Home' Community Care Review : CCR Jan-Feb 2015 Contents Respite care is disputed terrain. Advocates, carers and
governments have argued for years over funding, pathways,
consumer control and even the name. (The dictionary
meaning "A short period of rest or relief from something difficult or unpleasant"
has easily given offence to older people and carers). A 2013 National
Aged Care Alliance respite review seemed to settle much.
Then, in early November, Assistant Minister for Social Services
Mitch Fifield gave a clarion call for faster reform, urging us to "give
the consumer full control" and let them direct "how and with whom"
money is spent, all before the five-year review currently set for 2017.
So how could we move forward?
It's not hard to make the case for more and better respite care. Despite
almost 240,000 respite (or respite like) places in aged care, unmet
demand is rising. More older Australians want to age in their home with
the support of an informal carer, and respite is one of the most
valuable supports available to them. Yet for carers of people
aged over 65 the unmet demand is 17 per cent, and among the
over 75-year-old cohort it is 20 per cent - compared to general
unmet demand for respite in 2009 of 12 per cent. This demand
gap grew by an astonishing 33 per cent between 2009 and
2012, according to Australian Bureau of Statistics figures.
As well, the rapidly growing population of people with
dementia and their carers is poorly served by inflexible respite
care -- inflexibility in hours, settings, staff continuity. So what
are the solutions? The minister's invitation for more consumer-
led markets should be the way to deliver more and more flexible respite.
Can we do more to meet the minister's invitation for consumer-
led markets? Right now in Canberra, officials are working feverishly
to graft this faster paced reform onto the launch of the CHSP on
1 July 2015. And there was already a mountain of work in stitching
together various Home and Community Care (HACC) and National
Respite for Carers Program (NRCP) funded respite programs and
Given Mitch Fifield's recent call for a
swifter move to consumer-led markets,
which comes amidst the major changes
to home and community care, there
is an opportunity to seriously address
the shortage in respite provision,
writes CHRIS GRATION.
services. It would be tempting to sit back and let respite reform be
carried by growing consumer direction and budget holding in home
care packages (HCP). But can we, and should we, do more?
The three bullet points for respite in the CHSP -- flexible, cottage,
and emergency -- remain largely that: bullet points. There's a lot
more thinking still to be done about how that's going to work. And
to get the best thinking, we need to involve consumers and carers,
as well as service providers in co-design projects. Here are five ideas
More consumer choice and voice
Better CDC planning will lead to stronger consumer choice and
voice. We already have the evidence from consumer directed respite
care (CDRC) trials: good planning processes that involve carers and
primary care recipients can provide significant benefits and drive
innovation. But the planning process is crucial.
In fact, there's good evidence from the UK that while
many older social care recipients don't like individual
budgets they can benefit from good planning that
involves them and their carer. However, there are a few
provisos. I keep hearing accounts around the country of
HCP planning that does not include carers. And that's a
problem. We know that a startling 12 per cent of carers
have never used respite because the primary recipient
(aged person) doesn't want to use it. Therefore, planning
processes need to be good to resolve those tensions.
As well, once the CHSP is up and running, respite will be charged
to the HCP package at full cost recovery, meaning packages will need
to stretch further. We don't want planners tempted to reduce respite,
assuming that carers of people with a HCP have less need for respite
simply because a package has more supports.
Respite has dual pathways to access, for the consumer and for the
carer, and these need to work well together. If we get it right, there's good
14 | JANUARY 2015
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