1. What is the Future of Respite in Aged Care?
Paul Sadler, CEO, Presbyterian Aged Care NSW & ACT,
Chair NACA/DSS Home Support Advisory Group
National Respite Conference, Parramatta, October 2014

3. Respite & Aged Care Aged Care Reform history
Productivity Commission inquiry
Living Longer Living Better
Coalition Government policy
Key components of aged care reform
My Aged Care Gateway
Quality Arrangements
Home Care Packages
Commonwealth Home Support Program
Implications for Respite

4. The Productivity Commission Report August 2011
Focus:
Wellbeing of older Australians – promoting their independence, giving them choice and retaining their community engagement
Balance:
Individual responsibility
Affordability for taxpayers
Safety net for those that need it

5. Living Longer Living Better
Released by Prime Minister 20 April 2012
Complemented:
Health Reforms
National Disability Insurance Scheme (NDIS)
Response to Report on Economic Potential of Senior Australians

6. Key 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 care
Other measures, such as dementia supplements, funded by reducing basic subsidies
Marks further policy shift towards home care
Greater emphasis on user pays
5 Acts passed Federal Parliament June 2013 to enact aspects of Living Longer Living Better reforms
Guide to Aged Care Law released September 2014

8. Now the Aged Care Policy
5-year Healthy Life, Better Ageing Agreement
Based on PC Caring for Older Australians report and LLLB reforms
Negotiated with key stakeholders via Aged Care Sector Committee
Cut red tape
So far removal of Federal building certification requirement
Put $1.5 billion for Workforce Supplement back into general aged care funding
2.4% increase in aged care subsidies and community programs from 1 July 2014
$200 million for dementia research
Aged care transferred from Department of Health & Ageing to Department of Social Services

9. Aged Care: NDIS comparison
Applies to people gaining disability aged 65+
Applies to people gaining disability before age 65
Individual budget only in HCP, with CDC budget handled by provider
Only individual budgets controlled by NDIA and person with a disability
Block funding remains in HACC
Limited block funding in trial sites
Residential care remains, but reducing as proportion of aged care
Transition away from institutional care
Substantial co-contribution required with use of home asset for residential care; government funds safety net from general taxation
No co-contributions but choice to pay for extra services; mainly funded via 0.5% Medicare Levy increase and general taxation
Assessments by mix of ACATs, My Aged Care and service providers
Assessments by NDIA

10. Aged Care Gateway My Aged Care website and national call centre
New regional assessment services for home support services
Tender expected shortly
ACATs remain for access to Home Care Packages or residential care
Electronic client record from mid 2015
Initially in assessment services and call centre
Further trial of assessment tool around March/April 2015
Linking service for people with multiple needs

11. Quality Arrangements Australian Aged Care Quality Agency
Assumed responsibility for home care on 1 July 2014
Aged Care Commissioner powers strengthened
National Aged Care Advocacy Program boosted by 20%
Community Visitors Scheme expanded
Quality indicators eventually onto My Aged Care website

12. Annual Subsidy Level (2013-14)
Home Care Packages
Home Care packages (HCP) adjusted up from 25 to 45 places per 1,000 people 70+
Additional 84,538 Home Care packages over 10 years
2 new levels of Home Care package (piloted over )
Movement from HCP levels 1/2 to 3/4 requires ACAT assessment
All Home Care packages to be converted to Consumer Directed Care from July 2015
Home Care Package
Annual Subsidy Level ( )
Level 1
$7,501
Level 2 (formerly CACP)
$13,644
Level 3
$30,003
Level 4 (formerly EACH)
$45,607

13. Home Care Packages
Dementia and Cognition Supplement for all HCP levels
10% of basic subsidy funded by 2% reduction of CACP and EACH from 1 July 2013
Estimated 26% of clients will qualify
54% of veterans, with mental health condition verified by DVA, will attract Veterans Supplement
User charges from 1 July 2014
Basic fee of 17.5% of Age Pension retained
Income tested fee introduced, reducing subsidy payment
Annual cap of up to $10,000 and lifetime cap of $60,000 on income-tested care fees
Hardship provision available

14. Home Support Program
Commonwealth Home Support Program (CHSP) to replace HACC, NRCP, DTC and ACHA from 1 July 2015
Regular annual growth for HACC likely each year, and all elements of Home Support Program from July 2015
2014 Federal Budget has reduced future growth to 3.5% per annum
No change to HACC services until 2015
Reviews of some HACC service types during 2013 / early 2014
Respite care
Home modifications and maintenance
Meals
Community transport
Service Group 2 (assessment, case management, etc)

15. NACA Home Support Advisory Group
Representation
NACA mix of providers, consumers, unions and professionals
Complemented by State & Local Government, specific HACC service type providers
ACSA represented by Carole Bain (Silver Chain, WA)
Purpose
Provide advice on establishment of Commonwealth Home Support Program
Have released:
Discussion paper on design of CHSP
Discussion paper on place of respite in CHSP

18. Commonwealth Home Support Program
DSS has released Commonwealth Home Support Program (CHSP) Discussion Paper
Reviews of HACC service types are also published on website
DSS is working with HSP Advisory Group on Program Guidelines and Program Manual
Anticipate opportunity for further comment on these documents later in 2014
Sub-Group working on CHSP Fees Policy

19. Comparison NACA / DSS NACA Area DSS proposal Comment
Program Design (Vision) ✖
No single program; no individualised funding
Goal (Aim) ✔
Target Group & Eligibility
Some concern re “basic support”
Principles
Not articulated as such
Service streams
Except meals and transport stay separate
Reablement / wellness
Consumer direction
Only partial without individual budgets
Transition
Key areas acknowledged

20. CHSP 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; and
continue to build, and be informed by, a robust evidence base.

21. CHSP: 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.

22. NACA CHSP Design Service Streams
Service/Outcome Stream
Existing Service Types within the new streams
Social Participation and Access
Social Support, Centre Based Day Care, Community Visitors Scheme, and Transport
Health and Wellness
Allied 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 Centres
Carer Support
HACC 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 Respite
Household Maintenance
Domestic Assistance, Home Maintenance, Gardening and Linen
Service Innovation and System Resourcing
Service 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.

25. NACA Respite Recommendations
Create Carer Support Stream incorporating NRCP, HACC respite and carer support, and residential care respite
Services with a respite effect but other major focus (e.g. centre-based day care) shouldn’t be in this stream
Consumer direction philosophy should underpin service delivery
Streamlining of emergency respite access
Expansion of flexible respite, especially for working carers and special needs groups
Limit on amount of respite available per person
Effective linkages with Home Care Packages, Carer Support Centres and Aged Care Gateway

26. CHSP: Service Type Review Response
Respite service types streamlined to three
Flexible
In home day, in home night, host home day, host home night, individual community access and mobile respite
Cottage
Emergency
Commonwealth Carer Respite Centres funding
Centre-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

27. Carer 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 health
Future of HACC carer support services unclear
Will they transition to CHSP or a new DSS carer support program?
New model in place from July 2015

28. CHSP: Fees
A 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.

29. CHSP: Contestability
Contestability 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); and
Trialling 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

30. CHSP: Transition Clients with high level needs People under 65
NRCP carers of clients under 65
HACC Service Group 2
Assessment to My Aged Care
Case management to My Aged Care (short-term) or Home Care Packages (long-term)
Client care coordination removed
Client counselling to allied health / therapy
Informal counselling, support and information to My Aged Care
Advocacy to National Aged Care Advocacy Program

31. Implications for Respite Services
No one’s funding is guaranteed past 30 June 2015
However, change in aged care is likely to be evolutionary, not revolutionary
While details are still to be settled, scope of home care and home support programs is becoming clear
Respite will be a part of CHSP
Are you ready?
To go it alone?
To partner with another organisation?
To merge if necessary?

32. Useful links
National Aged Care Alliance Australian Department of Social Services Aged & Community Services Australia