There is a legitimate case for older people receiving care at home to hold an unspent funds balance, write Troy Speirs and Tim Hicks.

Tim Hicks

The Royal Commission into Aged Care Quality and Safety recommended an entitlement-based funding approach for the future Support at Home Program where subsidised care and support is matched to the needs of older people living at home.

Older Australians will receive an assessment to identify their care and support needs, approving funds allocation. An individual support plan will then be developed that includes the right types and amounts of funded care and support.

These individual support plans will be fine-tuned and collaboratively implemented by service providers and care-recipients. They may change over time as care-recipients become more aware of how services can best meet their needs or as these needs change.

Unspent funds

Research suggests that home care package recipients currently accumulate an average 10 to 20 per cent in unspent package funds while accessing care and support. This compares with the National Disability Insurance Scheme (NDIS), where unspent funds have ranged between 50 to 25 percent, reducing across the term of program participation as participants learn through their experience in collaborating with service providers to choose the right types and amounts of care and support.

There is a legitimate case for older people receiving care at home to hold an unspent funds balance. Their care needs may change, sometimes quite quickly. They need some flexibility to increase the amount of care and support they access at such times.

A small overallocation of funds for care and services above assessed need could be built into future program design. This level of flexibility in funds allocation would substantially reduce the demand for rapid reassessment and review of changing care needs.

This will also help reduce wait times for reassessment and review while the assessment workforce prioritises completing timely assessments of people needing care.

Demand for assessment workforce

Evidence indicates that over a near 12-month period, demands on the assessment workforce for review and reassessment following an initial assessment can account for between half to a third of all care-recipients receiving an initial assessment. Including funds overallocation into the Support at Home Program design makes sense. It will ensure care-recipients and providers can respond quickly where changes to care and support demand it.

Troy Speirs

The ability of care-recipients to choose when and how they spend their care funds is certainly a strength of the current home care package program. It has provided care-recipients flexibility to plan with service providers how they receive care and support.

There are, however, some rules that limit how funds are spent. For example, general expenses such as food can’t be paid for with home care package funds. The preparation and delivery of food, however, can be paid for with these funds and costs must be separated out.

Where government rules on how funds can or cannot be spent are unclear this has often created confusion for both care-recipients and service providers. How flexibility for care-recipients in choosing their care and supports will be integrated into the design of the future Support at Home Program remains to be seen.

We don’t want people being tightly restricted by an assessment process that sets out exactly what they can receive and gives no flexibility for choice.

We don’t want people being tightly restricted by an assessment process that sets out exactly what they can receive and gives no flexibility for choice. We also don’t want the restriction of care manager capability to adjust supports as a person’s needs change.

We cannot have a situation where people need to go back and be reassessed if they want to switch their supports around, or if there is a sudden change in their level of need – such as a fall or a carer going on an extended break.

We know from the NDIS that efforts to closely restrict the supports that are available to people just don’t work, and the are inconsistent with consumer directed care principles.

Pricing flexibility

Another element of flexibility is differences is prices. Care-recipients will notice that prices for care and support will be slightly different when comparing one service provider to another.

We need to allow these differences if we want to ensure there is flexibility for people to make choices. One person may prefer to pay a lower price for less experienced care staff that gives them flexibility to spend money elsewhere.

Another person may prefer to have only the most experienced staff delivering care to them – and price differences are vital in accommodating these choices. It should be remembered that fixed price controls, like those used in the NDIS, were only ever meant to be temporary up until the program reaches market maturity. LASA’s Home Care Price Regulation and Market Stewardship research report provides evidence of such maturity in home care.

On a final note, care-recipients need not only information on provider prices for care and support but also information on the experiences and outcomes that other care recipients have had with different providers.

This type of detailed information can help care-recipients considerably, informing their choices in accessing care and supports within an active home care marketplace.

* Troy Speirs is LASA Senior Policy Adviser and Tim Hicks is LASA General Manager Policy and Advocacy

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