The Support at Home Shitstorm
5 minute read
Content warning: if you are seeking the sweetness and light version of thinking on the Support at Home roll out, please read no further. If swearing offends you, sorry, you have already read too far…
I’m tired of the sector playing nice about the constant government stuff ups in home care. Someone has to call it - the Support at Home rollout is a steaming, confusing, exhausting mess. The kind of mess that makes experienced providers question their future in the sector, sends trusted staff to seek calmer waters, and leaves older Australians - those at the heart of this whole reform - uncertain and anxious.
And we're less than three months out from go-live.
A plan built on promises (and not much else)
When the Royal Commission called for a unified aged care system, many of us thought the long promised policy might finally happen. A single program. Simpler access. More flexibility. A genuine emphasis on supporting older people to live at home.
Instead, we waited and waited until we got version 15B of a reform plan no one fully understands, built on pricing that providers have to set themselves, with IT systems no one can access, and operational requirements that grow more complex every week.
To make things really tough, on top of all the change and complexity providers got cuts to operating budgets just when they needed financial support for implementation. Those cuts will soon be implemented to care management and package management fees will disappear altogether. Ouch!
Providers are not okay
We've heard from hundreds of providers across Australia, and they're telling us: morale is low, patience is thinner, and burnout is rising. They're working overtime trying to plan for a program that's still being built. They've attended so many DOHAC webinars that promised clarity but delivered more complexity and ambiguity. They're fielding calls from clients asking about the future of their services - and having no answers.
Smaller providers in particular are looking down the barrel of withdrawal. They simply don't have the margins or reserves to gamble on reform by faith alone. Some are holding out for "transition support" that hasn't been explained or funded. Others are already plotting mergers or exits.
Regional and remote services will get to apply for ‘thin market’ top up grants. Seriously? This is the new ‘system’ that they have spent so many years designing?
The forgotten consumer
Let's not forget who this is all meant to serve: older people. And yet, their voices have been drowned out in the reform noise. They're not hearing about increased choice or flexibility. They're hearing that the service they've relied on for years might soon be wrapped in red tape or disappear altogether.
They are now finding out that the new ‘Support at Home’ home care package pricing is so low it incentivises older people to move into residential care at the end of their lives. The cap on home mods is so low it will prematurely force people out of their homes. Plus the new system limits the time for palliative care at home. If you don’t die quickly enough then it’s residential care for you too.
The government promised a system that empowers older Australians. Instead, they're getting a confusing alphabet soup of new terminology, eligibility hurdles, package and service caps. It sucks.
Set your own price?
Let's take a moment to appreciate the absurdity of this: providers are being told to set their own prices, without consistent guidance and without a functional system to communicate those prices to clients.
How do you model your business viability when the rules keep shifting? How do you recruit staff when you can't explain the funding model? How do you prepare for July when you're still waiting for April clarity?
How do you contain your frustration?
Care Management cap and Package value
It's impossible to deliver high-quality support when providers are expected to deliver care management under a capped fee that doesn't reflect reality. Providers know the cap needs to be increased and the total package value dramatically lifted if the government is serious about empowering older people to live independently at home. But perhaps they’re not-so-serious about it at all?
The "Readiness" paradox
Let's play a quick game: take a shot every time you hear the word "readiness." Or maybe don't - you'll be under the table in 10 minutes.
The government says it's listening. That it's consulting. That providers will be ready, meanwhile:
there was no money for transition support in the March Federal Budget (except for a very big bundle of cash for government agencies)
the Support at Home ICT system doesn't exist in a usable form and the $10,000 for providers for ICT transition is just insulting - costs will far exceed that amount
key operational guidance is yet to be written
It doesn’t take Nostradamus to know that the new system will not cope with a massive increase in the required reassessments for 8 ongoing classifications and 3 short-term classifications. And how on earth will it cope with the projected increases in home care packages including the 83,000 new packages in 2025-26?
Just like the NDIS - the systems won’t cope and it will be providers who cop the brunt. And just like the NDIS the Government will shift the blame to providers when the media picks up on the implementation mess.
Sorry for being so negative so far, but bad news is things just got a little worse. The sector is now in limbo. With the government in caretaker mode, it’s really unclear what level of detail we’re going to get over the next month or more.
We deserve better
So here’s some basic stuff that needs to happen immediately (and should have happened a long time ago). The Government must:
Immediately release the final Support at Home rules
Increase the care management fee cap, increase total package values and increase the cap on home mods.
Provide some serious transition support funding for providers
These are bare minimum requirements if the Government is sincere about assisting providers to create support at home for older people.
Severe weather warning
This sector is full of smart, committed people doing incredible things in an increasingly broken system. We can't keep pretending that "reform" is progress if the foundations are not there. It’s time to stop being passive and playing nice in this sector. It’s way past time to say it like it is and call for change.
This is not just a minor squall we are experiencing, it's a full-blown shitstorm.
Postscript: In 2016 I wrote ‘Shitstorm - A Short History of the Implementation of the NDIS’. I did not have any unique foresight - I simply detailed the things that were going wrong in the NDIS and the likely mess that was coming. What I did that was different back then was say it out loud, everyone else was being nice. It’s 9 years later and I have been given a lot of advice that the aged care sector will not appreciate this style of frank assessment. Well, I’m over being nice - you can decide for yourselves.
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