New Home Mods Scheme Falls Short
5 minute read
Home Modifications Australia (MOD.A) is calling for an urgent review of the $15,000 lifetime cap for home modifications under the Government’s new Support at Home program, warning it will push many older Australians prematurely into residential aged care, increasing taxpayer costs and reducing quality of life.
The peak body representing the sector believes the funding cap will result in many older people being unable to remain living in their homes.
According to MOD.A Executive Director, Steve Pretzel, the Commonwealth government spent $16.3 billion in the 2023 financial year on 185,000 older people in residential aged care - a per resident cost of over $88,000. “On this basis, an older person forced out of their home and into residential aged care just three years prematurely would cost the taxpayer over a quarter of a million dollars. Appropriate modifications, often introduced progressively to follow the gradual functional decline of an older person, can add years of safe and independent living at home. It’s easy to see the value in that.” said Mr Pretzel.
Avoided medical costs is another area of significant economic benefit that MOD.A claims the funding cap fails to acknowledge. A 2021 study by the Australian Medical Association (AMA) reported annual savings of $4.5 billion could be made from potentially avoidable admissions to private and public hospitals from older people in the community.
Mr Pretzel explains: “For older people the bathroom is often considered the most dangerous room in the house. The combination of slippery surfaces, water, and the need to navigate small spaces can lead to falls, which are a significant risk for older adults. Bathrooms are particularly hazardous because falls here are often associated with severe injuries such as hip fractures, head trauma, and other serious complications. Apart from the obvious social cost, the cost to the community of the hospitalisation that often results from these types of falls is very significant.”
One of the most commonly prescribed home modifications is the removal of a bath, or the lowering or removal of a shower hob. These modifications enable an unsteady person to shower more safely and with greater dignity. When it becomes necessary to have someone support them in this task, a level access shower facilitates a walker or chair, and reduces the risk of injury to a carer.
This type of modification is often complex and will usually well exceed the arbitrary $15,000 cap. Preliminary data from a recent survey conducted by MOD.A indicates a typical price range of between $23,000 and $37,000 for this type of work. Notably, this work would be a net economic benefit if it delayed entry into residential care by only six months.
The proposed funding cap would rule out this type of modification for older people unable to self-fund the difference.
And the bathroom is just one of many areas of the home where home modifications are important. If one area is modified to address mobility issues, it is likely that other areas such as safe access to and from the home will have to be done too. People may skip doing the access modification so that they are safe in the bathroom but will be confined to the home and need services everytime they want to enter and leave for appointments; or if they choose the access modification, then they will may need services to assist with bathing and toileting etc, which may involve even more support than providing care support to get in and out of the home.
MOD.A is concerned that the home modifications provisions of the new Support at Home program are a significant retrograde step, despite the government’s promise of ‘nobody being worse off’. This is because under the current Home Care Packages program funding recipients can accumulate part of their funds over several years to pay for these more expensive but potentially life changing modifications. MOD.A survey respondents indicated that the vast majority of their Home Care Package clients used accumulated funds to pay for their home modifications. However under the new Support at Home program funds can not be accrued - the $15,000 limit is for life.
Mr Pretzel believes that this aspect of the new program will have other unintended consequences: “If an older person knows that they have only one opportunity for government-funded home modifications, many will likely reject clinically recommended, even simple, modifications now in order to preserve their funding on the basis that they may need something more substantial later. It will be tragic if some of these people then have a fall that could have been avoided and end up in residential care prematurely, or worse.
MOD.A argues that the economic benefit is just one aspect of the need for better recognition of home modifications.
“Moving to residential care prematurely is not only a poor outcome economically, it can also be a poor outcome socially. Surveys of older people continually demonstrate that ‘ageing in place’ is a preferred outcome. People want to stay living in the homes they are familiar with, with the furniture and mementoes that are important to them, in the suburbs they know and amongst their neighbours and friends. More importantly, these are the places of their most cherished memories - of children growing up, of milestone events.” says Mr Pretzel.
MOD.A cites several other concerns that need to be addressed: “There is no mention of the $15,000 limit being indexed to rising construction costs; the funding is set to include the costs of prescription, training and ‘wrap around services’, further diluting its effectiveness; and the government’s ‘solution’ to funding more extensive modifications requires homeowners to take out loans or equity release arrangements to pay any excess. On this last point, evidence from MOD.A members and survey responses indicates that in the majority of cases people without the financial resources to pay the gap will forego the modifications rather than enter into any form of debt at a late stage of life.”
Mr Pretzel is particularly disappointed about the way the $15,000 lifetime cap on home modifications was a last-minute inclusion in the program.
“The first we heard of the funding cap was the day before the Minister’s announcement in September. The announcement was unexpected, undermining two and a half years of constructive consultation. It goes against the principle of needs based assessment, it fails to recognise the progressive nature of functional decline in older people, and it will result in many older Australians being forced out of their homes and into residential care prematurely.”
With just over 6 months before the introduction of Support at Home, and two and a half years before the retirement of CHSP, MOD.A is hopeful that a more equitable solution can be found that will live up to the promises of the new aged care system.
MOD.A is urging the government to reconsider the cap and work collaboratively with industry stakeholders to implement a needs-based, flexible funding model that truly supports ageing in place.
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