Jun 28, 2017

When is a Package for Community Aged Care Not a Package?

Over the last 6 months, I have been travelling around Queensland speaking to older people about aged care services, and how to access My Aged Care to organise these services.

What I am consistently surprised by is the confusion that exists across the board in this group, especially when it comes to the question of “packages”. On February 27 this year, one of the most significant changes to the way in which community aged care is provided in this country was finally enacted.

On that date, consumers who were lucky enough to be in possession of a home care package were finally in charge of these packages, able to choose their service provider and able to dictate how the subsidy is spent. Much has been written about the unethical practices of some providers since this time, with exorbitant exit fees, scare mongering about what will happen if a person chooses to leave a provider, and a lack of transparency about the financial status of a person’s package just some of the issues brought to light.

The Government had consistently indicated its intention to move to a single community aged care system in this country, with the first step of these reforms implemented with the creation of the My Aged Care single entry point into the system in 2015, along with the creation of the Regional Assessment Services to be the gatekeepers into the Commonwealth Home Support Program (formerly the Home and Community Care/ HACC program).

The Government also announced that as of 1 July 2018, this program would be amalgamated with the Home Care Package program to create a single, unified aged care system.

At the time, consumer groups got a little bit excited. Finally, there was to be a sensible and single approach to community aged care. The confusion that had pervaded the system since Home Care Packages were introduced to rival the HACC program in the 1990s might finally be over.

Some providers (mostly those from the private sector) also got excited. Maybe the proposed changes would finally allow market forces to deal with the duplication and confusion that consumers were feeling? Maybe consumers might finally be able to get the services they wanted, from a service provider that was focused on them as a customer and not on preserving the status quo of inefficiency, significant overheads and large salaries.

Well, the 27th of February has come and gone, accompanied by the afore mentioned dodgy behaviours and more than a little scare mongering. These changes (well publicised) have also resulted in more than a little bit of confusion for consumers who have little to no idea where the funding for their services comes from. In the months leading up to the February date, I spoke to dozens of consumer forums and hundreds of older people. When asked if they had a package, the majority answered in the affirmative. Conversations have then gone something like this…….

“Of course I have a package”, they said.

“And please, can you be my provider?”

“I really like what you stand for.”

“I really like that you wont charge me travel.”

“I really like that you will visit me when I want to be visited.”

“I also love that you will try really hard to send the same carer every time I need a visit.”

Further investigation revealed that all those people who thought they had a package, and who were desperate to get away from their current provider were actually receiving services through the Commonwealth Home Support Program.

Our response then had to be … “Sorry, we can’t help you with those services. Those services are tied to the organisation that receives block funding for those services. We can, however, try to have them broker those services to us”.

“Would you, they asked?” “Sure,” we said……….

“No” became a mantra through which CHSP funded providers dealt with requests to change providers. We tried, clients tried, their families tried. The answer was still “No”. Some people we came across had been accepted for services by a provider but had been waiting for up to three months to get a service. Phone calls to the provider were either not returned or met with what can only be described as “stone walling”. Still, July 2018 was nearly here, wasn’t it? Only another 15 months or so until consumers had total control over their care.

Then came the May Federal Budget, and another announcement about aged care. The CHSP program is now to be extended until 2020. The Regional Assessment Services will also be funded until then, with the previously announced merge with the Aged Care assessment teams (ACATs) apparently off the agenda for now.

What the??? Current service providers will have their contracts extended from 1 July 2018 to 30 June 2020. Apparently, the Government wants to introduce increased choice to people receiving care under this program. Exactly what this means is anyone’s guess. A greater focus is also to be placed on wellness and enablement. What this means is also anyone’s guess, although a review is apparently planned.

Talk to most people over 65 who are eligible for services and they will tell you that all they want is to get the services they need. They want consistency in approach to their needs, with choice about who visits them, and what they do when they are there. According to these people, wellness for them will be achieved if they are able to receive assistance to do the things they can’t do so that they can live their lives the way they want. The decision to delay the reforms until 2020 puts at risk the whole agenda related to consumer directed care. Two years is a long time in Government policy.

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