RC calls for entitlement aged care system

The residential and home aged care and support programs should be combined into a single program as soon as possible with demand-driven funding based on assessed need, the royal commission has been advised.  

To achieve this, funding needs to be linked to actual costs and not rationed, Senior Counsel Assisting Peter Gray told the royal commissioners at a hearing in Adelaide on Wednesday.

Counsel Assisting’s proposal calls for a casemix funding classification model for residential care, an overall reorientation toward wellbeing and independence and assessments conducted by a national network of multi-disciplinary assessment teams.

Further, all older Australians should have access to government-funded allied health and other services that promote wellness, reablement and rehabilitation such as occupational therapy, physiotherapy, medication reviews and minor home modifications, according to the submission.

Mr Gray said counsel assisting’s “current proposals for far-reaching changes in aged care program design” were heavily influenced by the consultation that commenced with the launch of a paper in December (read more here).

However, the proposals differ in several material ways from those in the consultation paper including no proposal to structure the program into an entry-level support stream, care stream and investment stream, he said.

The 14-part submission and series of proposals seek to elicit responses from aged care stakeholders for future recommendations, Mr Gray said.

The proposals call for the Commonwealth Home Support Program, Home Care Packages Program and Residential Care Program to transition to a single program as soon as possible.

The new program should be based on a single eligibility assessment process, where funding is demand-driven based on assessed need and does not involve rationing, according to the submission.

Mr Gray said older Australians deserve a needs-based entitlement to aged care.

“People assessed as having needs justifying higher level of care at home should not have to wait until a rationed package becomes available.

“People receiving care whether at home or in residential facility should have confidence that their provider is funded to provide the care that is necessary to meet their assessed needs,” Mr Gray told the hearing.

It will require linking funding levels to actual costs of providing high quality and safe care for the first time and removing the current practice of rationing aged care funding, packages and places, he said.

“Funding would be set by an independent authority on the basis of efficient standardised costs ascertained at regular intervals by that authority. Funding would be updated regularly.”

Providers would be required to account for their expenditure on care.

Mr Gray said robust quality assurance measures about the entities eligible to receive uncapped funding are required before removing rationing.

These measures along with robust arrangements for ensuring accountability for spending funding on care must be in place in advance, he said.

Residential aged care proposals

Other elements of the proposal related only to residential aged care include:

• a casemix based funding classification model based on independent assessment by a comprehensive assessment team, and not by the service provider
• classification funding levels linked to actual cost data according to an independent pricing authority and the estimated cost of providing high quality care
• funded entitlements to cover basic assessed-for support services including transport and social activities
• providers’ clear responsibility for care co-ordination and planning subject to ongoing consultation with the older person and their representatives about their care 
• funding separate to the ongoing care budget for interventions independently assessed as necessary to sustain or restore function 
• requirement for providers to seek reassessment upon changes in circumstances with incentive to support reablement because of the extra funding 
• performance based loadings for reablement outcomes over time
• mandated culturally and psychologically safe assessment, care planning and care delivery to meet diverse needs 
• loadings or supplementary funding for some diverse needs, as well as rural, regional and remote areas where higher costs demonstrated
• guaranteed base funding in return for provider of last resort obligations in very thin markets.

A preventative and wellbeing focus

Mr Gray said the redesigned aged care program should have an increased focus on preventative and early interventions to maintain and restore function, sustain independence and enhance wellbeing.

He said the Australian Government should also fund and support the delivery of wellness, reablement and rehabilitation services to all older Australians including:

• occupational therapy
• physiotherapy
• nursing support
• personal care
• nutritional interventions
• medication reviews
• technologies to help with day-to-day activities
• minor home modifications
• measures to address loneliness.

“The provision of such services tailored to individual needs should be explored for all older Australians irrespective of whether they’re in their home or in a residential aged care facility and irrespective of their cognitive status or prognosis,” Mr Gray said. 

Other proposals

• Australian governments should fund and support education and information strategies to improve public awareness of ageing and aged care planning resources.
• In addition to people using the My Aged Care website and call centre, the system should accommodate referral by health practitioners, social workers, local government employees and other responsible professionals.
•  The Australian Government should fund and support education and information strategies to improve knowledge about aged care amongst professionals who have frequent contact with older Australians
• People seeking and receiving aged care should be offered personalised and face-to-face help at all stages plus ongoing case management by a new workforce of trained care finders.
•  Aged care assessments should be conducted by a national network of multi-disciplinary assessment teams supported and funded by a single organisation, which also employs or commissions the teams of care finders.
• Care finders and assessment teams in each area should have open channels of communication
• The Australian Government should fund and support information and local outreach to tell informal carers about services available to support them
• Comprehensive assessment aged care assessment should give attention to the needs of informal carers in their own right to provide quarantined entitlements for support services, such as counselling, training, and respite.
• There needs to be substantial increase in the scope, scale, availability and types of respite and a new framework of incentives for respite providers.
• Incentives to encourage a range of innovative accommodation models driven by choice.
• The Australian Government should implement a standardised data collection program designed on the collect-once-use-many-times principle and to inform longitudinal evaluation at the user, provider, and system levels.
• The data should include service usage data, health, safety and quality outcomes data, including medication data, diverse needs, quality of life metrics and transitions and interfaces with the health systems.
• The Australian Government should fund and support the development of ICT systems and linkages with government datasets and ensure ICT connectivity between different government bodies providing services relevant to aged care.

Stakeholders are invited to make a submission in response to Counsel Assisting’s submissions on program design before Wednesday 18 March 2020. 

Read the submission and find out more here.

The next hearing of the aged care royal commission will take place on 16-17 March in Adelaide as a workshop focusing on research, innovation and technology.

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