Limited Support at Home
4 minute read
The headline statement for Support at Home on the Department of Health website declares that it ‘will better support older people to remain independent at home’. Now that the Bill has been introduced to Parliament and more detail is available, we can compare what they’re offering to what we were hoping for. Suffice to say, we’re underwhelmed.
The current challenges
The limitations of the home care package program are well understood. Once a person’s needs extend beyond $61k per year, if they cannot afford to self-fund additional support, their only option is residential care. Right now, some have no choice but to remain in hospital until a place becomes available. Often, the saving grace is the ability to top up using unspent funds from earlier years when a person’s needs were lower.
This was the case for our customer Robin, whose unspent funds allowed her to extend her hours of support to morning, noon and night for a time. The funds only just stretched this far, leaving nothing for gardening, community access, personal products or equipment.
Robin was happy because she remained at home where she felt comfortable and safe, supported by a team who’d been with her for over a decade. The team were well equipped and trained to meet Robin’s needs, which were not complex, just higher in volume than before. When the unspent funds ran out, and with no family nearby, she was forced to move into hospital and eventually into residential care.
What we were hoping for
Under current average national rates, what it would have taken for Robin to remain at home receiving three visits a day is a minimum of $100k per year. A little more would allow for some community access and additional purchased products and services.
Given how common this scenario is, we were hoping for the classification levels to reach at least this amount. It would have kept Robin home for at least a couple more years until she chose to enter residential care. And it would’ve released some pressure on hospital beds and residential waitlists.
What we’re getting
When we first heard the classification levels for ongoing care were increasing from four to eight, we were optimistic. However, on closer inspection, the highest level offers a maximum of $78k per year for ongoing support. That’s just $17k more than the current maximum.
At the current national average hourly rate (bumped up 10% for package management which, we’re told, will be absorbed into hourly rates), that’s an extra 4 hours of standard weekday support per week. Not enough to give Robin the full support she needed, and certainly not enough to add the community participation elements that would support her to live a full life. Absolutely not enough to purchase any additional services like gardening or consumables such as continence pads.
Under Support at Home, Robin would no longer have unspent funds from earlier years to help top up her supports for a while either. Budgets will be released quarterly with a maximum rollover from one quarter to the next of $1,000 (that’s a whopping extra hour a week for the quarter!).
There are two short term classifications available to supplement funding at certain times. The ‘Restorative Care’ pathway provides for around $6k per episode for a maximum of 2 episodes per year for additional support including allied health. This may apply upon discharge from hospital for surgery, for example.
The ‘End of Life’ pathway offers up to $25k over 12 weeks to a person whose life expectancy is estimated at 3 months or less (should they live longer, the maximum extension to this funding is 4 weeks before they revert to their ongoing funding classification!). So, it’s horrible to say, but you have to be dying (and quickly) to get the sort of support we think a lot of people need.
Finally, assistive technology and home modification funding is available on top of the ongoing funding, up to a maximum of $15,000 each.
Unfortunately, none of these additional ‘buckets’ are available to increase ongoing care to the level required by someone like Robin so that she may remain in her own home for longer.
Support at Home would also require Robin to contribute 5% towards her personal care and 17.5% towards everyday living (such as domestic support). That equates to about 15% of her fortnightly single pension. Under the HCP program, no personal contributions were required.
And with care management slashed to 10% of the subsidy from its current cap of 20%, providers will have half the capacity to support their customers to navigate these changes. We haven’t yet seen how much more we’ll be squeezed by the imposed price caps.
If the headline statement and the goal of Support at Home was to ‘better support older people to remain independent at home’, I’m afraid it has woefully missed the mark. If the goal was really to reduce the cost to government by claiming more from older people and paying less to providers, then there were far simpler ways to do it.
If you’d like to hear more of what Lynsey has to say, she’ll be speaking at the upcoming Preparing for Support at Home Essential Briefing for Home Care Providers.
If you’ve got something to say and think Invox is the right place to say it, please let us know. We might be the right platform to publish your thoughts or concerns.
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