The Future of Respite in Aged Care

What is the Future of
Respite in Aged Care?
Paul Sadler, CEO, Presbyterian Aged Care NSW & ACT,
Chair NACA/DSS Home Support Advisory Group
National Respite Conference, Parramatta, October 2014
Respite & Aged Care
1. Aged Care Reform history
a) Productivity Commission inquiry
b) Living Longer Living Better
c) Coalition Government policy
2. Key components of aged care reform
a) My Aged Care Gateway
b) Quality Arrangements
c) Home Care Packages
3. Commonwealth Home Support Program
4. Implications for Respite
The Productivity Commission
Report August 2011
Wellbeing of older Australians – promoting
their independence, giving them choice and
retaining their community engagement
• Individual responsibility
• Affordability for taxpayers
• Safety net for those
that need it
Living Longer Living Better
• Released by Prime
Minister 20 April 2012
• Complemented:
• Health Reforms
• National Disability Insurance
Scheme (NDIS)
• Response to Report on
Economic Potential of
Senior Australians
Key Features of LLLB Reforms
• $3.7 billion package over 5 years (2012-2017)
• Only $577m new funding
• $1.6 billion taken from Aged Care Funding Instrument
(ACFI) cuts in residential care
• Other measures, such as dementia supplements, funded by
reducing basic subsidies
• Marks further policy shift towards home care
• Greater emphasis on user pays
• 5 Acts passed Federal Parliament June 2013 to enact aspects
of Living Longer Living Better reforms
• Guide to Aged Care Law released September 2014
Now the Aged Care Policy
• 5-year Healthy Life, Better Ageing Agreement
• Based on PC Caring for Older Australians report and LLLB reforms
• Negotiated with key stakeholders via Aged Care Sector Committee
• Cut red tape
• So far removal of Federal building certification requirement
• Put $1.5 billion for Workforce Supplement back into general
aged care funding
• 2.4% increase in aged care subsidies and community programs
from 1 July 2014
• $200 million for dementia research
• Aged care transferred from Department of Health & Ageing to
Department of Social Services
Aged Care: NDIS comparison
Aged Care
Applies to people gaining disability aged 65+
Applies to people gaining disability before age
Individual budget only in HCP, with CDC
budget handled by provider
Only individual budgets controlled by NDIA
and person with a disability
Block funding remains in HACC
Limited block funding in trial sites
Residential care remains, but reducing as
proportion of aged care
Transition away from institutional care
Substantial co-contribution required with use
of home asset for residential care;
government funds safety net from general
No co-contributions but choice to pay for extra
services; mainly funded via 0.5% Medicare
Levy increase and general taxation
Assessments by mix of ACATs, My Aged
Care and service providers
Assessments by NDIA
Aged Care Gateway
• My Aged Care website and national call centre
• New regional assessment services for home support
• Tender expected shortly
• ACATs remain for access to Home Care Packages or
residential care
• Electronic client record from mid 2015
• Initially in assessment services and call centre
• Further trial of assessment tool around March/April 2015
• Linking service for people with multiple needs
Quality Arrangements
• Australian Aged Care Quality Agency
• Assumed responsibility for home care on 1 July 2014
Aged Care Commissioner powers strengthened
National Aged Care Advocacy Program boosted by 20%
Community Visitors Scheme expanded
Quality indicators eventually onto My Aged Care website
Home Care Packages
• Home Care packages (HCP) adjusted up from 25 to 45 places per
1,000 people 70+
• Additional 84,538 Home Care packages over 10 years
• 2 new levels of Home Care package (piloted over 2013-2015)
Home Care Package
Annual Subsidy Level (2013-14)
Level 1
Level 2 (formerly CACP)
Level 3
Level 4 (formerly EACH)
• Movement from HCP levels 1/2 to 3/4 requires ACAT assessment
• All Home Care packages to be converted to Consumer Directed
Care from July 2015
Home Care Packages
• Dementia and Cognition Supplement for all HCP levels
• 10% of basic subsidy funded by 2% reduction of CACP and EACH
from 1 July 2013
• Estimated 26% of clients will qualify
• 54% of veterans, with mental health condition verified by DVA,
will attract Veterans Supplement
• User charges from 1 July 2014
• Basic fee of 17.5% of Age Pension retained
• Income tested fee introduced, reducing subsidy payment
• Annual cap of up to $10,000 and lifetime cap of $60,000 on
income-tested care fees
• Hardship provision available
Home Support Program
• Commonwealth Home Support Program (CHSP) to replace
HACC, NRCP, DTC and ACHA from 1 July 2015
• Regular annual growth for HACC likely each year, and all
elements of Home Support Program from July 2015
• 2014 Federal Budget has reduced future growth to 3.5% per annum
• No change to HACC services until 2015
• Reviews of some HACC service types during 2013 / early 2014
Respite care
Home modifications and maintenance
Community transport
Service Group 2 (assessment, case management, etc)
NACA Home Support Advisory Group
• NACA mix of providers, consumers, unions and professionals
• Complemented by State & Local Government, specific HACC
service type providers
• ACSA represented by Carole Bain (Silver Chain, WA)
• Provide advice on establishment of Commonwealth Home
Support Program
• Have released:
• Discussion paper on design of CHSP
• Discussion paper on place of respite in CHSP
Commonwealth Home Support Program
• DSS has released Commonwealth Home Support Program
(CHSP) Discussion Paper
• Reviews of HACC service types are also published on website
• DSS is working with HSP Advisory Group on Program
Guidelines and Program Manual
• Anticipate opportunity for further comment on these documents
later in 2014
• Sub-Group working on CHSP Fees Policy
Comparison NACA / DSS
DSS proposal
Program Design (Vision)
No single program; no individualised
Goal (Aim)
Target Group & Eligibility
Some concern re “basic support”
Not articulated as such
Service streams
Except meals and transport stay separate
Reablement / wellness
Consumer direction
Only partial without individual budgets
Key areas acknowledged
CHSP Key Directions
• It is proposed that the CHSP will:
• provide timely, basic home support services to frail older people
and their carers, to help them remain living independently in the
community - with people requiring higher levels of care eligible for
Home Care Packages or residential aged care;
• streamline the home support system in order to cut red tape for
providers and improve access for clients;
• increase sustainability through a more consistent approach to
client fees;
• be underpinned by a wellness and reablement philosophy;
• be accessed through My Aged Care; and
• continue to build, and be informed by, a robust evidence base.
CHSP: Consolidated Basic Support Program
• This will enable more older people to be able to access the care and respite
services they need. Clients with more complex needs will be supported to
transition over time to more appropriate levels of care such as Home Care
• There will be continuity for most service types, with some changes and
consolidation based on the outcomes of service reviews conducted during
2013-14. Service providers will be funded based on output based block
funding from 1 July 2015.
• Greater contestability will be introduced to ensure that client outcomes
are maximised and that value for money is achieved.
• The amalgamation of three community aged care programmes and
clarification of programme boundaries, such as a single set of eligibility
criteria, will reduce administrative burden for service providers and improve
client outcomes by providing more consistent and integrated care.
NACA CHSP Design Service Streams
Service/Outcome Stream
Existing Service Types within the new streams
Social Participation and Access
Social Support, Centre Based Day Care, Community Visitors Scheme, and Transport
Health and Wellness
Allied Heath services, Home Modifications, Goods and Equipment, Reablement,
Massage, Nursing Services, Personal Care, Personal Services (hygiene), Meals, other
Meal and Food Services and Day Therapy Centres
Carer Support
HACC Respite, In-Home day Respite, In-home Overnight Respite, Community AccessIndividual, Community Access-Group, Host Family Day/Overnight Respite, HACC
Counselling (for carers), Overnight Community Respite, Mobile Respite, Other Respite,
and Residential Respite
Household Maintenance
Domestic Assistance, Home Maintenance, Gardening and Linen
Service Innovation and System
Service innovation and system resourcing not covered in the above streams including
management of contracted/brokered services, system supports (e.g. training and
development roles, aged services workers), etc.
NACA Respite Recommendations
• Create Carer Support Stream incorporating NRCP, HACC
respite and carer support, and residential care respite
• Services with a respite effect but other major focus (e.g. centrebased day care) shouldn’t be in this stream
• Consumer direction philosophy should underpin service delivery
• Streamlining of emergency respite access
• Expansion of flexible respite, especially for working carers and
special needs groups
• Limit on amount of respite available per person
• Effective linkages with Home Care Packages, Carer Support
Centres and Aged Care Gateway
CHSP: Service Type Review Response
• Respite service types streamlined to three
• Flexible
• In home day, in home night, host home day, host home night,
individual community access and mobile respite
• Cottage
• Emergency
• Commonwealth Carer Respite Centres funding
• Centre-based day respite, residential day respite and
group community access respite are proposed for
funding under social participation outcome group as
part of centre-based day care
Carer Support
• LLLB flagged creation of Carer Support Centres
• DSS has commenced process to review how carer
support might be structured across its portfolio of
aged care, disability, mental health
• Future of HACC carer support services unclear
• Will they transition to CHSP or a new DSS carer support
• New model in place from July 2015
CHSP: Fees
• A nationally consistent fees policy will be introduced from
1 July 2015.
• For clients this will mean a fairer system where clients of
similar means will pay consistent fees (regardless of
location) for accessing Commonwealth Home Support
Programme services.
• For service providers the fee structure will acknowledge the
differing cost drivers of service types, for example, home
modifications may have a different fee structure to domestic
CHSP: Contestability
• Contestability implemented with following considerations:
• Transition of Vic and WA HACC services to Commonwealth;
• Existing capacity to operate new services and programme
• Whether all service types are suitable for tendering
(e.g. Meals on Wheels with a high volunteer contribution);
• The feasibility of tendering minimally funded services
(e.g. where an organisation receives less than $50,000pa); and
• Trialling different approaches to contestability
(such as ‘cashing out’ respite funds to carers/consumers).
• Contestability will apply to: new Regional Assessment Services; 29
Sector Support and Development roles; (most) growth funding
CHSP: Transition
• Clients with high level needs
• People under 65
• NRCP carers of clients under 65
• HACC Service Group 2
• Assessment to My Aged Care
• Case management to My Aged Care (short-term) or Home Care
Packages (long-term)
Client care coordination removed
Client counselling to allied health / therapy
Informal counselling, support and information to My Aged Care
Advocacy to National Aged Care Advocacy Program
Implications for Respite Services
• No one’s funding is guaranteed past 30 June 2015
• However, change in aged care is likely to be evolutionary,
not revolutionary
• While details are still to be settled, scope of home care and
home support programs is becoming clear
• Respite will be a part of CHSP
• Are you ready?
• To go it alone?
• To partner with another organisation?
• To merge if necessary?
Useful links
National Aged Care Alliance
Australian Department of Social Services
Aged & Community Services Australia
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