One year after Support at Home launched, a senior executive at one of the country’s established home care providers has given the program a failing grade.
Asked to score the first 12 months out of 10, Thea McCroary, Executive Director of Strategic Partnerships at Prestige Inhome Care, started at four. Then she thought about it.
“Okay. Three,” she said. “I’m trying to be positive. There’s enough challenges in aged care, I try to look for silver linings. Many days it probably feels like three.”
McCroary sits on Ageing Australia’s national council. She says what she is hearing across the sector matches what she sees at Prestige: a reform with the right intent that has not delivered on its promises to older people, their families, care workers or providers.
McCroary credits the government with some wins. She says releasing an extra 88,000 packages a year ago helped clear the initial backlog. She also says the reform put the client back at the centre of care, with every care plan tied to the person’s own goals.
“Their intent is definitely right,” she said. “It’s about choice as well, giving the clients choice and putting them at the centre.”
She also singled out end-of-life funding. In March, the government decided to automatically extend end-of-life support for another three months for people still alive when their funding period ends. Before that, people risked losing their care just as they were at their most unwell.
“That was disgraceful,” McCroary said. “When three months is up and someone’s already home, you brought them out of hospital, they need essential care. So at least we’ve lobbied and they’ve listened to that.”
Prestige works closely with hospitals to get patients home. But McCroary says access to the end-of-life pathway still varies widely between councils, hospitals and assessors. “Some turn it around very quickly and others it’s still taking too long. So it’s still far from perfect.”
The biggest failure, McCroary says, is delay. People who have been assessed are still waiting for funding, and others are waiting as long as 10 months just to be assessed.
Those who do get through often receive interim funding at 60% of their assessed level. McCroary says that is not enough.
Under Home Care Packages, Prestige could work with a client without co-contributions and spend the package on personal care and services that kept them safe at home. “It’s so different now,” she said. “They’re so confused and worried about co-contributions, and it’s taken so long for them to get it.”
The result, she says, is that many new clients take meals, allied health and home equipment, but hold back on actual care. And when people who need care go without, they end up in hospital, blocking beds.
McCroary says barely any new Support at Home packages are being released now. Instead, Prestige fields calls every day from people allocated the Commonwealth Home Support Programme (CHSP), which is designed for low-level care.
“The people that we’re talking to need far more than what a CHSP package can give,” she said. “So the government is intentionally not releasing those new Support at Home packages with the eight levels that are needed, and at 100% of that funding.”
Asked whether clients and families understand the new system, McCroary didn’t hesitate. “More confusion. Definitely more confusion.”
She says client statements often contain errors and budgets don’t match. Many of those errors come from software vendors still catching up to Support at Home. Family members ring Prestige to complain because they can’t make sense of it.
The cost of living makes it worse. Fewer people can afford to top up their care privately.
“They’re just desperate, and they’re very confused that they’ve been given a CHSP package and why can’t they get a provider to take that on, or why can’t they get the care they actually need through that,” she said. “Because they were told that would solve their problems.”
McCroary says the challenges sit mostly with new entrants. Existing package holders covered by the “no worse off” arrangement have not been as big an issue.
The government has suggested packages are being held back because providers aren’t ready. McCroary rejects that.
“Providers wouldn’t be having whole marketing plans, and you’re seeing adverts everywhere of companies competing to attract clients, because you need scale and growth to be sustainable with the cost of Support at Home,” she said. “I think they’re not talking to any providers I know. I’m on the Ageing Australia national council and everyone is crying the same story.”
She says Prestige, like every provider she talks to, is eager to take on more Support at Home clients and has the capacity to do so.
The squeeze on providers is real, she says. The 10% cap on care management is hurting most. Care managers now handle more reporting, more client expectations and more follow-up after falls, and that work “far exceeds what 10% funds”.
Price caps add to the pressure. McCroary worries that some providers have deliberately priced low to win market share. If caps are set using averages, that could be “the final straw for many providers”.
“If they price it too low, it just won’t be viable for providers to stay in it, which will really impact the community,” she said.
The exits have already started. Prestige has taken over clients from three smaller providers that had to leave Support at Home. Those providers came to Prestige so their clients would keep continuity of care.
“We’re big, but we’re finding it very difficult,” McCroary said. “We’ve got a lot of smart brains at the table trying to solve these really complex problems around claiming, statements, supporting clients with limited funding and making sure we’re sustainable. Many providers won’t be able to, particularly if they only offer Support at Home and don’t have that diverse client pool.”
The strain is showing in Prestige’s own teams. McCroary says case management teams have had a lot of turnover.
“These people work in this sector because they care passionately about the individuals. It’s not just a paycheck,” she said. “When you don’t have time to do that properly, and the reporting and the admin side and the constant changes, we’re losing good people from the sector.”
Finance teams are also at breaking point. Staff handling claims and billing spend hours on hold to Services Australia trying to fix errors. If claims don’t go through in time, McCroary says, that affects payroll and the business.
On regulation, McCroary is more positive. She says the new Act and strengthened Quality Standards have lifted the bar across all providers and put safe, client-centred care at the forefront.
But the reporting is becoming cumbersome. She says reportable incidents, dealings with the Commission and managing third-party compliance are heading the same way as the NDIS, where providers need whole teams just for admin.
“Great people who are passionate about the clients and their families should be out there in front of them doing care and working through their goals,” she said, “rather than admin in front of a desk.”
McCroary was asked about Aged Care Minister Sam Rae’s recent assessment that the reforms have made the system fairer, smarter and more efficient.
“I think that’s just a political line that couldn’t be further from the truth,” she said. “If he sat in our office for one day, listened to clients calling, sat with the teams working through this, looked at the management trying to review the P&Ls each year as it’s getting tighter and tighter… all of us still believe in having purpose, to help people stay at home. But they’re making it bloody hard.”
Given five minutes with the Minister, McCroary would tell him the intent of the Act was great, but it hasn’t been delivered.
“Almost 200,000 people waiting for a package is just not good enough,” she said. “It’s creating major stress for families at a time of crisis, for many families who have got a loved one very unwell.”
She wants more packages released as soon as possible, and more funding for providers so quality operators stay in the sector for the long haul. She also wants the care management cap lifted from 10% to between 15 and 20%. Above all, she wants the government to listen to providers and work with them, so older Australians get the support they were promised and hospital beds are freed up.
So, all things considered, is Support at Home better or worse than what came before?
McCroary points to the extra packages and the short-term funding for end-of-life and restorative care as real gains. “But the actual system is worse,” she said.
Providers have had to buy and train staff on whole new finance, client and rostering systems, she adds, while the government keeps changing its mind and moving the goalposts. “It just wasn’t thought through and well planned at all.”
