The Future of In Home Care – May Article

The Future of In Home Care – Integrated Care beyond 2020

Article One, May 2018

What do we know and what can we assume?

Written by Ilsa Bird – Sector Support Coordinator, Your Side

in collaboration with Lorraine Poulos – CEO and Managing Director, Lorraine Poulos and Associates

Aged Care reform is changing the nature of our sector, with significant transformations expected in CHSP and HCP. This article series will communicate some of the expected changes that providers will be facing in the future. Each article will propose potential scenarios based on aged care reform and the direction of integrated care as well as provide practical solutions and recommendations based on these reforms. I will be working with leaders within the sector as well as cross-sector to contribute to this series, encourage forward thinking and inform strategic planning beyond 2020.

Between now and the end of the year, this article series will address a number of pressing and critical issues facing service providers, including business strategy, finance, workforce, technology and innovation as well as governance and leadership. Each article will offer scenarios and practical steps for service providers to cope with change and reform leading into 2020. Our next article will be featured in the June e-Bulletin, focussing on consumers in 2020: CDC and the changing demographics of future consumers.

Last year the government announced a delay in their action plan to integrate CHSP and HCP, until July 2020. Although, we are not clear on the exact model or procedural context of this action plan, we can highlight the expected and assumed direction based on what we already know as well as successful models in other sectors.

So what do we know?

We know that the government’s current goal is to support older people to live at home and in their communities for longer as well as create a system that is consumer-driven and market-based. Presumably, working towards this goal will be continue in the future, and care in the sector will be delivered via a nationally consistent care and support service whereby consumers choose and control how they receive care with the removal of unnecessary distinction between home and residential care. Currently, support and care for consumers operates in distinctly separate programs; under different protocols and models which inhibits seamless movement between them as required when consumer needs change.

What can we assume about the future?

1. There will be an integration of HCP and CHSP into one nationally consistent service e.g. ‘Care at Home’

Although no specific timeline or schedule has been set in place, we know funding arrangements are due to cease in 2020. It is likely that any changes will be phased in over several years in order to minimise disruption to the sector, however we have already seen the development of the single set of draft standards in support of an integrated care model. In order to support older people to stay at home and in their communities for longer, a national approach will prioritise care at home, with continued focus on wellness and reablement. An integrated care at home approach would aim to be less-regulated and more market-driven in order to continue to enhance competition and increase consumer choice. It is expected that information available via MAC will provide increasingly transparent information regarding the quality of providers in order to inform choice.

2. There will be a combined independent assessment service and workforce for the integrated service

With the development of an integrated service, it is presumed that this will be accompanied by the integration of RAS and ACAT, whereby a new independent assessment service and workforce will be implemented. According to the Department, this service will remain free from cost to the consumer. It is expected that the National Screening and Assessment Form will undergo alterations and improvement to produce a single assessment tool that will be utilised by the assessment workforce. It has been recommended that assessment will not be for a particular care type; instead it will determine holistic care factors, length of care required and level of care required to inform level of funding. Resultantly, consumers will choose how they use the funding e.g. the context in which they receive care, the services they receive and which providers they wish to use. Carer needs will also be regularly assessed to identify needs early and reduce access to crisis or emergency services.

3. There will be significant reform to ensure quality and safety in aged care

Reform is already underway to ensure quality and safety in the aged care sector. As of July 2018, a single set of aged care standards will be implemented for all aged care services including CHSP, HCP, Residential and Respite care services. Providers will have one year to adjust and transition as assessment against the standards will take effect from July 2019.  The key changes of the new standards relative to the old is that although the standards will apply to all aged care services, their application will be flexible and relative to the diversity of services and consumers. In addition to this, the focus of the new standards is directed towards quality outcomes for consumers rather than the processes and procedures of providers. A pilot program is currently underway to inform the development of supplementary and guidance materials for consumers and providers regarding the implementation of the new standards.  Further reform has also recently been announced in order to further regulate the quality and safety in aged care. During April, Ken Wyatt announced the development of a national and independent Aged Care Quality and Safety Commission commencing January 1, 2019. The commission will be a one stop shop for consumers as it will bring together the functions of the Aged Care Quality Agency, the Aged Care Complaints Commissioner as well as the regulatory functions of the Department of Health. In addition to this, information regarding the quality of providers will become more transparent. Data that rates providers against the standards and allows consumers to compare the service providers will be publicly available via the MAC website.

According to Lorraine Poulos, an experienced sector expert and former quality assessor, there are many similarities and some new requirements when we compare the Home Care Standards and the draft Aged Care Quality Standards (ACQS). Lorraine begins by taking a look at the current Standard 1, Effective Management. The new standards include Standard 8, Organisational Governance, which covers areas such as risk management, clinical governance, continuous improvement, abuse and neglect and ensuring clear responsibilities and accountabilities. Many of these requirements are included in the expected outcomes of Standard 1. Lorraine states that what has changed is that there is more detail and a much stronger focus on protecting the consumer, their rights and clinical care.  Home Care Standards, Standard 2, Appropriate Access and Service Delivery can be closely aligned with the new Standard 2, Ongoing Assessment and Planning with Consumers. The promotion of independence is a key component of the Home Care Standards via expected outcome 3.5 Independence, however, Lorraine believes the new Standard 4, Services and Supports for Daily Living is more prescriptive and includes requirements relating to shared care i.e. when others are involved there is a requirement for a more inclusive model and accompanying documentation.

4. Funding for the new integrated care at home service will be predominantly individualised

Based on the changes that have already occurred in the sector, we can assume that funding for the care at home service will be predominantly individualised funding; however it is recommended that additional block funding will be available where appropriate. It is suggested that prices will be set and published by providers, and although pricing will not necessarily be regulated, it is assumed that the government will provide reasonable market prices in order for consumers to compare pricing. The Aged Care Financing Authority will monitor funding and financing in the sector and advise the government accordingly.  The department have recognised the benefits of individualised funding as this model offers choice and control for consumers, provides transparency about cost and develops a market-based environment whereby innovation and quality is encouraged. The outcome of this is that consumers can spend their personal and government contribution with any registered provider and exercise choice and control over how they choose to spend their money. Furthermore, block funding allows providers to be better supported to deliver flexible services for vulnerable consumers or consumers who have differing needs. It is suggested that block funding, at least partly, may be considered for services such as transport, home modification, aids and equipment, remote area services as well as services for population groups that require specialised support.

In accordance with this information, Lorraine Poulos suggests a recent article that poses some important questions for the sector to consider right now. Nick Mersiades writing for Catholic Health Australia (see reference below) states the following in his Aged Care Update article:

• Should individual budgets (packages) and ‘funding following the consumer’ be extended to all 900,000 (and growing) current CHSP consumers or is there a continuing role for some CHSP adjacent services to be block funded?
• Should block funded CHSP services be paid according to the number of consumers they attract in order to foster consumer choice and control?
• Would the national prioritisation process used for home care packages apply for all in home care services?
• Noting that the overwhelming majority of current CHSP consumers access only one or two services, would package levels apply for CHSP adjacent services, as currently applies for home care packages, or would each consumer’s subsidy be determined separately, as currently occurs in the NDIS. Alternatively, would individually determined subsidies (the NDIS approach) replace current funding of home care by package levels?
• What level of subsidy would apply for home-based care and support compared with the level of care subsidy that applies in residential care, noting that at higher levels of care need, home care is an alternative to residential care, and the latter covers the full cost of 24-hour care.
• What are the IT, payment system and overhead implications of extending individual budgets to another 900,000 consumers?
• Developing a consistent and equitable fees regime across all home-based care and support, and administrative arrangements for conducting means assessment.
• Developing funding and related arrangements designed to enable and encourage home-based care providers to take a reablement approach to service delivery.
• Developing a strategy for the 1,600 currently block funded and contracted CHSP providers, most offering a limited menu of contracted services, to transition to a competitive service environment where their viability is dependent on attracting consumers. Only a small proportion of providers currently deliver both home care packages and CHSP services.

According to Lorraine, there have been significant challenges for providers of disability services with the introduction of individualised NDIS funding and until the above questions are considered and answered by Government it remains difficult for providers to plan for the future.

So what does this all mean for CHSP and HCP providers?

As a result of reform and the integration of CHSP and HCP, providers are will be required to plan and implemented for significant change in a range of areas in preparation for and beyond 2020. To adapt to these changes, Lorraine Poulos suggests the following practical steps for service providers:

1. Review your clinical care practices and governance framework
2. Review your care plans when clinical care is provided and when care is ‘shared’ with families and others
3. Review your approach to reablement and wellness
4. Invest in an auditing program that aligns with the new standards
5. Consider having a Consumer Advisory group to encourage  a stronger consumer voice – if you have consumer input already then it would be a good idea to include a robust feedback mechanism whereby they critique or analyse whether you are meeting their identified needs

The next article will be about the changing role of consumers and CDC, so please sign up to the e-bulletin to receive the ‘Future Care at Home – Beyond 2020’ article series.