The Royal Commission into Aged Care Quality and Safety brought to light evidence that many of us found shocking and confronting.
Unfortunately, I have to say some of us weren’t that surprised. Standards of care have been noticeably inconsistent. The lack of appropriately experienced and qualified staff across the sector has created gaps in care that even the most kind-hearted and dedicated staff cannot meet.
A lot of the stories were about experiences in residential care but there were some distressing examples in home care. In particular, there was a lot of emphasis placed on the number of older people living independently who were waiting for high level packages of care. To explain this simply there are a finite number of packages of care (in dollar value). So even if someone was assessed as needing substantial support, say to the dollar value of $52,377.50 a year to remain living safely and with dignity in their own homes, they were sometimes waiting for up to 18 months for that amount of care to be provided. Many died whilst on the waiting list.
Whilst waiting they had to be supported by programs of basic care supplemented by families, friends and volunteer services. At SCS, under the Commonwealth Home Support Program, we are only funded to provide “entry level support” judged to be one or two services, or in dollar value to about $8,800 a year. At times, I would say that the majority of the 40 or so nursing patients in our care were on a waiting list for a home care package – at one of four levels – and nearly all required significant support. We provided that support and put in place other services.
Did we say to someone frail and poorly that they could only receive two weekly services, from a of meals, showers, nursing and social and emotional support, and which of the two would they do without that week? Of course not. We have committed staff with a strong duty of care and, in any case, we are a quality, trusted local community organisation established more than 60 years ago to provide exactly that support. With our block funding we were able to manage our budget flexibly whilst remaining within the constraints of our contracts and with additional funding from our local Lane Cove, Hunters Hill and Ryde Councils.
On 6th January this year, the Department of Health released a document describing the new Support at Home Program to replace the three programs of care for seniors who need support to continue living at home. This was in direct response to the recommendations from the Aged Care Royal Commission. This outlines a program without the current four package levels, but describes a proposal where individuals are assessed using a single system and have a personalised plan for the support they need. It also describes a significant, prescribed set of regulations and guidelines and policies, procedures and standards for any organisation seeking to be a provider. It also proposes a national price list.
The assessed individual and/or their family then approaches providers of services to get quotes for what they can get, in the plan they have been given. This is very sensible and appears to remove the “waiting list” problem.
The new program will also introduce payment in arrears for the providers. Providers will claim once the support is done. At the moment we have three-year contracts and payments are in blocks in advance. This means we can budget annually, employ staff on permanent contracts and therefore ensure that people see the same nurse or support worker every time. This is one of the main aspects that our clients love about us.
From August 2022, our funding becomes monthly in arrears and from July 2023, with the introduction of the Support at Home Program, we will only be paid in arrears for services provided.
When NDIS introduced the same payment system, we operated that aspect of our service at a loss for the first two years and had only started breaking even before COVID hit us. This was partly because the support workers were engaged on permanent and not casual contracts.
The proposed changes to the aged care system will challenge many organisations small and large community based, locally respected organisations. Similar policy changes overseas have resulted in the number of small community providers being significantly reduced, resulting in just a small number of nationally and mainly profit-focussed organisations surviving. SCS will always work to ensure services are delivered at the highest level of quality and consistency for each and every member of our community.