Regional community care providers have rejected a return to block funding, saying the benefits of consumer directed care are too important to give up.
During a hearing of the royal commission in Mudgee last Tuesday, Counsel Assisting Erin Hill asked representatives from three providers what they thought about the proposition that consumer directed care for home care packages should be replaced with block grants through a competitive tender as a solution to thin markets and “scale diseconomies” in regional areas.
Helen Miller, Head of Operations Aged and Community at Orange-based LiveBetter Community Services, said the principles of consumer-directed care were sound and should be maintained.
“I believe that everyone has a right to a choice,” she said. “Yes, I understand that the markets are thin in rural, regional and remote (areas), but I do not believe it takes away from the fact that consumers should have a choice.”
Jaclyn Attridge, head of Operations for Home and Community Care at Uniting NSW ACT, said consumer-directed care had significantly improved options for consumers.
“I don’t think a funding model should take that away,” she said. “You wouldn’t want to lose that underlying principle of choice and control for consumers by changing a funding model.”
Choice was critical to ageing in place with dignity, said Dean Chesterman, General Manager Branch for home and community care operations at Australian Unity which provides home care in the Mudgee region via its Aboriginal home care and disability services businesses.
But said discussions about equitable care in rural and remote areas were more important than questions about the funding mechanism.
Mr Chesterman said people in rural areas faced significant issues arising from limited access to services and a lack of skilled staff.
He said there needed to be “more responsive funding mechanisms” that allowed people to get the care they needed at the right time.
“The biggest challenge as providers that we have, to enable the correct service delivery, is going to require the right skilled workforce at the right time and in the right place.”
Ms Miller said people in remote areas often faced an unacceptable wait for services like home modifications. Some clients were waiting months just to have safety assessments done.
“We can often have clients who are waiting for six or seven months just to have the assessment, so therefore they’re in a bathroom that is considered unsafe,” she said.
Ms Attridge said deregulation and market competition had “squashed” traditional collaboration among community care providers.
“We don’t do that as much as we used to,” she said. “I think we’re kind of learning how to behave in a more marketised environment.
“Before … you would talk to other providers if you had a consumer that was in need that you couldn’t meet the need, you would pick up the phone and talk to the other providers to see what options were available.
“There were good networking opportunities there that don’t exist the way that they used to anymore.”
Meanwhile, the commission also heard that even if the problem of waiting lists, identified in the interim report as one of three areas requiring immediate action, was resolved overnight it wouldn’t fix the problem of unmet demand.
From an operational perspective, I thought, ‘Oh my God. Workforce’.
Ms Miller said without an adequate workforce, it didn’t matter how many packages were released.
‘When I read your interim report and heard that there were going to be more home care packages released, from … a client perspective, I thought ‘fantastic’,” she told the commissioners.
“But from an operational perspective, I thought, ‘Oh my God. Workforce’. For me then it’s about workforce, it’s around supply. It’s around ensuring that we look at it in totality.”
Mr Chesterman said if more packages are going to be released in the near future providers will have to have time to prepare.
“I think there’d need to be more transparency around when and where are those packages going to be released, so providers can be more proactive in setting themselves up in readiness for some of those changes,” he said.