Home Care providers have expressed concern that the flurry of work being done by consultants as part of the government’s response to the Aged Care Royal Commission isn’t going to produce the home care system Australia needs.
The federal government has engaged the Boston Consulting Group to carry out an Australia-wide survey of providers to assess their readiness for change as part of its response to the royal commission.
It has also contracted business management consultants HealthConsult to develop a new support at home category to replace the CHSP and HCP systems, including developing an assessment, classification and funding model.
In a panel discussion during LASA’s Home Care Virtual Forum on Wednesday, Community Vision CEO Michelle Jenkins said unless providers own the reform process, they won’t get the outcomes they need.
“I think if we wait for the government and all the consultants to come back with what they think is right, we going to get a different version of what we’ve already got,” she said.
“And I don’t believe it’s necessarily going to be the best outcome for consumers.”
Not enough emphasis on outcomes
ECH CEO David Panter said a major concern about the approach being taken by the consultants was their emphasis on collecting data on inputs, rather than outcomes.
“I don’t understand how this sort of study gets a grip on value for money without looking at the cost of inputs and the value of outputs achieved by those inputs,” he said.
Ms Jenkins said the government currently has some 70 projects underway “with all these consultancies doing little bits”.
“It’s like putting a jigsaw together when you’ve got pieces missing,” she said. “And the pieces are the outcomes for consumers, and the input that providers can have in the process to make sure we get something that is going to work for us and be sustainable.
“I don’t think we’re going to get that.”
Care Connect CEO Paul Ostrowski said there was a sense the whole consultation process was a fait accompli.
You get the assumption that when the questions come to us a lot of the assumptions have been made.Paul Ostrowski
“You get the assumption that when the questions come to us a lot of the assumptions have been made that ignore the complexities around the delivery of care,” he said.
“At what point do we down weapons and come together and have a real conversation?”
People ‘forced’ in to residential care prematurely
Mr Panter said home care in Australia is underdeveloped compared to his home country of the UK and aged care policies here were sending older people into residential care prematurely.
“It’s about policies, it’s about incentives, it’s about ways in which the system is designed that … enables people to enter residential care prematurely,” he said.
He says ECH has been looking at ways that home care providers can help people remain at home as long as they want, and if desired, die good death at home.
Having higher level home care packages, providing an onsite, salaried GP service and having a closer interface with emergency departments and ambulance services to reduce hospital admissions are all potential ways of enabling home care providers to support people remaining in their homes, Mr Panter said.
Recognising the importance of active care management is also crucial, he said.
“It annoys me when the department of health describes care management as ‘case management’ and ‘administration’. For us it’s not that, its an active process that really makes a difference and helps people stay longer at home.”
The panel also heard that having a better home care system would prevent family members putting loved ones into care because they felt guilt about not being able to look after them properly.
I often wonder how many of our parents or grandparents end up in residential care because we are concerned that we can’t be there often enough to support them”.Paul Ostrowski
“I often wonder how many of our parents or grandparents end up in residential care because we are concerned that we can’t be there often enough to support them. Maybe we need a home care system that addresses this anxiety,” Mr Ostrowski said.
Mr Panter said providers needed to put “a huge amount of pressure” on the health department to make sure it gets home care redesign right.
“Unless we see the emphasis on active care management, unless we see an understanding of what is possible within the home environment, it’s going to be very easy for us to end up with a new home care program that does not bring the benefits that older Australians are looking for,” he said.