1 and 2 packages.

Elsewhere Sue Macri, the former associate commissioner on the Productivity Commission’s 2011 inquiry into aged care, upon which the current community care reforms were based, has questioned why the Level 1 packages were introduced.

She said the PC recommended a new service to fill the gap between the then Community Aged Care Packages and Extended Aged Care at Home program, but the Labor Government “for some unknown reason” additionally introduced the Level 1 packages.

Ms Macri said the Department of Social Services should review the utilisation of the lower level packages as a priority.

To subscribe to CCR please visit https://www.australianageingagenda.com.au/subscribe-to-ccr/

Tags: acar, acat, acfa, acsa, community-care-review-slider, cota, home-care-packages, ian-yates, john-kelly, sue-macri,

4 thoughts on “Special report: Home care package levels missing their mark

  1. I absolutely concur with the need for more 3-4 packages. Having waited almost two months for a level 2 package, during which time my mother was again hospitalised for chronic fluid build up in lung and legs, her physical condition is markedly depleted since her original ACAT assessment. I was told, when attempting to have her re-assessed, that as long as she could manage her own medication and shower herself ( her family believe that balancing on her four wheeled walker, putting the brakes on, leaning from this to the bar in the shower and then falling onto the shower chair is dangerous and only a matter of time before she comes to grief). She has had six falls, two in recent weeks. She needs a bed aid to raise herself and get up and is currently on strong diuretics twice daily meaning she must get up all through the night urinating roughly hourly. She currently has post hospital acute chair with a nurse coming alternate days to check her fluid retention, weigh her, check her pressure sore and check for shortness of breath. I am told by our provider that she is entitled to only 3.5 hours of assistance under her level 2 package but that nursing would chew all that up because of the higher pay rate than domestic assistance. She currently receives just fortnightly community cleaning, totally inadequate for someone who is incontinent and can’t do their own washing. I was most interested to read your findings as I too have been struggling with the concept that my mother must either fall or take that now small backward step to needing help with showering, in order to be able to access the care she needs to stay at home, rather than end up on a far more expensive alternative of full time care in a facilty…something she is desperate to avoid. My mother is 96. Her family are all 1 hrs plus away and still working so it is impossible for us to give her what she needs…. The red tape and misinformation I have endured in trying to simply access her package and get a continence test done so she can have assistance with the costly pants she must wear has been frustrating, Currently she CAN now have the continence test done but not while she is receiving the acute nursing support as this would be ‘double dipping’….mum continues to buy her own very expensive pants using her aged pension. If my mother had received the assistance she needed on coming out of hospital the first time (there were no package available, I believe she would have been able to get back to where she was and return to her weekly gym session etc. Having languished for weeks after huge weight loss and inactivity, she can no longer even lift her own legs into the car when we take her to the doctors. I am sure my mother is one of thousands…and as a baby boomer myself, I am degrading getting old.

  2. Again the govt fails to relises that the more money you put into any govt controlled enity the more people will rip the system off ie medicare doctors ,builder’s , unemployment and now the most vulnerable old aged and health care companies ripping them off with rediculous charges if penalties against these businesses upheld maybe the govt would not be in the debt situation they are

  3. I am a Level 4 package ,and the stress many people,go thru, We have not organised for the comingI of the many people needing the services.,and we have very highly trained staff .so how did we get it all wrong.I.I say thank you to all you are doing.We have to remember we are doing our best and we are are bibs ,and once again ,l? It took me one hour to write these words but I got there ,I bless all of you so I’m doing to have a drink , Pam

  4. Even on level 4 funding 15 hrs a week exercises 2hrs daily none Sunday and a can of thickener a fortnight, there is a short fall in my hubbies budget because of penalty rates for public holidays, the fund only takes 18% management funds hourly rates of $50 gobbles up more than the level 4 pays.

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