Regional providers reject return to block funding
Regional community care providers have rejected a return to block funding, saying the benefits of consumer directed care are too important to give up.
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.
Equitable care
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.”
Waiting lists
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.
Of course they don’t want block funding they are in the business of providing services via packages.
We keep hearing can’t get staff in rural and remote area’s and the reason is people want permanent work 6 to 8 hours at a time, not an hour here and an hour there which is what you get providing care for clients on Home Care Packages.
A block funded organisation knows what its budget is, it can hire permanent staff on permanent hours and have the staff available as required.
From personal experience Block Funded organisation work together for the betterment of the clients rather than competing against each other for the available dollars.
I have lived and worked in Rural and Remote communities for most of my life and the Home Care and Personal Care Workers are trying to get permanent hours in the local Aged Care Facilities or supermarket to have a guaranteed income.
Try getting a home loan when your pay slips show you work 30 hours one week and 10 hours the next because some of your clients are in hospital or in respite.
The role out of Home Care Packages into Rural and Remote areas is creating Working Poor amongst the workers and clients going without care as the Home Care workforce look for permanent work else where.
Why can’t you have choice and control in a block funding model?
The Principles should apply across any funding stream!
This is so far from the truth, I am shocked that this has been printed.
Far less choice for clients, the package providers make the choices, no consistency of service or support workers.
Support workers treated badly could go on and on!
They exist for profit not the clients best interests.
Perhaps someone could enlighten me about how choice is eroded through block grants? As long as reputable providers exist, with access to funds to meet client needs, the system would work out fine, particularly with regard to workforce issues mentioned above.
I think the existence of unspent funding is yelling at us that there is underservicing within existing packages or the allocation of individual funding is too high in many instances.A very inefficient use of resources.
Does it need to be complex? No.
A move back to a fee for service model, with a notional advance payment, works fine.
As clients take up approved packages, the provider is automatically funded through its fee for service. No doubt remote consumers can be protected against any price gouging if providers are thin on the ground but often market forces will take care of this in any case.
Concentrate on making providers accountable through quality governance, training, client outcomes and responsiveness KPIs and the ordinary providers will leave the home care space.
What is left? Not a race to the bottom but a race to the top where value for money and quality care becomes the norm, not a false narrative that CDC gives clients more choice.
live regionally and looking for in-house respite and have a level 4 package -cant do, only 1 service provider and have been told not enough staff and insurances prevent staff doing overnight respite. We have to pay more for individual social support as no group activities available – so much for consumer choice!