Home' Community Care Review : CCR Nov-Dec 2015 Contents places will continue to be capped via the
nationally applied continuation of aged
care planning ratios (per 1,000 people over
70) which by 2021/22 will be:
• Home Care -- 45 per 1,000
• Residential Care -- 78 per 1,000
• Short-Term Restorative Care (new) --
2 per 1,000.
There are no changes proposed for
current fee arrangements or Department of
Human Services claiming processes.
For the consumer
The new approach may well address
complaints about limited choice. But the
process of prioritisation will be of great
interest. People will be assigned a priority
for funding access after being assessed as
eligible by an ACAT (a two-step process).
The department's discussion paper
proposes priority factors such as:
• Time spent waiting for a package
• Urgency of assessed need
• Availability of other supports
• Risk of no longer being safe at home.
The other potential issue for consumers
and their representatives is the very
business of exercising choice. Often entry
into the aged care system comes at a time of
crisis in a family when the need to exercise
more complex choice may actually be
burdensome. Choice needs to be informed.
When people are encountering a very
personal and unfamiliar area of service how
do they obtain and assess the right kind of
information? How do they weigh it up?
For the Federal Government
Managing a priority access list brings
political risk analogous to that well-
known hot potato for state governments
-- management of hospital waiting lists. And
will more competition really secure higher
quality care? There are implications for the
health system if market theory fails.
A proliferation of providers (as in the
UK and the US) and the shift away from
conditional funding to providers (for
example previous specific conditions
of allocation) risks a looser connection
between beneficial aged care outcomes and
management of health system demand.
Factors which will influence consumer choice
of provider in a teeming market may not be
those which achieve the best care outcomes.
Currently the government uses mechanisms
of control through specific conditions of
allocation beyond the quality standards,
and is able to influence care offerings and
monitor performance in conjunction with the
Aged Care Approvals Round. In the UK and
in the US, failures in enforcement of quality
issues have come to the fore.
The policy levers available under the
current system may be weakened under
a heavily market-based approach, which
implies a more hands-off regime. Just look
at the vocational training sector scandals.
For the provider
The implications are massive. They include
the fundamental fact there will be no
guarantee of the level of future income
from home care packages after February
2017. Every provider will need to re-
examine their entire business model in an
environment where profile, attractiveness of
offerings and value for money will be front
and centre. It can be predicted that the
following will be likely success factors:
• Skilled, consumer-responsive and
• Well-tuned and well-communicated
• Flexible service provision
• Value for money/low overheads
• Demographic and market knowledge
• Highly focused case management
• Facilitation of (well managed) brokerage
for non-standard services
• Technology-enabled efficiencies
• Advanced quality and performance
There is every likelihood that customer
rating websites (think TripAdvisor)
will quickly emerge and there are also
suggestions that an official star rating
system will apply at some point.
Transparency of available supply
Current publication of regional place
allocations and an annual government
stocktake of places and ratios make the
available supply of aged care packages
transparent. The number of places available
can be identified against planning ratios,
as can disparities between regions.
How will transparency of supply levels
be made available under the proposed
arrangements? The national priority list
will be established and controlled by
the department through My Aged Care.
Will there be information regularly made
available on how many people are in receipt
of subsidised aged care? Where will that
information be and, without breaching
privacy, how can it be verified?
Is rural and remote in jeopardy?
At present, the main choice which many
older people from less populated areas
want to exercise is to simply get care at
home at all. From anyone. Low population
density usually means low provider interest
and that is unlikely to change.
Current regional allocation of places
puts some level of obligation on
providers to service all parts of a region.
Sometimes this is best met through
regional provider collaborations. There is
a real danger that increased competition
between providers will lead to reduced
incentives for collaboration (as seen in
the UK) and an increased focus on the
more lucrative population centres in non-
There are potential answers to this
dilemma but they would involve variation
from the pure choice model being
proposed. One option is a bid process to be
part of a consolidated 'provision panel' with
sub-regional volume guarantees, service
obligations and some incentives.
While recent home care changes have
been substantial, they have all been
within an envelope of provider certainty
as to revenue potential. CDC, for example,
only requires a more consumer-focused
approach within existing business models.
But the envelope and business model
are about to be transformed. The well-
developed content of the government's
discussion paper reveals an intention to
fundamentally recast the home care sector.
The power of greater competition is being
invoked to deliver better quality care.
Some argue that many providers have
become too comfortable with a guaranteed
income stream to the disadvantage of
consumers. These proposed changes will
test that assumption as providers compete
to survive. n
Brian Sullivan is a senior consultant
with Verso consulting specialising in
community, aged and health policy.
will need to re-
examine their entire
business model in an
of offerings and value
for money will be
front and centre.
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