The Future of In Home Care – Final Article Where to from here?

Where to from here? The future of care at home

This year our article series has addressed a range of topics to assist providers in preparing for the future. Our contributors have provided practical advice about the legislative changes beyond 2020, the consumer profile, workforce, technology and innovation, governance and leadership, customer centricity and adapting your business model. We hope these articles have allowed you to consider the implications of reform on your organisational structure, systems, staff and clients.

In this final article we will be discussing the scenarios for the future of care at home and considerations for providers. We will also look at some lessons from the NDIS and a preparation checklist to ensure that your organisation is ready for change.

Where are we going?

According to the Aged Care Roadmap, the destination for care is a market-based system that is consumer driven. Consumers will have choice as to where and how they receive care, with seamless movement between home and residential based care. This system will have an uncapped supply that is monitored by the government. Aged care will be delivered in a holistic and person-centred manner enabling consumers to access integrated services. System design will ensure linkages with the health, mental health, disability and community services sectors. Services across sectors will complement rather than duplicate each other.

One of the key destinations identified in the Roadmap is an integrated care at home program – a combined Home Care Packages Program and CHSP comprising:

• predominantly individualised funding that follows the consumer
• additional government assistance where there is insufficient market response
• block funding (grants to providers) where considered most appropriate/efficient.

The Roadmap envisages that the integrated program would also include:

• a single assessment process for eligibility, care needs and funding levels for care at home
• integrated fee arrangements
• high quality care driven by a single set of standards

At this point in time, the Department has not announced any systematic or funding changes to CHSP beyond 2020. However, the Department have stated that some reforms may be introduced as early as 2019; which is evident from the introduction of the single set of quality standards. Beyond 2020, the Department have suggested that more significant reform will take place including changes to the mix of individualised and block funding as well as the establishment of an integrated assessment workforce; however, this may phased in over several years. In response to this, the sector has suggested that major changes should be co-designed and piloted before a national phased roll-out.

What does the journey look like?

There are several scenarios that may be implemented in order to reach the destination outlined in the Roadmap. These are outlined below as wells as the implications and considerations for providers.

Who pays?

Scenario: Mandatory client contributions are introduced for all CHSP services that are standardised according to the client’s financial capacity.

If client contributions are introduced for CHSP, consider how you can enhance the customer journey to ensure that your clients receive quality services. Providers must accept responsibility for continuous improvement towards best practice accountability, governance and operational management to deliver high quality aged care services. Consider an audit system and collect and evaluate customer feedback.

How will this impact your current systems and culture? Staff will be required to request payment – are they adequately trained to do so? Boards will also see debt owing on the balance sheet and organisations will needs to have systems in place to monitor ageing debts.

Scenario: Predominantly individualised funding particularly for nursing, personal care, domestic assistance, home maintenance, respite and allied health services.

The department has recognised the benefits of individualised funding. This model offers choice and control for consumers, provides transparency about cost and develops a market-based environment driven by innovation and quality. If funding for care at home services was entirely individualised, how would you market your services to ensure organisational sustainability? Consider that consumers prefer quality to price.

Scenario: Block funding for all entry level services.

There is a potential for this scenario, however, don’t assume that government won’t change how this occurs. We know that government are seeking to work with less providers across other funding areas, and this could mean more of the block funding is allocated to larger organisations through a competitive grant process. How will your organisation fare in a grant application, are partnerships or mergers on your agenda, will you diversify services to adequately compete?

Scenario: Mixed model e.g. block and individualised or vouchers.

How would a mixed model impact your service offering and revenue stream? Consider the administrative implications of consumers utilising vouchers rather than managing budgets.

How is it structured?

Scenario: Introduction of an HCP level ‘5’ package.

If there are changes to the structure of care at home, are you equipped to deliver these services? Providers must understand the needs of their clients in order to create a successful business model. Consider your workforce preparedness, the potential for upskilling and training to care for clients with complex needs. How will your clients know what you offer and why will they choose you? Do you have a robust quality brand underpinned by quality service delivery?

Scenario: CHSP becomes an HCP level ‘1’ package or redirection of HCP level 1 funding to CHSP.

Do you have the appropriate workforce numbers to service clients effectively? How will you recruit or is there an opportunity for a brokerage partnership with other providers? Ensure that you understand your customer pipeline and map your service demand against your workforce capacity. Consider new recruitment sources such as engaging with Millennials, a graduate program or seek those with qualifications outside of the sector.

What system and regulatory changes will take place?

Scenario: MAC system changes e.g. development of a consumer dashboard which allows consumers to find, compare, book, pay for care and manage accounts online.

In order to facilitate reform, systematic changes must take place. As the sector becomes more market based, how will you ensure that your organisation stands out on a MAC dashboard service? Customer centricity and service quality will become increasingly more important as consumers have the power to provide feedback about services and compare providers. Providers must ensure they understand their customer segments and how they fit within your service offering. The Board’s role is to look beyond the uncertainty and ensure that the organisation is committed to a clear direction. The Aged Care Roadmap sets the direction for the sector and can be used to inform organisational strategy. For example, if consumer payments were performed via a dashboard with MAC, how would this impact upon your organisational ICT infrastructure, workforce requirements and other systems?

Scenario: De-regulation.

De-regulation would mean Government intervention would be focused on areas of potential market failure and consumer protection. Reducing red tape and developing fit-for-purpose regulation will give providers freedom to be innovative in how they deliver services. Consider the use of technology to deliver services e.g. telehealth conferencing or remote vitals monitoring. If the sector becomes increasingly de-regulated, we may see more providers entering the sector, meaning increased competition for providers and increased choice for consumers. Consider an audit as part of the strategic planning process in order to review the strengths, weakness, opportunities and threats of both the internal and external environment.

Scenario: Increased regulation of administrative and exit fees.

Alternatively, if fees become more regulated, how will this impact upon your revenue, balance sheet and competitive edge? Consider how you can use innovation and technology to improve administrative efficiency and reduce overheads e.g. digital self-service options.

How are clients assessed?  

Scenario: GP or self-assessment for entry level services

We know that our current workforce will not cope with the future demands and therefore a combined assessment workforce may also face this shortfall. If consumers are approved for entry level services in an alternate way, what can you do to improve the customer journey?

Each of the above scenarios will impact upon several organisational factors for providers. The Board must be equipped to plan strategically and consider the impacts of each potential outcome. Do you currently have the right mix of skills on your Board to cope with change or are there gaps that need to be recruited for?

What can we learn from the NDIS?

As aged care becomes increasingly de-regulated and moves towards increased consumer choice and control, providers can draw on lessons from the implementation of the NDIS.  According to Glenn Rappensberg, CEO of Novita Children’s Services, organisations must consider if their governance, business models and strategies are adequate to enable a response that allows for growth and sustainability through the changes. Providers should also critically evaluate possibilities or mergers, acquisitions and partnerships to ensure success.

Rappensberg states that providers need to assess their capacity for risk and where they can afford to invest as well as potentially lose. As the sector is driven by a market-based environment, services must innovate and consider other possible revenue streams.  Providers should consider these lessons from the NDIS and how this may be reflected in future aged care reforms.

Are you prepared for the journey?

Based on the possible and probable scenarios above, as well as the reforms that we already know are taking place, providers must consider if they are prepared for the future market. Lorraine Poulos has developed the following list of questions for providers to evaluate their options and capacity for sustainability.

1. Imagine your service was a private business that was not reliant on government funding – what would need to change?
2. Have you undertaken business case scenarios – best case/worst case?
3. Who could you partner with to improve your chances of success?
4. How many of your CHSP consumers are self-funded retirees or part pensioners? Would they continue to pay for your services if they were charged on a full cost recovery basis?
5. What service types could you provide that you are not currently providing?
6. Would you consider the NDIS as a possibility to diversify your model?
7. What opportunities exist in the area of restorative care?
8. How can you better connect with the healthcare system?
9. How can you connect with your community? What local events can you be involved in? Do you know your market demographics?
10. At what point do you consider it may be time to exit or merge?

As the year ends, it is important that providers have a clear direction for the year ahead. Consider the scenarios above and how these impact upon your clients, workforce, competitors and the aged care sector. Providers must have a strong governance structure, clear strategic direction and understand how they can utilise innovation and technology to deliver efficient and quality services.

This is the final article in our series ‘The Future of In-Home Care – Integrated Care Beyond 2020’, we hope they have been informative and provided practical support for future planning in your organisation. If you would like to see any of the articles in this series, please see the archive here. Next year we will be releasing an article series about quality and best-practice in service delivery. We will be collaborating with sector and cross-sector experts on topics such as Wellness and Reablement, palliative care principles, elder abuse prevention and training, becoming a dementia friendly organisation, supporting informal carers and innovation and technology to meet changing client needs. To ensure that you receive a copy of these articles, please sign-up to our e-Bulletin here.