The aged-care reforms, Living Longer, Living Better, (LLLB) introduced by the former Labor Government, came into effect on July 1st 2014. In relation to Home Care, the changes are a combination of consumer directed practice reforms and structural reforms. These reforms are designed to address issues related to funding community care for an ageing demographic, including government subsidised care at home. The reforms are the result of an extensive report brought down by the Productivity Commission in August 2011.
01 July 2014 was a line in the sand – we were told that consumers of community aged care would start to see a better and fairer aged care system. Nearly six months on it’s interesting to reflect on the experience of LiveWell Care and our clients when navigating the post reform community aged care system.
Navigating the system is still complex
Despite some good federal initiatives such as the My Aged Care Website which is designed to help consumers develop a better grasp of the aged care system. The consumer is still left with a very fragmented system with little guidance as to how best navigate the system successfully in relation to their own, often very specific, individual care needs.
The supports within this fragmented Community Care system are a mixture of Private, Federally funded and a combination of State and Federal funded supports (Home and Community Care-HACC). The lack of single Community Care system becomes increasingly frustrating when consumers work out that being in receipt of one type of funded service may exclude them from receiving a service from an alternate funded service.
Demand v Supply
In late May, when Senator Fifield announced the opening of the Aged Care Approvals Round (ACAR), he said government recognised that many older Australians wished to remain in their home for as long as possible. When Fifield revealed the round’s outcome in December, he announced the expected number of home care allocations at 6,653 across the country up 818 places from 5835 last year. Victorian’s can expect access to 1,768 places. Various issues of under-supply of places in some areas and over-supply of places in others were highlighted as ongoing issues and this has been followed by more calls for ACAR reform.
Around nine in ten older people were still waiting for a home care package nine months to a year after they were first approved for care, according to a study published in an issue of the Australasian Journal on Ageing. This study found that only 35 out of 285 approved aged care packages (or 12 per cent) in Townsville in North Queensland were actually provided to assessed clients during a 12-month period. While it was unknown how many older people were offered a package but refused one, the study’s authors said the lengthy waiting times pointed to a local community care system that was “failing” older people in need.
Consumer Directed Care
All new Home Care packages allocated by the government are to be provided on the basis of consumer directed care (CDC). All existing Home Care packages will be operated as CDC Home Care packages from July 1 2015. CDC Home Care Packages aim to provide consumers with more choice and control as to how they receive support from their Home Care package provider and more choice and control as to how they utilise their home care packages budget.
Service providers are now required to be more transparent with their administrative costs and how they allocate the resources from these packages. In November the government voiced its support for moving towards the more ambitious proposals put forward by the Productivity Commission in 2011. Senator Mitch Fifield announced support for moving to cashed-out model of home care, and adopting a single community care system. He flagged the possibility of moving to a consumer-led market ahead of the five year review of the aged care reforms in 2017.
Currently, consumers care needs are categorised as either Level 1,2,3 or 4 by the Aged Care Assessment Service (ACAS) and consumers are selected by the Home Care Package provider once they have a vacancy. Funds are not allocated to an individual based on need but rather to an approved provider who will administer the Home Care Package.
Income Tested Fees
The reforms have also brought a new income-based means test for home care. What this means is that those who receive a part-pension or who are self-funded retirees will be required to pay a basic fee (applicable to all Home Care Package recipients) up to 17.5% of the pension (at the time of publication $3,493.05 p.a.) and an additional income tested fee determined by Centrelink. This is based on their accessible income. Income tested fees are capped at $5,000 p.a. for part pensioners and $10,000 p.a. for self-funded retirees with a lifetime cap of $60,000.
Armed with an understanding of what they are likely to pay, LiveWell Care clients have been able to make an informed decision as to what type of service will best meet their own individual needs. More importantly, our clients are aware in advance of the fees associated with a publicly funded care and have a clear understanding of what they can expect from such services.
LiveWell Care is finding that self-funded retirees who have been assessed for a low level Home care package (1 or 2) are increasingly opting to privately engage their case management and direct care support due mainly to the combined cost of income tested fee and basic fee associated with Home Care Packages.
LiveWell Care continues to be engaged by individuals and family members of older people experiencing times of uncertainty and change. The focus from the previous and current government to provide increased choice and control is a step in the right direction in supporting older people to remain living in their own homes. We agree that choice is a good thing, as long as the options are clearly explained and fully understood, without this clarity then choice can become a confusing and often overwhelming array of options and entitlements.
Reference:
* Waiting times for Aged Care Packages: The need to know, Griffiths M, Russell R, Brunker G, Boccalatte M and Goldstraw P, Australasian Journal on Ageing, Volume 33, Issue 1. Pages 26-28 March 2014