A new discussion paper argues the case for mandatory HCP and CHSP contributions, saying this could help make the aged care system more sustainable.

Dr Nicole Sutton

Released by the University of Technology Sydney’s Ageing Research Collaborative, the discussion paper notes that the current aged care system is under stress and the situation is worsening.

Commissioned by peak body the Aged & Community Care Providers Association with the support of the Council on the Ageing Australia and National Seniors Australia, it’s hoped that the document’s release will spark an urgent conversation, the report’s co-author Dr Nicole Sutton says.

“We would like the paper to promote a frank, national policy debate on the sustainability of the aged care sector,” she told Australian Ageing Agenda.

Mandatory contributions

The paper makes a raft of recommendations, including some specifically addressing the home care sector.

At present many providers don’t charge the basic daily fee, and in 2019-20 HCP recipients contributed only $102 million, or just three per cent of the total program expenditure.

The report says more clarity is needed about the role of the basic daily fee payable for home care, and argues that “from both equity and sustainability perspectives”, there is a case for having a mandatory, income tested consumer care contribution for both CHSP and HCP.

The introduction of the new unified support at home program offers a chance to mandate a voluntary contribution, the paper says, but the current plans lack clarity on this.

The authors would also like to see a more detailed classification system under the new program, so services can be better matched with needs.

Supporting independence

Another way of improving long term sustainability of the aged care system is by supporting older people to maintain their health and independence, the paper says.

One way of doing this is to enable people purchase more non-subsidised top-up-services to help them age in place,

“Further investigation is warranted to understand the nature of the current and potential markets for non-subsidised aged care-related services and accommodation settings, and how they may be combined with services that are subsidised and regulated by the government.”

The report also recommends boosting the role of Nurse Practitioners and primary health networks in aged care, providing more restorative and transition services, improving palliative care, and supporting carers – including via subsidised respite care.

Spending to grow

The paper says government expenditure on aged care this year is expected to be $27 billion, or 1.2 per cent of GDP, growing to 2.1 per cent of GDP by 2060-61.

It warns that government forward estimates of aged care spending fails to take in several factors, including the growth of Home Care Packages beyond 2023 to address the ‘bulge’ in ageing baby boomers.

Against this outlook, data for HCP providers shows a tightening of financial performance in recent years. Prior to 2017, providers typically earned $3,000 a year per customer. That’s dropped to $1,369 in 2019–20.

Data from the first six months of the 2021–22 financial year show that the operating result of home care services has declined by 25.5 per cent compared to the same period a year ago.

The paper puts the recent decline in profitability down to a plateauing of revenue while costs have increased, particularly around care management, advisory administration and support.

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  1. What papers like this fail to take into consideration is that many of people currently on HCPs have significant disabilities. However, because they took on the HCP before the NDIS was adopted, they do not have access to NDIS funding to support the extra costs incurred in managing not just the consequences of ageing, but also of managing their disability related health issues. These people already incur significant additional costs in their day to day living. To further penalise them (particularly if their sole income is from a pension) is simply cruel.

  2. Consumers of aged care services must have more rigidity around what they can and cannot purchase using tax-payer funding. Gardening, questionable home modifications and equipment that is not explicitly responsive to an assessed ageing related condition. Passive aggression and threats to port from clients and family members if they don’t get what they want further complicate. Senior Executive managers who placate rather than stand their ground with these unreasonable claims thus rolling hard working case managers under the proverbial wheels. Case Managers are wedged between the clients demands and the scavenging of consumers in the marketplace by competition with senior management pressuring to retain market share. The department has still not released the most recent draft of guidelines into the community, due in Feb 22. Removing the tiered package system and replacing it with an assessed annual budget with specific services and goods approval rather than a ‘savings account’ will go a long way to addressing these issues without having to add an out of pocket cost to consumers. Packaged services were never designed to set up these under-spends now in the millions of dollars with the blame resting squarely with the designers of such a system. The ‘white-goods’ home care package phenomena is disgraceful when there are perfectly good options such as the NILS scheme for people who want electronics and appliances. Why is this not made mandatory? Senior advocate groups constantly complaining when people are not ‘given’ these supports points to a further lack of understanding of the scope and purpose of home care packages. I for one look forward to clarity with rules and to remove the bulge of entitlement that has crept into home care packages since 2015.

  3. Fantastic comment from above ‘hard working case manager’. I struggled with the ethics of supporting people with white goods and other regular maintenance costs that are part of living at home. when working in a HCP environment.
    I am strongly supportive of contribution to care costs. We do this through our lifetime whether it’s a mortgage, rent, utilities, etc. The system is unsustainable with its reliance on a subsidy and not good for the end user.
    We need more non-subsidised options or more wellness/reablement options like counselling to support older adults to continue living at home.

  4. Hardly unexpected. This is now a competitive market and we have all been schooled in how to get the best deal or whatever we can get! The companies have very been good at doing that. It was the potential to make a lot of money that was the carrot used to attract them. Whoever has more power squeezes the other and most often its the provider.
    Why don’t we turn it into a community-led service. We could make those who provide care directly accountable to the community by making them work closely with community bodies and local community government. Then we might both behave better and learn to trust one another. Anyone who didn’t would soon not be welcome! This would be a different sort of market, one where the community would support those who work well with them and might be happier to contribute personally or in taxes.

  5. The HCP program actually worked fairly well pre intro of MAC, idividualised spending and the competative marketplace(bar the transparency issues). All the focus was on support rather than SPENDING. There was less under utilisation of package funds. Now its all about money-from all sides. Case management is now funds administration and arguing with screeching family members. A lot of us who were execeptionally skilled and been doing this for years have walked away, as it became so disheartening & management everywhere offered little support. 60 % of my case load that were on Level 2 HCP’s in my last stint were using the HCP for lawn mowing & house beautification in the guise of Property maintenance-like pressure washing the whole outside of the house. Like, should the Government/Tax payer be responsible for mowing peoples lawns every 2 weeks?? But I wasnt allowed to fund podiatrist prescibed, individually made foot orthotics or shoes for someone with compromised mobility. Go figure. So many were on 3-4 levels and only had level 2 needs-but no way to take them backwards down a level. Any it is totally inequitable that a CHSP client pays $20-$30 a week for 3 showers, some SSI and DA and a HCP client pays nothing for the same services. Or the CHSP client has to pay for their grab rails and the HCP client doesnt. Half the clients with HCPs’s(Level 2 especially) who dont need them would hand them back if they had to cough up a weekly fee. The approved services list needs to be reigned in. There should be a co-contribution for all programs, unless you apply for hardship exemptions.

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