NATIONAL UPDATE
POLICY UNDER THE MICROSCOPE:
IMPROVING HOME CARE PACKAGE ASSIGNMENT Consumer support could be improved if government addresses the time lapse between home care package assessment and assignment.
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he Department of Health has released its third Home Care Packages Program Data Report, identifying that at 31 December 2017 there were more than 75,000 consumers in receipt of a home care package, while more than 100,000 consumers waited in the national queue1. Among consumers in the queue, over half have been approved for assignment of level 4 home care packages, indicating a substantial demand for high level in-home care. Additionally, among consumers in receipt of a home care package, nearly half had been assigned or were accessing an interim home care package at a level lower than what they had been approved as needing. As a consequence, there are a substantial number of home care package consumers who are likely to have unmet care needs1. At the other end of the spectrum, Leading Age Services Australia (LASA) has identified that almost half of home care package consumers have accumulated unspent funds at a level greater than $5,0002. Similar results have been reported elsewhere3. Some packages have unspent funds exceeding $20,0002. This suggests that there are many consumers in receipt of a home care package who are not using all their home care package funds to access care and services. In considering this data more closely, there appears to be a large number of consumers who are either in receipt of an interim package with unmet needs or an approved package but not accessing the full range of care and services that their package is funded to provide for. It has been suggested that this bimodal distribution of home care packages accounts for the majority of home care package consumers either having unmet needs or unspent funds. With some consumers receiving a package that is funded at a level lower than their current care needs (consumers with unmet care needs) and some consumers receiving a package that is funded at a level higher than their current care needs (consumers with accumulated unspent package funds), this bimodal distribution of home care packages is argued as reflecting a mismatch between a consumer’s care needs and the home care package level they have been assigned. Mismatches are likely to be a consequence of lengthy wait times on the national queue. Current wait times between assessment of a consumer’s care needs and assignment of a home care package are often associated with a delay of between six and 12 months1.
Interestingly, extensive delays in consumer access to a home care package probably existed prior to establishment of the national queue. Now the queue is providing greater transparency of consumer demand. Previously however, mismatches from lengthy wait times were managed through program-level cross-subsidisation, where providers would identify consumers in their home care package program accessing care at a level less than what they were funded for. Providers would allocate some of these unspent funds to meet care needs of other consumers that were greater than what their package funds would allow. Such cross-subsidisation practices were effective because of the timeliness with which approved providers could identify both unmet needs and unspent funds in the context of program level budget administration and care delivery. Program-level crosssubsidisation, however, is no longer legislatively permissible with the move to individualised home care package funding. As a consequence, the time that lapses between consumers having their care needs assessed and a package assigned creates operational risks for approved providers. Providers are now faced with increasing numbers of consumers with either unmet needs or unspent funds. This is likely to generate a demand for more frequent care plan reviews in managing associated risks. This in turn results in additional care costs that will be passed on to the consumer. In response, LASA has been advocating for the Australian Government to address this lapse of time between consumer approval for, and assignment of, home care packages. There is a need to significantly reduce wait times on the national queue to minimise such risks and improve home care package assignment. Clearly, the number of higher level home care packages available to consumers needs to be increased. Concurrently, assessment services need to be adequately resourced, as many consumers may need a reassessment, review or reassignment of their home care package in response to changing care needs or accumulation of unspent funds. ■ Troy Speirs is LASA’s Principal Advisor, Home Care.
References 1. Department of Health, March 2018, Home Care Packages Program Data Report 2nd Quarter 2017–18. 2. Leading Age Services Australia, November 2017, Second Home Care Provider Survey Report.
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3. Stewart and Brown, September 2017, Aged Care Financial Performance Survey, Home Care Report.