Support workers key to home care reform success

Improving home support workers’ training and conditions has been the most important step in reforming New Zealand’s community aged care system over the last 12 years.

Without doing that, improvements in home and community services would not have been achieved.

That’s according to Professor Matthew Parsons, Clinical Chair in Gerontology at the University of Auckland and the Waikato District Health Board.

“Without doubt the most important step in all of this is safeguarding the support worker and improving the conditions for the support worker. If you don’t do that, there’s no gain,” Professor Parsons told Australian Ageing Agenda.

Professor Parsons will share the lessons learned from New Zealand’s experience in an upcoming webinar on community aged care reforms hosted by the Australian Association of Gerontology.

He said demonstrated gains New Zealand has achieved included reductions in cost; reductions in staff turnover; qualitative improvements in satisfaction; improvements in health-related quality of life and in the independence level of clients; improvements in the relationship between the contract holder and the contractee; as well as a significant reduction in residential care utilisation across the country.

New Zealand’s reform journey began in 2002 with the government’s Health of Older People Strategy, which included ageing in place as a key element.

“At that time we had internationally a very high rate of institution for older people, which was quite similar to [Australia’s]. There was a very concerted effort across all district health boards to remedy that and to actually start to offer real options for older people to remain living in their homes. The only way of doing that was to improve home and community care services,” Professor Parsons said.

Getting there has involved a series of mainly NGO-driven initiatives to prove efficacy and effectiveness before progressive adoption by the 20 district health boards, he said.

New Zealand’s approach is known as the Restorative Home Support model, which Professor Parsons described as “a cross-system quality-improvement initiative spanning multiple areas.”

“Some of the key messages are the successes and failures of the initiatives over mostly the last 10 to 12 years ranging from lack of adoption, skill sets of staff and increasingly realising that when you start touching smaller mountains of the model, it has spin-offs across the whole system,” he said.

“One of the key findings early on was the lynchpin in all of this – the support worker.”

As a result, he said the model quickly changed to focus on improving the workforce conditions of support workers, which meant implementing a national training program.

“Initially, when we implemented the first trial it quickly became apparent that training was required around promoting independence for the support workers, which was then delivered.”

He said the training was paid for by the NGOs and linked to a support worker’s salary so the more training a worker did, the better their pay.

As other providers came on board with the model, similar training programs were set up followed by a more advanced model. The national training provider then purchased that and developed and implemented it along a qualifications framework, which is now the minimum expectation that every support worker must have, he said.

While training has been paramount, Professor Parsons stressed it was just one of the required elements of workforce development. Others include salary, career progression, travel allowance and travel time, guaranteed hours, support for working in teams supported by clinicians and regular reviews, he said.

Getting funding right

Elsewhere on successes and failures, “changing the funding model to actually support organisations to implement the quality systems that we require” was one of the more significant learnings, he said.

“We use case-mix funding, which can be either tailored to the individual or to bulk funding. That has been progressively adopted across the country over the last six years,” Professor Parsons said.

An individual has an assessment at the beginning of their package and is placed in a group for a particular clinical pathway, which is costed. People are generally split into non-complex or complex. If they are non-complex for example, the assessment is undertaken by the provider and there are funds attached to that, and then they will deliver the services aligned to it, Professor Parsons said.

He said while the New Zealand and Australian systems were very similar, Australia was going down the individualised funding route whereas NZ was unlikely to ever rollout national implementation of such a model.

Individualised funding can be implemented for those who want it, and it is quite common amongst under 65s, but the feedback for over 65s was that it wasn’t as well-received so therefore there hasn’t been a push for it, Professor Parsons said.

“We have pushed the case-mix [model] because we are more interested in clinical pathways, which will then have the quality outcomes attached to it; the key performance indicators attached to it.”

In his presentation, Professor Parsons said he would focus on the contracting and the request for proposal (RFP) processes, which he noted Australian service providers would be going through imminently as services were contracted out under competitive tendering processes.

It will include the key aspects of successful applications from both a responding and a receiving perspective of the tenders; the financial modelling; pathways; and simplicity of language.

Professor Parsons will appear in the AAG webinar, Community Aged Care Reforms in New Zealand and Australia, alongside Lee-Fay Low from the University of Sydney and Carol Bain from the Silver Chain Group. The webinar, which will be facilitated by Professor Gill Lewin, takes place on 19 February.

Australian Ageing Agenda is the media partner of the AAG.