Budget: ACAR to end in move to market system in home care

The ACAR for home care packages will be abolished with funding to be allocated directly to consumers rather than providers from February 2017, the government announced in Tuesday’s Budget, paving the way for a significant shake-up of the home care sector.

The Aged Care Approvals Round for home care packages will be abolished with funding to be allocated directly to consumers rather than providers from February 2017, the Federal Government announced in Tuesday’s Budget, paving the way for a significant shake-up of the home care sector.

The budget measure, costing $73.7 million over four years, advances the government’s plans for a more market-based, consumer-driven aged care system, first flagged in Assistant Minister for Social Services’ landmark CEDA speech in November last year.

The government also confirmed it will work to consolidate the Home Care Packages program and the Commonwealth Home Support Program into a single home care system from July 2018.

While consumers will have greater choice and flexibility to direct their package to their preferred approved provider, planning ratios will continue, capping the overall supply of packages available.

NDIS-style individualised budgets will also be paid to chosen providers rather than “cashed out” to consumers as is an option in consumer directed models overseas, such as in the UK.

The changes will present a significant challenge to the business models of providers through the end of ACAR and the transition to a more competitive market.

Under the changes, the My Aged Care Gateway will be responsible for prioritising clients’ access to packages at the regional level and it will receive $19.9 million over two years in capital funding to enhance its functionality.

Senator Fifield said the move to open up competition in the home care sector will lead to enhanced quality, innovation and service delivery.

“Packages will be portable, allowing consumers to change their service provider, including where the consumer moves to another location,” he said.

Ian Yates, chief executive of Council on the Ageing (COTA), welcomed the home care changes and said giving funding directly to the person in need of support will create a more responsive and efficient system.

“It will also drive up the quality of service provision as older people will be able to shop around for the best provider to meet their particular needs and will be able to move from one provider to another if they are not satisfied with the service being provided,” he said.

However, Mr Yates said it was disappointing that older people will have to wait until 2017 for the changes to kick-in and the reform should happen sooner.

“We also wanted to see a timetable for the government to move residential care to this model and we hope that will happen soon,” he said.

Catholic Health Australia said while this measure was a welcome development in the staging of reform, it continued to advocate for the removal of service rationing for all aged care services.

Stopping reform at this point would continue inequitable access to services where demand exceeds the number of packages available through the regional planning ratio, the peak body said.

Hal Kendig, Professor of Ageing and Public Policy at the ANU Centre for Research in Ageing, Health and Wellbeing, said it was encouraging to see the government moving ahead with a consumer directed home care system.

“This shift in power relationships is fundamental to a more open market that should work towards more choice, control, innovation, and quality of care,” he said.

“However, resources remain heavily constrained and CDC implementation will require careful monitoring, especially with the trend towards older people having to meet more of the costs themselves.”

Regarding the transition to a single home care system, few details were released with the Federal Government only saying it would consult with stakeholders on potential program and funding options, as well as options for implementation and transition.

Currently, the CHSP is block funded, while home care packages are funded through individual budgets.

Budget: Full AAA coverage

Tags: budget-2015, cha, cota, home-care, ian-yates, mitch-fifield,

15 thoughts on “Budget: ACAR to end in move to market system in home care

  1. So with this announcement the Department, providers, consumers and their families and carers have barely 20 months to get ready for the biggest changes to home care since the beginning of the original HACC program in the 1980s.

    How are we going to assist frail 80 year olds to manage thousands of dollars, determine their care needs, identify, locate and engage relevant service providers, arrange appropriate selection processes, monitor performance, compliance with regulations, acquit government funds allocated, etc etc.

    This seems to be one of those ideas that look good in the planning but the implementation will be a disaster. The consumer will end up getting less services. It will all cost more money. Current providers will not be able to sustain their employment levels. Shysters will prevail.

    This is another “pink batts” program all over again. Will governments ever realise that certain self-interest groups just want to “have a win” and have little regard for the sustainability of such crazy notions.

    “We’ll all be doomed” was the cry from Hanrahan in the poem. There’ll be lots of real Hanrahans in Australia today across many different groups within the broad ageing sector.

  2. Couldn’t agree more Tony. This idea has been pushed by self interested big providers who think they will be able to grab a bigger “market share” and a pretty naiive COTA. Funding will still be “rationed” through continuation of planning ratios (as it has to be in such a massive Govt. program). The intended system whereby funding will be given to individuals on a regional “priority list’ basis begs numerous questions about priority criteria and list management. No way it can be sorted in 20 months – if ever!

  3. most care available to our elderly are not accessed because the majority of people are not aware of what they are eligible for. At least 70% of our elderly are not aware of extended care packages and continue to pay full price for dental, podiatry etc. so I suppose the government is hoping for this to continue thus saving them money as usual. Make it transparent to ALL people what they are entitled to receive not hide available care options

  4. And worse still this system will only cater to the ‘informed’ consumers who can access the funding through the my Aged Care process i.e. those that know what answers to give! The already marginalised, especially older people from CaLD communities, people living alone without families/advocates etc. have little hope of getting any of this ‘pie’. Bloody disgrace I think – shame on you Australian Government. The idea might have merit but where’s the supports it place to ensure it works…..where’s the safety net in this system?

  5. I agree with Sue that as long as people are not informed, their access will be impeded. A single portal with translated information is NOT the answer. People with good to reasonable (and limited) English skills need access to information as an education process about the changes. Want to know more about how we can do this together? Speak to people who work at the grassroots and within communities.

  6. Speaking with people at the grassroots level is imperative, who advocates for the aged with unscrupolous family members siphoning off the funds for a home care package??. The curent system is doomed to fail.

  7. I, like many other people find it hard to understand the consequences of these changes, but taking into account the track record of this government, it seems to me, that this is another big stinking cost saving turd, polished and dressed up as a present.

  8. All the above comments are valid.
    Finally care workers have had a decent pay increase, however there has been a lot of talk about workers being paid a net $25 overall- what will happen to their real wages, like super,
    petrol and car expenses. There has been a push for qualified staff and I agree that its important to have well trained staff, however if we are following the Brits example- aged care services will definitely deteriorate- and many more people will end up in nursing homes.
    Currently many CALD services are carrying clients that really need a Level 3 / 4 PACKAGE on a level 2 resource and this will also affect the planning process(unrealistic figures). The only positive about the changes will be the transparency of fees and costs for clients and sets the stage for 10 to 20years time (for when this model will actual have benefit to consumers).

  9. Having been mistreated by our aged care provider for a number of years I see this change as the answer to our problems. Our aged care provider failed to provide services to Mum for a long time even though she was in great need. That enabled it to keep the left over funds for itself. It has also proved itself incompetent in providing services because the extensive errors it makes in service delivery are harmful to us.

    Further, it charges around $500 per week for the little it does. When it is considered a case manager typically spends only one or two hours a week per client that translates to between $250 and $500 per hour for an administrative officer to send a few emails, faxes or make a few calls. Sometimes there is no contact so that means $500 a week for virtually nothing. As the case managers in this organisation are unskilled in providing accurate or knowledgeable advice it means they are basically administrative officers who typically arrange or cancel services performed by other agencies.

    Our provider has shown itself to be arrogant, unresponsive, ignorant, negligent and incompetent. Allowing us to change providers would enable us to choose a more efficient and competent service provider. We will be able to choose a provider that helps the elderly by having a lost cost organisation structure rather than one that uses about half the funds to keep itself in business.

  10. Am so pleased I came across this topic on Community Aged Home care & the Commonwealth Packages to assist the aged in managing their own Home care through the assistance of HSW;s. (often regarded as Carers). We read so much about people being overcharged by providers, the lack of empathy and many other complaints. One of the major complaints it would seem is the lack of availability of the packages to suit the aged’s own particular needs & no one would know this more than we, ourselves, the aged. It seems ridiculous that because, eg., a provider does not have, say, a level 4 package they can offer a client but can tell us ‘ we can offer you a level 2 until a higher level package is available’, unquote, that tells the Government one thing, they need to be allocating more level 4 (high care) packages since our aged population is forever increasing & our individual ages keep on increasing. The genuine aged folk would be far better served by allocating less level 2’s which are of little use to most and increasing the allocations of level 4 packages where there is a dire need. When we helped the building of Australia by bringing our own children in the world there was no such thing as child care fees, little family care subs., and all the other subs, say, for having children,, we paid our own way and worked at 2 and 3 jobs to raise and educate our children. It is at this end of our life we need genuine assistance so let’s vote for level 4 home help packages for all over the age of 70 years thus giving back our independence and accepting only that which we truly need like someone to wash our hair or back for those who cannot raise their arms above their head due to the result of a stroke or even just old age, who cannot wear laced shoes due to the fact they can’t tie a shoe lace anymore and the million other things for which we would all be so grateful with the level 4 package home help, after all, to keep more people out of aged care residential has to and, of course, is far less costly with the aid of a level 4 home care community package than cramming us all into Residential aged care facilities. In fact, you will find the aged generation is far more thrifty and will rarely accept any more than they really need.
    Next time anyone complains about the providers (there are many less greedy than greedy), think of those who truly give far more in empathy for the little amount of salary they receive. They are the carers you hardly hear of who have sat all day at the side of an elderly soul as they fight to hold on to their last breath, afterwhich they then go home to weep for the loss of a dear elderly person to whom they always cared for so very much. These are truly the salt of the earth, yes, the Carers. Our thanks to them & bless them!.
    Finally, 2017 will not come soon enough for us who are quite capable of handling our own finances and affairs (& for those who can’t, they will have someone who cares sufficiently to do it for them),so roll on February 2017 and hopefully sooner when we can control our own destiny financially, with our own level 4 package & with the way we choose to manage our own aged care plan be it CDC or whatever the next government ‘brainer’ will be by then.

  11. The agencies will continue to fleece the home care packages.

    Without a cap on the infamous ‘Administration fee’ and other ‘sundries’ nothing will change. It is all rather late for my husband who has early onset dementia.

    These so called not-for-profits, with many bearing religious names, are exploiting human misery and they can charge what they like. Transparency???

    It is a Government program meant to help persons like my husband and others but the ‘miners’ moved in swiftly.

    That they still can take 30-40% and more out of a package is despicable.
    That they will still not negotiate on their charges is unethical.
    It is not their money and the Federal Government needs to legislate strongly to stop this misuse of the home care package monies.

  12. Roll on 2017!!

    After navigating around Service Providers, i am not impressed.

    They are definitely skimming off their staff.

    Some are only getting 21 dollars an hour, but being charged out at 40-60 an hour out of the package. Super and workers comp etc does not add up to 40 or 60 an hour!!

    Admin charges should cover payroll management.

    I would prefer to pay staff on ABN rates direct to the staff person, so they can take advantage of Tax Deductions for their own sub-contract business.
    Would be very beneficial for working mums doing a second income for the family.

    Then i could pay domestic help at 35-40 an hour direct to the worker. Monthly invoice from worker paid in 7 Days by Care provider.

    So on Level 2 the Care provider would have to maybe 2-3 invoices a month for maybe 20-25 hours in total. No super to worry about, no workers comp etc. Contractor looks after their own super and compo, insurance.

    15 minutes in invoices a month

    I could direct hire a nurse for a little more and not have to pay double agency fees, if the care provider nurse is not available.

    Plus if i employ a person via the Care Provider under ABN i can quickly change the staff person if they are the agro/grumpy types that plague the system.

    Aged care is a service industry, they have to give service. The vast majority of staff are super, caring people. Its a hard job.
    But i want the better staff to be rewarded with their own ABN facility so they can actually get more work than the part time nature of most care providers. The better staff will get more customers, no matter what company they work for.

    Male family carer: caring for 85/84 mum and dad. Doing the best so we get value for taxpayer dollars and care for my parents.

  13. I think there is a lot of mis-information around at the moment about 27 Feb 2017. If you research there is a lot of information to clarify these misunderstandings. Plus then there is the reality of service provision which is huge.

    After 30 years of working in this system I can help demystify some of the myths:
    – Case management (my current client load is 92 active clients) takes more than a few phone calls and emails. Dealing with the My Aged Care Provider portal is an absolute nightmare. I spend a lot of my time clarifying the never ending changes. One minute they need to be referred for any new service, the next minute no they can be given a reference code and then choose themselves. I also spend a great deal of time on the never ending paper chase and data entry. These are all required for compliance reasons. Not to mention the work I do to ensure that all service provision suits the needs of the client goals. Then there are the endless reviews and reassessments and not to mention our organizational requirements. Case management when done properly is a full time job on its own. Then on top of all this there is the quarterly reporting to the Government of outputs, finances, compliance, then reporting to the Management Committee and other internal reporting. The view that unqualified admin staff are undertaking it in their spare time is just not true. You do have to be qualified in order to be a case manager as it is a complex job that needs a certain amount of knowledge to be done, including issues around staff management, risk management, WH&S and all sorts. Its up to the case manager to assess the home environment to make sure it is safe and suitable for workers.
    – Shifting providers is not an easy task. Yes after 27 Feb 2017 your unspent portion of your funding is portable, however in order for you to move there has to be availability. Currently many organisations have a wait list of 6 months or more, meaning you will be classed as a new client and have to go on the wait list. So how are you going to cover the period of whatever time is it where you will receive no services at all?
    – part of the charges that providers are enforced to charge are daily service fees, that it, you pay a basic fee of $9.70 a day regardless of whether you receive a service that day or not. On top of that, if you have been assessed as able to pay, you will also be charged an extra fee. Then on top of that you have your service fees. What many dont understand is that at the moment you only pay a contribution towards the full cost as it is heavily subsidized by the funding the Government provides to providers via block funding. From 1 July 2018 that all ceases and the recipient of the service will be paying the full cost of the service. So for example we currently offer weekly bus trips with lunch, morning tea, pick up from home transport for $25.00 a day. This is going to have to increase to cover staff and vehicle costs which will mean probably $60 or more. What you will be paying for is the actual cost of service provision, with no subsidies. Providers will have no choice but to add fees to pay for their infrastructure. You the consumer will be paying for all the CEO’s big wages, the buildings, the car fleets, the employees. So business will be forced to take in vast numbers of clients to support their business. Guess who looses? The consumer does because the quality of care will dramatically fall, it already is.
    – For those of you who are competent and can manager your budget, you can become your own service provider. You receive the funding and a provider and have to broker your own services. You will also need to account for every cent and you cannot go out and spend the money on the pokies or trips, or rent and so on. That budget is to purchase your own supports, ones that are eligible. You will have to do your own reporting that we case managers do now for you and let me tell you it is endless!
    – You will have to prioritise what goals you want supported becuase your individual budget only goes so far. So if you have goals of wanting to go and on trips to socialise or social support as its called, will probably become a luxury. If you have $7500 on level one, thats not going to buy a lot of services when you add you admin costs etc. Although the government is looking at this issue of what services are charing it will take a long time to change this. Remember any business has fees and charges and aged care services are included in that. We may be not for profit but that does not mean we cannot make a profit to survive it just means that no one receives dividends, it just goes back into running the business.
    – Consumers as such do not receive the funding (unless they are their own case managers), the consumer nominates who they want to manage their funds and the organisation receives it and like any financial management service, incur costs to look after and handle money. Its not only the care workers, there may also be accountants, specialists and so on that go in to running the services and these all come at a cost, and its a cost the consumer will now be forced to pay, and pay you will!

    Don’t place your anger with service providers, this has been forced on us as well as we need to bend and be flexible. Now block funding is ending and the money follows the consumer, you will no longer be receiving subsidised services. This will force many to rethink their goals and priorities because your budget will force you. Make the most of this system while its still here. It may not be perfect but its better than what is coming. It wont be the answer many think it might be. You’ll find out why England no longer has this system and why the university graduates who went and studied the English system looked at the model only, not the outcomes.

    If it was me, I’d be looking a the new private providers who will support your goals and offer you a real variety of supports at competitive prices. The large not for profits have has since 1 July 2015 to transition to CDC and most have not and never will. They will only provide the same low quality services they do now but just charge you a lot more to support their infrastructure!

    Do your research and start understanding what is really going to happen. The age of welfare entitlement is over and its going to be a user pays system!

  14. I totally agree with Ted Wards, even though I am not a case manager. I work in the aged care system. It will be and is starting to be like the American system, user pays. If you are wealthy, you will be fine, as for the rest, it is good luck. This is so very disheartening for the workers who care about the aged. We can see what is around the corner, but no one is interested in listening to our point of view…..

  15. All the vindication for charging high fees is based on literacy how about a bit of numeracy Well Ted 92 clients and if you get over $400 per month as my wife’s case manager does that would amount to $36,800. This is based on level 3 I doubt one person can handle 92 cases, anyway, you could afford. to pay for additional help. By the way this is apart from the $500 plus that goes to head office also a mandatory charge, out of hours charges etc.This is while I prepare meals,do the dishes, the washing the medication, toilet trips.How about I contact my wife’s care manager and charge my time out at say $25/per hr that is cheaper than $54/per hr and give the difference back to the government Ha.The Goose that layed the Golden Egg is not dead its called the Government

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