The unintended consequences of major Government home care reform

The government funded home care industry is going through the most rapid set of changes felt over the last twenty years. Importantly, the changes to government funded home care in Australia are very similar to changes already implemented in New Zealand, Canada and the United Kingdom. We are not out of step. As is so often the case, the best laid plans may be undone by implementation.

In home care the next big change happens on 1 July 2015, only a few short weeks away, when the system switches over completely to Consumer Directed Care (CDC). This will affect every person in Australia on a government funded home care package. At the same time the means (income) testing of home care recipients kicks in. Everyone that is not on a full aged pension will need to submit their assets and income information to Centrelink for assessment. If that were not enough, the replacement for the HACC system, the Commonwealth Home Support Programme (CHSP), also rolls out on 1 July 2015.

Consumer Directed Care and the Commonwealth Home Support Programme are not simply philosophical changes to place the person (consumer) at the centre of care provision. It comes with significant systems, compliance and operational changes as well as a whole new assessment and case referral system to be driven through the Government MyAgedCare website.

The buzzwords are Choice, Client Centred Care, Wellness & Reablement.

As Assistant Minister for Social Services Mitch Fifield recently said at the November 2014 meeting of the Committee for Economic Development Australia, "Dollars should follow need. And I think care should follow choice." He has stated often that "the consumer should be at the centre and in charge.'

The excellent changes that the Government is implementing may, however, have a few unintended consequences:

MyAgedCare website.

Choice is a great concept if a person can establish what exactly the choices are and for what. The MyAgedCare website is planned to be the solution to the question of choice. It is the single gateway for information and accessing services. This will provide challenges if the person: is in their late 70s or 80s, seriously ill, suffering from dementia or depression, don't have a computer, can't use a telephone, don't speak English, don't have a support system at home. Even if their son or daughter has a PhD and is helping, this website will be a challenge.

ACAT + RAS Assessments and time delays

On 1 July 2015, one of the major changes to home care is the introduction of the Regional Assessment Service (RAS), which will be responsible for assessing the home support needs of older people under the Commonwealth Home Support Programme. The MyAgedCare website says, "It [RAS] will also provide support for locating and accessing suitable services based on the preferences of older people."

Government announcements state that the RAS "will complement the existing Aged Care Assessment Teams (ACATs) which undertake assessments for higher intensity home care and residential care services." There will be effectively two assessment services doing pretty much the same job, but for two different buckets of money. How does the consumer choose? Which is which? ACAT assessment waiting lists are already over 3 months in some regions. How long will RAS assessments take?

One of things that may frustrate choice is that many of the companies with RAS and ACAT contracts are, in fact, also in-home care providers. Will they be tempted to pick and choose customers coming through the system for themselves?

Financial planning services

Most people applying for government assistance to stay at home will need to complete a Form SA456. This form is to be used to assess the level of co-contribution (means testing) by the person to help fund their care. This is 18 pages of questions on assets and income to be completed and lodged with Centrelink. The reality is that the vast majority of people, even if they are well organised financially, will need to take some financial advice on the implications of Form SA456. This will all take time, plus finding a financial planner will be a challenge as very few specialise in the complexities of aged care funding.

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