THIS blog has not focused much on home care, but there are a couple of major reforms of home care coming up which threaten to cut services to current care recipients.
Let’s first look at the Home Care Packages Programme, which delivers coordinated services to around 83,000 older people in their homes each year. These are people who would likely otherwise have to move into a nursing home.
From 1 July this year, this program will be delivered on a consumer directed care basis. Known as CDC, consumer directed care is designed to give care recipients more say over what care and services they receive and when. Care recipients will have some control over their care package’s budget and will be able to choose the services they want rather than be told which services they will get.
Sounds like a great reform. However, under CDC, providers will have to spend an individual package’s budget on the individual concerned. Although this sounds fair and sensible, it removes a provider’s ability to cross subsidise, which is currently quite common to ensure high needs clients get enough services. In other words, no longer will providers be able to take money from low needs clients who tend to under-spend their package and give the remaining amount to high needs clients.
From 1 July many high needs clients will lose services because without extra funding from the provider, their packages fall short. Unless they can make up the difference themselves (and some people are being told it will cost hundreds of dollars extra per week) they will have to cut back services or move into a nursing home.
Some high needs clients are actually receiving a low care package because of a huge under-supply of the high care packages, and they have that package boosted by funds from cross subsidisation. These clients will very likely have to move into a nursing home after 1 July.
The Department of Social Services has been aware of this problem at least since April last year when providers gave clear examples of the impact on their care recipients. Yet, nothing has been done by the Department to at least ensure existing home care recipients don’t lose services.
There are also changes afoot in Home and Community Care, which is being re-badged the Commonwealth Home Support Programme (CHSP).
As part of the Australian Government’s push to make aged care more user pays, it has proposed to increase fees for the bulk of the program’s 550,000 care recipients from 1 November 2015.
Meals on Wheels fees will rise to a minimum of $9 per meal plus the cost of ingredients. Domestic assistance will be $10 per hour for pensioners, social support will be at least $9 per hour and flexible respite will be charged at a minimum of $11 per hour.
The draft fee proposal has now closed for consultation. However, providers and groups like CPSA were unanimous: these fees are prohibitive and will see people stop getting services.
The Department of Social Services claimed that the fees reflect current charges across Australia. However, a comparison with fees charged in Victoria (where the CHSP will not operate) shows that the new CHSP fee schedule greatly exceeds that of Victorian charges for people on very low incomes.
Comparison of proposed CHSP fees with the Victorian HACC program:
|Proposed CHSP fees for a full-rate pensioner||Victorian HACC fees for a full-rate pensioner (2014)||CHSP fee difference|
|Allied health||$10 per hour||$9.40 per consultation||+ 6.3% and up|
|Nursing||$10 per hour||$3.60 per visit||+177% and up|
|Domestic assistance||$10 per hour||$5.80 per hour||+72%|
|Personal care||$10 per hour||$4.30 per hour||+132%|
|Respite||$11 per hour||$2.90 per hour||+279%|
|Home maintenance||$12 per hour||$11.60 per hour||+3%|
|Meals||$9 plus ingredients||$8.70||+3% and up|
Equally, CPSA has spoken to a number of not-for-profit NSW providers who are horrified at the proposed fees and say that their clients simply won’t be able to afford home care.
What is puzzling about the proposed fees is that none of the extra revenue will offset government subsidies, so providers will make a windfall gain. However, not-for-profit providers claim to not need the extra revenue, with at least one provider telling the Black Box that the only way they see fit to expend the extra cash is to give it back to their clients.
There is strong opposition to these higher fees and hopefully the Department will redraft them so that a pensioner can afford home care in the future. But these home care reforms seemingly go against the rhetoric of giving older people the services they want: care in the home.