Some 6 per cent or 50,000 aged care clients access more than five Commonwealth Home Support Program services, unpublished data from the Department of Health shows.
A small number of clients grandfathered from state-based Home and Community Care (HACC) systems are also receiving more than $100,000 in government funding under the entry-level home support program. That is double the annual subsidy for a Level 4 home care package, which is designed to support high needs clients in the community.
The data presented to an industry conference earlier this month shows that all clients needing services that are above entry-level support have not yet been transitioned to a home care package or residential care since the creation of the CHSP on 1 July 2015.
It also provides further evidence of the unmet demand for package-level care and the lack of seamless integration between the home support and home care programs.
Karen Pickering, assistant secretary of the health department’s home support branch, told the Next Phase of Aged Care Reform conference in Sydney, that one-quarter of CHSP clients receive three or more service types.
The department told the conference:
- 54 per cent of CHSP clients access one service type
- 22 per cent access two service types
- 12 per cent access three service types
- 6 per cent access four service types
- 6 per cent access five or more service types.
The data helps paint a fuller picture of the national home support program, which is the largest but most poorly understood part of the aged care system.
The program’s Data Exchange system was introduced as the new reporting framework from 1 November 2015.
Average client expenditure
While there continues to be a small group of grandfathered CHSP clients with complex needs, on average the government spends just $2,800 per person, per year on a CHSP client compared with $8,000 for a level one package.
However, inconsistencies in pricing, service offerings and availability between jurisdictions continued to present challenges for the national program, said Ms Pickering.
As a result of the grandfathering arrangements that were put in place in 2015, not all clients receiving home support services are registered with My Aged Care, she said.
Government data on the national program showed that domestic assistance, allied health therapy and transport services continued to be the most popular home support services.
The number of CHSP clients by service type in 2016-2017 was:
- Domestic assistance – 265,223
- Allied health and therapy services – 208,035
- Transport – 136,304
- Home maintenance – 125,339
- Nursing care – 100,808
- Meals – 95,598
- Social support individual -95,368
- Social support group – 88,446
- Specialised support services – 55,936
- Home modifications – 42,504
- Flexible respite – 27,931
- Centre-based respite – 14,749
- Goods, equipment and assistive technology – 13,261
- Assistance with Care and Housing for the Aged (ACHA) program– 4,745
- Other food services – 4,316
- Cottage respite – 3,556
National wellness review
Ms Pickering also outlined the high-level findings from the government’s recent review of wellness and reablement within the home care sector.
The review, completed by the Nous Group in June but not yet released, found awareness of wellness and reablement was very low among consumers, families, carers and GPs.
“There was also significant variation in the understanding and application of wellness and reablement between service providers and assessment services ranging from little to no understanding to highly effective and innovative service offerings,” Ms Pickering told the Sydney audience.
The department was currently considering the review’s findings, she said.
Extended CHSP contracts are expected to be available in the first quarter of 2018 and will include new conditions related to implementing a wellness approach, as announced in the May budget.
She said the department was currently consulting with the National Aged Care Alliance’s CHSP advisory group on the new funding conditions.
Integrated care at home program
On the next stage of community aged care reform, Ms Pickering said the department had received 330 responses to its discussion paper that was released for consultation in July.
Stakeholders said future reform should be phased and co-designed with the sector.
“Most stakeholders said future reform should include an integrated assessment model combining ACAT and RAS workforces,” she said.
The majority of submissions said consumer contributions should also be consistent and equitable and based on a person’s capacity to pay.
There was no consensus on the model of an integrated program and the government was yet to make a decision on the future design or funding of the program, she said.
The NACA advisory group is providing further options and advice to the department.