Potential key design elements for the Commonwealth Home Support Program
Session 5 – DSS Paper 5.1
Purpose
The purpose of this paper is to invite discussion by the Commonwealth Home Support Program (CHSP) Advisory Group on potential key design
elements for the program. The paper provides a summary of the potential framework, rather than a detailed description of how the program
might operate. Together with the other agenda papers for the December meeting, the paper is to facilitate discussion within the Advisory Group
and does not necessarily represent a preferred or settled approach to implementation. It is intended that a more detailed discussion paper will be
developed for consultation purposes following the Advisory Group meeting.
1. Eligibility
Current arrangements
(mainly based on the Commonwealth HACC
Program)
CHSP commencing 1 July 2015
Older people aged 65 years and over (and
Aboriginal and Torres Strait Islander people aged
50 years and over) who live in the community, have
difficulty in performing activities of daily living
without help due to functional limitations, and are
at risk of admission to long term residential care.
Same eligibility across all of the programs being consolidated in
the CHSP (noting that some differences may be necessary for the
ACHA stream reflecting the specific target population).
There are different eligibility criteria for the NRCP,
DTC and ACHA programs.
Eligibility criteria for the CHSP will be similar to the current
Commonwealth HACC Program, but without the requirement for
a person to be “at risk of admission to long term residential
care”– this is not appropriate for a basic support program with a
philosophy of promoting wellness and reablement.
Eligibility for respite services under the CHSP will also include
carers of people aged 65 years and over (and Aboriginal and
Torres Strait Islander people aged 50 years and over).
Where services are currently provided to people aged less than
65 years or their carers (eg in the NRCP), options could be
explored for these services to be funded through other
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Potential key design elements for the Commonwealth Home Support Program
Commonwealth or state government programs from 1 July 2015,
rather than through the CHSP.
2. Entering the
program
Potential clients are able to contact service
providers directly (perhaps after contacting My
Aged Care or an ACAT, although this is not a
requirement).
For further detail, see the client pathway and the separate
paper on Client Entry and Assessment in the CHSP.
In summary:
No consistent approach to assessment nationally.
Assessment may be conducted by Access Points in
some states and regions or by individual HACC
service providers using a variety of tools.
From July 2015, all new clients will need to enter the CHSP
through the Aged Care Gateway (this may involve being referred
to the Gateway if the client contacts a service provider directly or
the service provider facilitating online client self-registration).1
No central client record.
The Gateway will conduct a phone-based screening. A central
client record will be established as part of this process.
Following the initial screening, some clients will be referred to a
face-to-face assessment (where available) using a standardised
assessment tool. Protocols will be developed as to which clients
should be referred for a face-to-face assessment.
Regionally-based face-to-face assessment services will be
progressively implemented across Australia, building on existing
services, eg in Victoria and WA.
3. Wellness and
reablement focus
Service providers are encouraged to adopt a
wellness or reablement approach in service delivery
to clients, and there has historically been some
The CHSP will have a focus on wellness and reablement
throughout the program. See separate paper on Client Entry
1
Different arrangements may apply for ACHA clients. The manner in which carers will interact with the Gateway and services is still subject to finalising the business model
for Carer Support Centres, particularly how the Centres will interact with the Gateway and the CHSP.
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Potential key design elements for the Commonwealth Home Support Program
work to develop this at a jurisdictional level by
some state governments, but there is currently no
systematic approach to restorative care or
reablement services across the Commonwealth
HACC Program.
There is also currently no incentive for providers to
deliver fewer services to a larger number of clients
or to take on new clients
and Assessment in the CHSP.
This will be implemented through:
 the introduction of regionally-based face-to-face assessment
services;
 a standardised national assessment tool which includes a
focus on wellness and reablement;
 goal oriented support plans for clients;
 a greater focus on wellness and reablement in staff training
and service delivery supported by funding for sector support
and development, eg development of best practice guidelines;
 the introduction of quality indicators relating to client
wellness and reablement.
In addition, the CHSP could include a separate funding stream
(or service type), which would provide short-term incentive
restorative care services to suitable clients, If adopted, this would
provide intensive services over a 8-12 week period to improve
the functional status and independence of clients and minimise
the need for ongoing services. The services would be a planned
program of interventions delivered or co-ordinated by a
multidisciplinary health professional team, potentially building
on current DTC and HACC funded allied health services. The
restorative care stream could commence in July 2015 in a small
number of regions, with the potential for expansion in the future.
4. Services and
expenditure per
client
No limit on the amount or type of services that a
client can receive. A client can potentially receive
the same or different kinds of services from
multiple service providers, exceeding the support
available under a Home Care Package.
The CHSP will be positioned as a basic support program for
older people and their carers to assist people to remain living
independently in the community.
The NACA discussion paper on CHSP design suggests that
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Potential key design elements for the Commonwealth Home Support Program
expenditure per CHSP client should generally be less than the
level of funding available under a Home Care Level 2 package
(currently around $13,600 pa). However, expenditure up to this
level would potentially position the CHSP above a basic support
program and not be sustainable into the future. Average
expenditure per client under the Commonwealth HACC Program
is currently around $2,300 per annum.
Clients who require long-term case management or receive
several ongoing different service types or a high number of hours
of care per week will generally be beyond the scope of the
CHSP. Other more appropriate care options (including home
care or residential care where appropriate) should be encouraged
for these clients.
Where a client has been assessed as eligible for a Home Care
Packages but is unable to access a package, the client will be able
to receive services under the CHSP, as an interim arrangement,
but only to a basic level of support consistent with other clients
under the CHSP.
There will not be a mechanism to enforce a strict monetary cap
or maximum level of services per CHSP client from July 2015,
but the introduction of a more rigorous and standardised
approach to assessment will provide greater scope to ensure that
services under the CHSP are appropriate for a client’s needs.
In the longer term, the introduction of a centralised client record
will provide the capacity for closer monitoring of the services
being used by individual clients.
5. Type of services
A range of services are funded in 7 service-s groups
Most of the services types currently funded under the
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Potential key design elements for the Commonwealth Home Support Program
across 19 service types for the HACC Program
(plus additional service types across NRCP, DTC
and ACHA).
Commonwealth HACC Program, NRCP, DTC and ACHA will
continue to be funded under the CHSP, with some consolidation.
The main potential changes to service types relate to those
currently in Service Group 2:
 Face-to-face assessment services would not be separately
funded under the CHSP, as this function would be
undertaken under the Aged Care Gateway framework.
 Case management services under the CHSP would be
time-limited (eg 6-12 weeks per client).
 Client care co-ordination and informal counselling, support
and information (from the Counselling/Support, Information
and Advocacy service types) would no longer be funded as
separate service types, as this is intrinsic to service delivery
and applicable to all services.
 The National Aged Care Advocacy Program could be
expanded from July 2015 to provide independent advocacy
services for CHSP clients, rather than funding advocacy
services as a separate service type within the CHSP.
There would potentially be a reduced number of respite care
service types with the consolidation of NRCP into the CHSP.
A new service type for restorative care - a short term intensive
program within the CHSP potentially building on DTCs and
allied health services - could also be introduced (see item 3
above and the separate paper on client entry and assessment in
the CHSP).
6. Funding model
In general providers receive output based block
funding. This is most commonly through a three
year funding agreement that specifies the service
Providers will continue to receive output based block funding
from 1 July 2015. The funding agreement will specify service
types and associated outputs at a regional level. However, service
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Potential key design elements for the Commonwealth Home Support Program
types and number of outputs to be delivered within
a specified region. Units of output vary and include
for instance hours of service, number of trips,
number of meals etc.
There is some flexibility to deliver other services
within and across service groups but within the
same total grant funding.
Within service types the price the Commonwealth
Government pays providers for a unit of service
varies within and between HACC regions. The
rationale for this variation is not always clear.
types will also be grouped by higher order outcome streams.
This will provide the foundation for a more outcome based
funding model, where over time providers would be able to
deliver a broader range of services to best meet client needs.
From 1 July 2015, the Commonwealth will be seeking to
establish more standardised unit pricing and accompanying
activity definitions to ensure that Government funding is
equitable, sustainable and transparent.
This process will need to consider a number of factors including:
 variability in current service models,
 differential cost drivers, such as rurality
 interaction with the CHSP fees policy and
 impacts for individual providers and service output
volumes.
Development of the CHSP unit pricing model will be informed
by stakeholder consultation and by a review of established unit
prices within the Victorian HACC program.
The 5 year review will consider opportunities and challenges in
the CHSP adopting a subsidy based funding model consistent
with Home Care Packages.
7. Client fees
While there are principles underpinning a fees
policy for the HACC Program, in practice, there are
different approaches to how fees are applied and
collected by service providers; there are also
differences between the states and across service
A national fees policy will be introduced from July 2015, with
the overall contribution of client fees increasingly incrementally
over three years.
The fees policy will need to provide sufficient incentives for
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Potential key design elements for the Commonwealth Home Support Program
types.
clients to move to other forms of care when their needs exceed
what can be provided in the CHSP.
The national fees policy will be developed in consultation with
stakeholders in the first half of 2014. Development work will
consider the fee policies already operating in some jurisdictions.
8. Planning and
allocation of new
funding
Planning and allocation arrangements have
historically varied by program and jurisdiction.
From 1 July 2015, expansion funding for home support services
would be underpinned by a population based funds allocation
model. This would take into account the existing services
available in a given region, projected growth in the target
population and other factors influencing service delivery supply
and demand.
The 5 year review would consider whether a single population
based funds allocation model could be used to inform both
expansion of home support and home care services subject to
broader consideration of program interfaces. This would lead to
a more integrated aged care system, and geographic equity.
Priorities for expansion funding within a region would be
informed by a range of quantitative and qualitative data,
including consultation with a range of stakeholders.
Also informed by stakeholder consultation, the home support
planning framework would include a more coordinated and
strategic approach to service system development activity. This
would enable better alignment with strategic program directions,
such as adopting a wellness approach to service delivery, and
focus on addressing systemic program issues, such as data
integrity concerns.
Draft for discussion with Commonwealth Home Support Program Advisory Group – 13 December 2013
Potential key design elements for the Commonwealth Home Support Program
9. Program
performance
framework
Program performance (between programs and
across jurisdictions) has historically been monitored
and evaluated on an ad hoc basis.
Unit prices vary markedly across jurisdictions.
Building on the existing MDS, a program performance
framework will be developed. This will allow the Department to
define what data it needs from providers and clients, and what
options are available for its collection (as much as possible
minimising the overall level of reporting on service providers).2
This framework will allow the Department, over time, to
evaluate:




client outcomes;
the efficient price the Department should pay for different
service types;
the relative efficacy of different service types; and
the performance of individual service providers.
This framework could then be used to identify strategies to
increase the effectiveness and efficiency of the program over
time, and set planning priorities, as discussed above.
2
The performance framework will also take into account of data available from a future electronic client record.
Draft for discussion with Commonwealth Home Support Program Advisory Group – 13 December 2013