Australia’s home care providers have had their last say on the aged care royal commission before the final report is handed down on Friday.

Here’s a look at their hopes and fears for the future of their industry, based on their submissions on the recommendations of counsel assisting.

Thumbs down for silos, thumbs up for reablement

Feros Care warns against proposals to create separate support categories for respite, social support and assistive technology, saying  siloed approaches don’t work.

“The siloed approach to funding buckets in the NDIS and the CHSP has proven problematic and should not be replicated within the new aged care program moving forward,” the provider says.

Rather, it recommends a flexible care package that can be tailored to a client’s goals and needs, and which it says has been a successful component of both the home care package program and aged care reform.

The siloed approach to funding buckets in the NDIS and the CHSP has proven problematic and should not be replicated within the new aged care program moving forward.

Feros Care

Feros Care says a focus on reablement and restorative programs should be the hallmark of any new aged care program design.

“Supporting older people to regain and improve their physical function, independence, social connection, and improving their home environment can delay the need for expensive ongoing care,” it submits.

“An injection of proactive and preventive services will reduce the ongoing financial cost of home care packages.”

It says scaling the number of short term restorative care and transitional care packages available within each region will help delay the need for ongoing or higher level home care packages.

“This aligns with the new act’s objective of assisting older people to live an active, self-determined and dignified life,” the submission says.

It also wants to see more packages of dementia specific in-home respite for carers, enabling short term support in an older person’s home around the clock.

Workforce constraints

Dementia care specialist HammondCare, which provides community care to more than 5,000 Australians, gives in-principle support to the recommendation to immediately begin work on eliminating the home care waiting list.

But it says the government must work closely with the sector to understand “likely barriers” to meeting the December 2021 target.

“This includes consideration for workforce constraints – attracting, recruiting and training this new workforce,” HammondCare says.

Assistive and digital technology

Integratedliving, a leading provider of rural, regional and remote services, says the proposal to uncap the supply of home care places is possibly the largest structural change among counsel assisting’s recommendations, along with increasing home care funding to residential care.

The way the transition is managed will be critical to its success, the provider says, including ensuring that unrealistic expectations aren’t created.

“There will need to simulation and demonstration of how long it will take home care providers to expand supply to meet new demand,” integratedliving says.

“It is critical that the public expectation is appropriately set so the public trust in the system of care is not inadvertently harmed.”

It says assistive and digital technology must be “fully implemented as soon as possible” to help to keep clients safely in their homes, improve understanding of best practice care, reduce inequity of services in rural and remote Australia, and help overcome the workforce shortages in rural and remote areas by supplementing them with virtual services.

There will need to simulation and demonstration of how long it will take home care providers to expand supply to meet new demand.

integratedliving

Integratedliving also wants improved access to preventative health services and better integrated health care for people who are ageing and living with chronic conditions.

Improved governance and quality indicators

Baptist Care Australia says it supports measures to lift governance and accountability but warns against introducing civil penalties that are out of step with comparable health and community sectors.

“We consider a more appropriate vehicle would be the development of an improved governance standard, to be assessed by existing or future regulatory measures,” Board chair Russell Bricknell says in his submission.

Baptist Care also say targets for reducing the home care package queue will put pressure on the current workforce capacity.

“There is a risk that the required volume of skilled, competent and qualified workers may not be able to be sourced and trained in the timeframe proposed, in particular care managers,” it says.

Since providers are not present 24/7 and do not control the home environment, indicators need to align with what is practically controllable and achievable.

Baptist Care Australia

Baptist Care says it supports counsel assisting’s proposal to develop quality indicators for care at home, but says this must take into account the “uniqueness of the home environment and the degree of control a provider has over it.

“Each client is different to the extent that the family, approved provider, general practitioner, other services, etc contribute to their services,” it says.

“Since providers are not present 24/7 and do not control the home environment, indicators need to align with what is practically controllable and achievable.”

Outreach services

UnitingCare Australia says there’s an urgent need for investment to enable older people to remain in the community and supports the creation for an integrated aged care system – as long as appropriate transition arrangements are in place.

UnitingCare also says there’s need for preventative dementia outreach, as well the recommended post-diagnosis pathway.

Victorian-based specialist housing and homelessness provider Wintringham said it was disappointed homelessness wasn’t addressed in the submissions and calls for block funding for homecare homeless services providers and/or an increase in CHSP outreach.

Exemptions for smaller providers

Specialist in-home care franchise Home Instead raises concerns about recommendations around governance, specifically that the governing body of an approved provider must have a majority of independent non-executive members.

Home Instead says it is among a cohort of small businesses providing aged care services where directors also constitute the executive, and says this cohort should be able to apply for an exemption.

Consumer management

Michael Argent, CEO of self-described consumer management early adopter Better Living Homecare, says he supports set prices for subsidies and payments, but not the proposal for setting prices for services and hours of care.

We cannot see any justification for an external body to take the responsibility and control away from providers and market forces to determine their own prices for hours of care.”

Michael Argent

“The current home care packages system of providers determining their own charges for care hours based on their own business imperative does not seem to have been exploited and therefore does not need reform,” he says.

“We cannot see any justification for an external body to take the responsibility and control away from providers and market forces to determine their own prices for hours of care.”

Removing self-management as proposed by counsel assisting will have “significant and unintended consequences on consumer choice and control”, he says.

Read what the peaks had to say in their final submissions here.

Read about counsel assisting’s final submissions here.

This story first ran on Community Care Review.

Read AAA’s coverage

Peaks challenge Counsel Assisting’s staffing standard

Providers say allied health proposal needs improving

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