Home care reforms and older people—well-intentioned, but not well-informed

Thursday, August 9, 2018

‘Reforms to home care arrangements for older people are well-intentioned—but have led to some problems’, Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven said today.

‘Tied in with this is a serious lack of national data to properly evaluate the impact of these reforms—in short we don’t know what’s truly going on beyond gut feeling and a few limited surveys.’

The AHHA has released an Issues Brief through its Deeble Institute for Health Policy Research, The impact of the home care reforms on the older person, the aged care workforce and the wider health system.

Author of the Issues Brief, Dr Mikaela Jorgensen from the Australian Institute of Health Innovation at Macquarie University, said the Australian aged care system was currently ‘in the middle of an overhaul’.

‘A 10-year reform plan was released by the Australian Government in 2012 aimed at creating a sustainable, consumer-driven and market-based aged care system.

‘Many of the policy changes have focused on packaged home care services, which provide support for older people who are eligible for residential aged care to remain in their own homes.

‘For example, the My Aged Care contact centre and website were created to simplify and improve access to this kind of care for older people and their carers.’

‘While government surveys show satisfaction with the My Aged Care contact centre and website is around 77–79%, non-government surveys have the figure at 54%.

‘We also wonder if the My Aged Care website is truly fit-for-purpose when over 50% of people aged 65 and over in Australia do not use the internet regularly, and 42% of those aged 80 and over have never used it.’

Ms Verhoeven said the Australian Government’s Home Packages Program ‘has been welcomed in most senses—except for the waiting time to get onto the program at an approved level of care’.

‘The number of places available is capped by the government. At the end of last year 105,000 people were waiting, 27% of them for more than a year. The total number of people in the queue is greater than the number receiving care.

‘Something needs to be done about this underlying mismatch. Removing the cap on the number of home care places would ideal—but we don’t know the fiscal impact because it is impossible to estimate the true unmet demand for packages in the community. This is because the data needed are simply not available.

‘One potential solution could be to add questions around the need for formal aged care services to the ABS’s regular Survey of Disability, Ageing and Carers’, Ms Verhoeven said.

‘Another major reform was the change to awarding home care packages to individuals rather than providers. One big problem is that there are currently no sources of information on quality so that people can choose among providers. Some people complained about the administrative fees charged by providers (up to 40% of the total package). Others saw their new administrative and financial responsibilities as burdensome rather than empowering.

‘And there are differences in people’s abilities to exercise the choice and control afforded them under this reform—for example, many people surveyed as part of the My Aged Care evaluations were not even sure whether they were receiving a home care package’, Ms Verhoeven said.

Dr Jorgensen’s work was supported by AHHA, and Brisbane North and North Western Melbourne Primary Health Networks, through a Jeff Cheverton Memorial Scholarship at the Deeble Institute.

The Issues Brief is available on the AHHA website here

The Australian Healthcare and Hospitals Association is the national peak body for public and not-for-profit hospitals, and community and primary healthcare services.

Media enquiries:  Alison Verhoeven

Chief Executive, Australian Healthcare and Hospitals Association

0403 282 501