The aged care system should be redesigned into four streams with different funding models and simultaneous access, the co-author of the recent national study looking into the needs, costs and classification of residential aged care has told the aged care royal commission.

University of Wollongong’s Australian Health Services Research Institute director Professor Kathy Eagar, who co-authored the 2019 Resource Utilisation and Classification Study report, discussed her previously submitted proposal at The Royal Commission into Aged Care Quality and Safety on Thursday.

She has proposed redesigning the aged care system to include age friendly community services plus home-based primary and secondary level aged care services and out-of-home tertiary level aged care services. The streams are not just commonwealth funding programs and people are not limited to one stream at any given time, Professor Eagar said.

“In my model, a person can be accessing services on each of these streams simultaneously.  So, somebody can be in residential care and still accessing community services or a community transport service with their carer,” Professor Eagar told the inquiry.

The age friendly community services stream does not provide direct care and support, but rather aims to strengthen the community capacity for healthy ageing through block-funded grants, Professor Eagar said.

“It’s someone in that stream… approaching the local fitness centres and saying ‘how about you roll out a program for the over 70s a few times a week?’ And we will, through our assessment service, identify people who could benefit from that. And that could be one of the services we might promote so that everything doesn’t come back to what the Commonwealth has to fund,” she said.

Aged care streams

Professor Eagar said the primary, secondary and tertiary level streams each include an ongoing and episodic care stream.

The ongoing primary aged care services stream includes house cleaning and laundry services, and the episodic primary care stream includes short-term nursing care, such as wound dressing, she said.

The primary aged care stream includes “services that can be accessed directly without going through a formal comprehensive assessment on referral from somewhere like a GP or a hospital discharge planner,” she said.

It would be funded under a price and volume basis, which utilises a list of reasonable and necessary hours of service to guide the hours allocated to each care recipient, Professor Eager said.

The secondary stream is for people living at home with higher level care needs and would be funded using an Australian National Aged Care Classification case mix classification developed from the RUCS project. The ongoing aspect of this stream involves hands on personal care, Professor Eagar said.

“I would put in there, personal health, and… allied nurses to be involved and I would also in the category of episodic care put restorative care enabling programs, centre-based transition programs and the like,” she said.

The inquiry heard that the tertiary aged care service stream is for those who are unable to live at home and it will be based on the RUCS AN-ACC funding model.

The ongoing tertiary care stream would include residential care, cluster housing and community aged care hospice, and the episodic tertiary care stream includes residential respite services and transition care. 

Royal commission to file COVID-19 report  this month

Elsewhere during the hearing, royal commissioner Tony Pagone announced the commission would issue a special report on the COVID-19 pandemic ahead of its final report due on 26 February 2021.

The pandemic report will be delivered to the Governor-General on 30 September and will contain specific recommendations to expedite and facilitate the implementation of its comprehensive measures to protect older Australians, Mr Pagone said.

The hearing continues today until Tuesday 22 September.

View all our royal commission coverage here.

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  1. I agree with the report, but also can’t help feeling that if we looked into 2-3 decades past, it seems clear to me, that the system was much like that, here in Victoria at least. Importantly, the skill of those involved was appropriate.

  2. I did make a submission to the Redesign which certainly looks more broadly across services. However, I’d like to see non-clinical services like counselling added to the list of service options across any level. Short-term, intensive. Skilled and diverse MH professionals including counsellors. An argument against counselling would be that people have access to Medicare rebate services but that is not a justified argument. Short term counselling could allow most people to respond to their crisis and move forward, similar to the way EAP operates.

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