Address to COTA’s Transitioning to the Commonwealth Home Support Programme Conference
Could I acknowledge Ian Yates, COTA Australia Chief Executive who has partnered with Criterion to put on this conference.
One of the reasons I’m so pleased to be here is that this conference is focussing on home care and support.
So often at aged care events the focus is on residential care.
No one would deny that residential care is a very important component of supporting older people.
But older people tell me that they want to remain independent and in control. This generally equates to continuing to live in your own home and engaging with your community on your own terms.
And the program we are here to talk about today is designed to support older people and their carers to do just that.
The Commonwealth Home Support Program comes into being on 1 July this year.
As you know it will bring together the Home and Community Care program, the National Respite for Carers program, Day Therapy Centres and the Assistance for Care & Housing for the Aged program.
These four programs currently deliver similar services to people in similar circumstances under different rules and regulations.
The creation of the Commonwealth Home Support Program has been broadly discussed since its announcement in 2012.
But this Government’s focus over the last few months has been on providing greater definition. I was delighted to announce the new programme structure and its key features just before Christmas last year.
I know that Ben, who works in my Department, will go through this in more detail immediately following my presentation but I want to draw your attention to the headlines.
The CHSP will provide an entry level to aged care support. That is low level supports on a short term or ongoing basis or higher intensity services delivered on a short term or episodic basis.
The CHSP will be accessed through, and supported by, a central national assessment process delivered by the My Aged Care Gateway and Regional Assessment Services.
This will separate assessment from service delivery keeping the focus on individuals’ needs and goals.
The Regional Assessment Service will work with the person to determine the mix of supports they need to live in their home and refer on to services who can meet those needs.
This change will ensure that consistent, high quality assessment processes are used across 52 aged care planning regions in metropolitan, regional and remote locations across the country.
A central client record will be kept at My Aged Care – so important to stop consumers, their families or nominated representatives from having to tell their story over and over again.
A pilot will commence soon to iron out any bugs before the Regional Assessment Services commence operation on 1 July. I expect to be able to announce the successful tenderers shortly.
Funding for the RAS has been redirected from existing HACC Service Group 2 providers. This is possible because those services currently undertaking assessments will no longer need to do so.
I know this has been a cause for concern. That’s why I put in place a process to identify and reclassify any services funded within Service Group 2 that were not providing assessment, case co-ordination or case management but direct service delivery.
That process is almost finalised and I hope will smooth the way ahead because that separation of assessment and service delivery is critical to where the system needs to move in future … but more on that later.
The CHSP will operate under a streamlined programme structure with four streams – community and home support, carer relationships and support, assistance with care and housing and service system development.
Providers will benefit from these significantly streamlined funding arrangements, with less red tape, simplified grant agreements and more time to deliver important services for older Australians.
A national fees policy will be introduced. The policy will bring fee arrangements for home support and home care packages closer together.
This aims to address the disincentive that currently exists for those with higher support needs to move to packaged care where they can be better supported.
And there is an important principle with all of the aged care changes that it is appropriate and fair for those who can contribute to the cost of their care to do so.
There will of course also be protections for those who can’t afford to.
My Department has developed a discussion paper – with sector input coming from a NACA Advisory Group. That paper is available for comment now and I would urge you to take the opportunity to provide input.
The CHSP will be underpinned by restorative and consumer directed care philosophies.
Restorative care – sometimes referred to as wellness or reablement – builds on an individual’s strengths and capacities.
It enables people to remain independent by restoring or maintaining function so that people only have to ask for help for those things they can’t do for themselves or need some help to accomplish.
Some services already operate this way but for many this will be a brave new world which will require cultural change.
To assist with that my Department, working with a National Aged Care Alliance Advisory Group, has produced a Good Practice Guide. It’s been made available to assist service providers implement restorative care on a day to day basis with their clients.
This approach will be complemented by the implementation of the CDC philosophy. Giving people more say over the services they receive, when and how they receive them will keep the Commonwealth Home Support Program contemporary with the home care package program.
All of these changes are important and will undoubtedly improve the experience older people have with home support services and the processes and red tape required of providers.
These changes are reflective of the desire most in the sector have – be they a consumer, a provider or a Government Minister – to move aged care to a consumer led market orientation.
This has in fact been talked about now for some time.
Ten years ago my colleague, the Foreign Minister, in her capacity as Aged Care Minister, was foretelling that ‘a person needing care could, with advice from families and professionals, decide how to spend the dollars ear-marked for their long term care’.
This is what happens now in the NDIS.
It begs the question for me of why we haven’t done this in aged care for older Australians who have managed their lives for a lifetime.
Home care packages will be fully consumer directed from 1 July this year.
The intent is to give consumers more control,
- through identifying how much money they are entitled to; and
- how those dollars are spent
But government funding still goes to the provider.
Ultimately public and private dollars need to follow the person rather than the provider.
The easiest place to start this is in packaged care.
The next logical step is to give the consumer full control of their package and let them direct how and with whom it is spent to meet their assessed needs.
Why not let the packages we currently have – and the 80,000 new ones coming on line over the next ten years – operate this way and move a step closer to the consumer led market to which we aspire.
The flow on question is why we wouldn’t consolidate the Commonwealth Home Support Program and Home Care packages into one consumer directed funding program supporting people to live at home.
And this is where I want to head. However there are a couple of important riders on achieving this.
I’m aware that to keep some types of services available in the system we may need to continue a block funding model. This will be considered as we evolve our thinking.
In addition there are some areas – particularly in rural and remote areas – where a market can’t operate and other arrangements need to be put in place.
For all of the changes I’ve outlined – those that are being implemented come 1 July 2015 and those that are flagged for the future – we need informed consumers.
The My Aged Care Gateway is providing a new level of information and transparency about aged care services.
We know consumers are using the information to compare services and make decisions.
Their decisions are starting to effect market behaviour.
Residential care accommodation prices are starting to reflect other accommodation prices in the locale – as indeed it should, given it is an accommodation purchase.
We need this level of transparency for home care and support too.
My Aged Care needs to become the virtual market place where consumers and providers – or demand and supply – meet.
A Trip Adviser for aged care services.
This is why I have charged the Department to expand My Aged Care to list all aged care services whether or not they are government funded.
Implemented in stages as the IT is developed we will start to see other services listed from 1 July this year.
And finally we need a modern market quality system.
Traditionally when governments and sectors talk about quality they are really talking about safety.
Safety is critical but it isn’t the only – or even the most important – way to define and measure quality.
A more sophisticated definition of quality should be meeting or exceeding your customer’s expectations.
Ultimately the customer’s definition of what is quality is the only one that really matters.
And consumer choice is the ultimate aged care ‘safeguard’.
‘Trip Advisor’ style capacities on My Aged Care will develop ratings for the quality of providers and their services, according to what matters to consumers; rather than what Departments and providers think they should be.
And we should embrace this development while ensuring that safety is a given.
We have a collective and cultural challenge.
We need to design and deliver the Commonwealth Home Support Progam well and pass on those benefits I talked about earlier to consumers and providers.
But we need to do that with one eye firmly on the future – how the services delivered through the Commonwealth Home Support Program will form part of the consumer led market we are inevitably working towards.