First of the 5 pillars: the government’s plans to improve the provision of aged care

Now that the Royal Commission has finished and the worst of the pandemic and vaccination problems seem to be over, we can all take a deep breath and think again about the changes to the aged care system planned over the next few years.

Since May 2021, the path of development for the aged care system has been reset. There is less concern about how to get to the destination and more of a focus on the specific changes being planned. We no longer have a roadmap to indicate where we’re going. So, you may ask, what are these changes?

The changes planned by the government are succinctly summarised in a plan with a grand title: Five pillars over five years. Although not written on stone tablets like the ten commandments, the classical, quasi-biblical references are hard to miss.

The first of these pillars concerns ‘Home Care’. No wonder. Although care at home is often ignored in the media and in political discussions and receives far less funding than residential care, home remains the place in which the overwhelming majority of aged care residents are to be found.

In the no-man’s land between the recommendations of the Royal Commission and the responses by the government lie at least two proposals that are exciting, yet also so risky as to be dangerous. It is time for those who currently work in community support and home care (or hope to do so in future), as well as those who are counting on it to help remain at home in their hour of need, to get engaged. There is much to lose.

Unpaid carers, family and friends remain the real unsung and increasingly forgotten heroes of aged care in Australia. Alongside them, at present, there are two relatively poorly funded systems of formal care services responsible for the delivery of formal care at home. For years it has been planned to integrate the two approaches, but this was never finalised. In practice it seemed to mean that we would have just one system, which sounds sensible, but it would have been at the cost of the least expensive yet highly effective lower tier of support.

Home Care Packages, the more costly, complex and higher level of service for those at home, provide funding budgets at four different levels to individual consumers. This is the form of care for which waiting lists have been increasing massively over recent years. The May federal budget pledged to fund an additional 40,000 care places over the next year, with further expansion pledged for future years.

Although there has been much demand for additional high-level places, provision has not kept up with demand. According to auditor’s reports, while funding has increased the budget management practices associated with the way care is arranged for each individual have actually seen a reduction in the hours of care per week. There has also been an accumulation of considerable amounts of unspent funds. This suggests that more attention needs to be paid to this funding model.

The Commonwealth Home Support Programme is less costly but it serves almost four times the number of consumers. Typically based on local, community organisations, these services are less focused on individualised funding than on community sharing.

To date, funding has been what the Royal Commission described as grant-based. The ambitious but risky plans of the government are first: the development of a new aged care program, with a single assessment process and care finders; and second, the commitment to develop and extend a system of locally coordinated social supports to reduce and prevent social isolation. Does this sit alongside the new program or is it another component of it? Or worse, is it just another marketing trick?

The funding mechanism is an apparently subtle and so far little discussed area of conflict in the Royal Commission’s recommendations and the government’s response. The Commissioners recommended the clear reinstatement of grant funding. The government has responded not with a promise, but a process measure they term ‘Home Care – Future design and funding’. The design of a new support at home program will be finalised following sector consultation and further development of the model, but a key feature has already been decided – funding ahead of spending will cease and is instead to be paid in arrears.

In November, a national conference is planned for the CHSP program. These providers have lacked a strong collective voice in national discussions to date. Might there finally be a move to develop one?

Let’s not wait any longer or the chariots, slaves, priests and philosophers who can help shape a new future will have moved on to other pillars.

Michael Fine is an honorary professor in the School of Social Sciences at Macquarie University.

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