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Wednesday, June 29, 2022

NARI says home care system in desperate need of comprehensive reform

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Home care package funding will require full, systemic overhaul to ensure long term sustainability, according to a position statement released today from the National Ageing Research Institute (NARI).

The document analyses the Federal Government’s responses to key recommendations of the Royal Commission into Aged Care Quality and Safety in relation to home care, and identifies where more could be done.

Based on its research and experience in the aged care sector, NARI says systemic, rather than incremental reform, of the home care system, is crucial, including:

  • Transition to a needs-based system of funding and delivering home care services where older people do not need to wait to access the care that they need;
  • Funding that is personalised, flexible, and closely aligned with the individual needs of each older person (under a model that takes the form of individualised budgets or case-mix classification);
  • The introduction of a more streamlined flexible process of needs assessment to improve the experience of older people accessing home care services; and
  • Mechanisms that assist all older people to navigate and access the home care system and make informed choices, including the introduction of a network of care finders and improved quality regulation measures such as star ratings.

Associate professor Frances Batchelor, director of clinical gerontology at NARI, said the royal commission highlighted the fact that Australians increasingly are wishing to remain at home.

“But the current aged care system is not providing adequate access to services and supports to help them remain at home,” she said.

Associate professor Frances Batchelor, NARI principal research fellow and director of the clinical gerontology division.

On average there are about 100,000 older Australians on waiting lists for home care packages, with many waiting more than 12 months before their applications are granted.

Whilst the Federal Government has committed to issuing an extra 80,000 home care packages over the next two years to address this backlog, Batchelor said this will only provide “temporary relief”.

“Without substantial change to the ration-based system, the waitlist will only build up again as more and more people require aged care at home into the future,” she said.

NARI’s position indicates that sustainability of the system will rely on not simply more money flowing into the system, but of fundamental shift in the economic philosophy.

Instead of the rationed system currently in place, NARI suggests a needs-based, entitlement system.

Where the Government’s current system caps the supply of packages at a certain number, NARI’s ideal system would see continuous supply as per community demand, which would effectively abolish waiting lists.  

“Funding needs to be better distributed so it is allocated in a more cost-effective way, to ensure every person in need of care at home is able to receive it, when they need it,” Batchelor said.

Batchelor told Aged Care News that the current bundled payment system is part of the problem.

“Allocating funding as a fixed figure means there is no flexibility, and the care is not truly tied to the unique needs of each older person.

“A case-mix model would mean funds can be better targeted and tailored for a person’s individual needs.”

Economic modelling suggests that by the year 2050, there will be need for just under four million Home Care Packages (HCP) and Commonwealth Home Support Programs (CHSP).

When asked if this would be fiscally feasible under a needs-based system, Batchelor told Aged Care News that whilst such planning is ‘a matter for Government’, a comprehensive cost-benefit analysis suggests it is a necessary step in ensuring the sustainability of the whole health-care system.

“I think what’s important to consider is the alternative if home care is not properly funded,” she said.

“It will result in downstream effects on health care, and premature admissions to residential aged care – which would be more expensive in the long run.”

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