3Respite & Aged Care Aged Care Reform history Productivity Commission inquiryLiving Longer Living BetterCoalition Government policyKey components of aged care reformMy Aged Care GatewayQuality ArrangementsHome Care PackagesCommonwealth Home Support ProgramImplications for Respite
4The Productivity Commission Report August 2011 Focus:Wellbeing of older Australians – promoting their independence, giving them choice and retaining their community engagementBalance:Individual responsibilityAffordability for taxpayersSafety net for those that need it
5Living Longer Living Better Released by Prime Minister 20 April 2012Complemented:Health ReformsNational Disability Insurance Scheme (NDIS)Response to Report on Economic Potential of Senior Australians
6Key Features of LLLB Reforms $3.7 billion package over 5 years ( )Only $577m new funding$1.6 billion taken from Aged Care Funding Instrument (ACFI) cuts in residential careOther measures, such as dementia supplements, funded by reducing basic subsidiesMarks further policy shift towards home careGreater emphasis on user pays5 Acts passed Federal Parliament June 2013 to enact aspects of Living Longer Living Better reformsGuide to Aged Care Law released September 2014
8Now the Aged Care Policy 5-year Healthy Life, Better Ageing AgreementBased on PC Caring for Older Australians report and LLLB reformsNegotiated with key stakeholders via Aged Care Sector CommitteeCut red tapeSo far removal of Federal building certification requirementPut $1.5 billion for Workforce Supplement back into general aged care funding2.4% increase in aged care subsidies and community programs from 1 July 2014$200 million for dementia researchAged care transferred from Department of Health & Ageing to Department of Social Services
9Aged Care: NDIS comparison Applies to people gaining disability aged 65+Applies to people gaining disability before age 65Individual budget only in HCP, with CDC budget handled by providerOnly individual budgets controlled by NDIA and person with a disabilityBlock funding remains in HACCLimited block funding in trial sitesResidential care remains, but reducing as proportion of aged careTransition away from institutional careSubstantial co-contribution required with use of home asset for residential care; government funds safety net from general taxationNo co-contributions but choice to pay for extra services; mainly funded via 0.5% Medicare Levy increase and general taxationAssessments by mix of ACATs, My Aged Care and service providersAssessments by NDIA
10Aged Care Gateway My Aged Care website and national call centre New regional assessment services for home support servicesTender expected shortlyACATs remain for access to Home Care Packages or residential careElectronic client record from mid 2015Initially in assessment services and call centreFurther trial of assessment tool around March/April 2015Linking service for people with multiple needs
11Quality Arrangements Australian Aged Care Quality Agency Assumed responsibility for home care on 1 July 2014Aged Care Commissioner powers strengthenedNational Aged Care Advocacy Program boosted by 20%Community Visitors Scheme expandedQuality indicators eventually onto My Aged Care website
12Annual Subsidy Level (2013-14) Home Care PackagesHome Care packages (HCP) adjusted up from 25 to 45 places per 1,000 people 70+Additional 84,538 Home Care packages over 10 years2 new levels of Home Care package (piloted over )Movement from HCP levels 1/2 to 3/4 requires ACAT assessmentAll Home Care packages to be converted to Consumer Directed Care from July 2015Home Care PackageAnnual Subsidy Level ( )Level 1$7,501Level 2 (formerly CACP)$13,644Level 3$30,003Level 4 (formerly EACH)$45,607
13Home Care PackagesDementia and Cognition Supplement for all HCP levels10% of basic subsidy funded by 2% reduction of CACP and EACH from 1 July 2013Estimated 26% of clients will qualify54% of veterans, with mental health condition verified by DVA, will attract Veterans SupplementUser charges from 1 July 2014Basic fee of 17.5% of Age Pension retainedIncome tested fee introduced, reducing subsidy paymentAnnual cap of up to $10,000 and lifetime cap of $60,000 on income-tested care feesHardship provision available
14Home Support ProgramCommonwealth Home Support Program (CHSP) to replace HACC, NRCP, DTC and ACHA from 1 July 2015Regular annual growth for HACC likely each year, and all elements of Home Support Program from July 20152014 Federal Budget has reduced future growth to 3.5% per annumNo change to HACC services until 2015Reviews of some HACC service types during 2013 / early 2014Respite careHome modifications and maintenanceMealsCommunity transportService Group 2 (assessment, case management, etc)
15NACA Home Support Advisory Group RepresentationNACA mix of providers, consumers, unions and professionalsComplemented by State & Local Government, specific HACC service type providersACSA represented by Carole Bain (Silver Chain, WA)PurposeProvide advice on establishment of Commonwealth Home Support ProgramHave released:Discussion paper on design of CHSPDiscussion paper on place of respite in CHSP
18Commonwealth Home Support Program DSS has released Commonwealth Home Support Program (CHSP) Discussion PaperReviews of HACC service types are also published on websiteDSS is working with HSP Advisory Group on Program Guidelines and Program ManualAnticipate opportunity for further comment on these documents later in 2014Sub-Group working on CHSP Fees Policy
19Comparison NACA / DSS NACA Area DSS proposal Comment Program Design (Vision)✖No single program; no individualised fundingGoal (Aim)✔Target Group & EligibilitySome concern re “basic support”PrinciplesNot articulated as suchService streamsExcept meals and transport stay separateReablement / wellnessConsumer directionOnly partial without individual budgetsTransitionKey areas acknowledged
20CHSP Key Directions It is proposed that the CHSP will: provide timely, basic home support services to frail older people and their carers, to help them remain living independently in the community - with people requiring higher levels of care eligible for Home Care Packages or residential aged care;streamline the home support system in order to cut red tape for providers and improve access for clients;increase sustainability through a more consistent approach to client fees;be underpinned by a wellness and reablement philosophy;be accessed through My Aged Care; andcontinue to build, and be informed by, a robust evidence base.
21CHSP: Consolidated Basic Support Program This will enable more older people to be able to access the care and respite services they need. Clients with more complex needs will be supported to transition over time to more appropriate levels of care such as Home Care Packages.There will be continuity for most service types, with some changes and consolidation based on the outcomes of service reviews conducted during Service providers will be funded based on output based block funding from 1 July 2015.Greater contestability will be introduced to ensure that client outcomes are maximised and that value for money is achieved.The amalgamation of three community aged care programmes and clarification of programme boundaries, such as a single set of eligibility criteria, will reduce administrative burden for service providers and improve client outcomes by providing more consistent and integrated care.
22NACA CHSP Design Service Streams Service/Outcome StreamExisting Service Types within the new streamsSocial Participation and AccessSocial Support, Centre Based Day Care, Community Visitors Scheme, and TransportHealth and WellnessAllied Heath services, Home Modifications, Goods and Equipment, Reablement, Massage, Nursing Services, Personal Care, Personal Services (hygiene), Meals, other Meal and Food Services and Day Therapy CentresCarer SupportHACC Respite, In-Home day Respite, In-home Overnight Respite, Community Access-Individual, Community Access-Group, Host Family Day/Overnight Respite, HACC Counselling (for carers), Overnight Community Respite, Mobile Respite, Other Respite, and Residential RespiteHousehold MaintenanceDomestic Assistance, Home Maintenance, Gardening and LinenService Innovation and System ResourcingService innovation and system resourcing not covered in the above streams including management of contracted/brokered services, system supports (e.g. training and development roles, aged services workers), etc.
25NACA Respite Recommendations Create Carer Support Stream incorporating NRCP, HACC respite and carer support, and residential care respiteServices with a respite effect but other major focus (e.g. centre-based day care) shouldn’t be in this streamConsumer direction philosophy should underpin service deliveryStreamlining of emergency respite accessExpansion of flexible respite, especially for working carers and special needs groupsLimit on amount of respite available per personEffective linkages with Home Care Packages, Carer Support Centres and Aged Care Gateway
26CHSP: Service Type Review Response Respite service types streamlined to threeFlexibleIn home day, in home night, host home day, host home night, individual community access and mobile respiteCottageEmergencyCommonwealth Carer Respite Centres fundingCentre-based day respite, residential day respite and group community access respite are proposed for funding under social participation outcome group as part of centre-based day care
27Carer Support LLLB flagged creation of Carer Support Centres DSS has commenced process to review how carer support might be structured across its portfolio of aged care, disability, mental healthFuture of HACC carer support services unclearWill they transition to CHSP or a new DSS carer support program?New model in place from July 2015
28CHSP: FeesA nationally consistent fees policy will be introduced from 1 July 2015.For clients this will mean a fairer system where clients of similar means will pay consistent fees (regardless of location) for accessing Commonwealth Home Support Programme services.For service providers the fee structure will acknowledge the differing cost drivers of service types, for example, home modifications may have a different fee structure to domestic assistance.
29CHSP: ContestabilityContestability implemented with following considerations:Transition of Vic and WA HACC services to Commonwealth;Existing capacity to operate new services and programme infrastructure;Whether all service types are suitable for tendering (e.g. Meals on Wheels with a high volunteer contribution);The feasibility of tendering minimally funded services (e.g. where an organisation receives less than $50,000pa); andTrialling different approaches to contestability (such as ‘cashing out’ respite funds to carers/consumers).Contestability will apply to: new Regional Assessment Services; Sector Support and Development roles; (most) growth funding
30CHSP: Transition Clients with high level needs People under 65 NRCP carers of clients under 65HACC Service Group 2Assessment to My Aged CareCase management to My Aged Care (short-term) or Home Care Packages (long-term)Client care coordination removedClient counselling to allied health / therapyInformal counselling, support and information to My Aged CareAdvocacy to National Aged Care Advocacy Program
31Implications for Respite Services No one’s funding is guaranteed past 30 June 2015However, change in aged care is likely to be evolutionary, not revolutionaryWhile details are still to be settled, scope of home care and home support programs is becoming clearRespite will be a part of CHSPAre you ready?To go it alone?To partner with another organisation?To merge if necessary?
32Useful linksNational Aged Care Alliance Australian Department of Social Services Aged & Community Services Australia