Home' Community Care Review : CCR Jan-Feb 2015 Contents focus
Alternatively, NACA said the government
could transfer a proportion of funding from
the HACC program to create additional
home care packages and transfer existing
high service clients to these new packages.
NACA said some clients under the NRCP
would also be affected because of their high
needs and would need to be considered in
the transition arrangements.
The department did not respond to
questions from CCR about the number of
clients likely to be affected by the move to
the CHSP but a spokesperson said existing
clients who do not fit the CHSP eligibility
criteria will continue to receive the same
support from their current provider until
they transition to more appropriate forms of
care. The spokesperson said further details
regarding transition arrangements would
released in "coming weeks".
Another big issue that was flagged in the
discussion paper was the introduction
of competitive tendering or "greater
contestability" as it is described by DSS.
The department said contestable processes
would "ensure that client outcomes are
maximised and that value for money
However, the extent of the government's
intentions in this area remains unclear.
Paul Sadler, chair of the NACA Home
Support Advisory Group, said NACA has
advised the government against large-scale
competitive tendering for funding within
the home support program.
"However, NACA can also see there is
an argument for testing the market from
time to time and in certain places. We also
recognise that in some instances there is no
market. If you are in a rural or remote area
or in a particular service niche or specialist
service then market testing may not be
appropriate," Sadler told CCR.
NACA advised the government that any
decision to introduce contestability should
consider the savings to the department as
well as the improvement of quality services
to clients and the impact on staff.
A cost of care study would also need
to be conducted to determine a fair
and sustainable price for each service
type across Australia before moving to
competitive tendering, the alliance said.
Reflecting on recent history, Sadler said
this wasn't the first time that contestability
has been tried in community care programs.
"The previous Coalition government -- when
Julie Bishop was minister for aged care --
had a go at doing a tender for the whole of
the National Respite for Carers Program in
the mid-2000s, and I would have to say that
the experience of the sector at the time was
that it was a very disruptive process.
"There were some changes of service
provider but in the bigger picture not a lot.
So we went through this process of every
single dollar and every client and service
being put at risk and you didn't end up
changing the system massively at the end
of the process."
Sadler said time was running
out to communicate to the sector
the government's intentions around
contestability before the program start date.
Council on the Ageing (COTA) said
it remained concerned that competitive
and contestable approaches "may not
be in the best interests of investment in
demonstrated best practice or innovative
and untested ideas."
The Department of Health in Victoria
said it also held reservations about the
move to competitive tendering in the
CHSP in light of the impact on service
fragmentation in home care packages.
"From a provider and client perspective
the Commonwealth's current method of
contestability for the allocation of new home
care packages results in the introduction of
multiple new providers in a local area."
The health department said often new
providers have no local knowledge or
presence in the community, which is a
cause of current service fragmentation
"There is little apparent accountability
for providers who may not be meeting
their obligations to clients within a local
catchment. Home care package providers
can cherry pick from waiting lists and some
people 'fall through the gaps', waiting for
extended periods for a package," the health
department told the Federal Government.
Smaller organisations such as CALD
and Aboriginal agencies may also be
disadvantaged in competing for funds, said
the state department.
It said the CHSP would need to reconcile
these two realities: "contestability versus
system stability" with locally-based
providers accountable to local communities.
More than basic
Elsewhere, a number of sector stakeholders
have said that support for short-term
intensive services under a wellness and
reablement focus must explicitly form part
of the CHSP.
The program's focus on 'basic support' or
low-level services was seen as contradicting
the place of higher intensity episodic or
short-term restorative services in the home
support program in order to improve an
older person's function or capacity.
The term 'basic' also did not reflect
the range of service types that would be
provided, such as complex nursing care and
NACA proposed an alternative definition
of basic support as: "providing small
amounts of a single or a few services when
this is sufficient to maintain independent
community living and wellbeing; or a
higher intensity of episodic or short-term
services where improvements in function
or capacity can be made, or further
Derryn Wilson, policy officer with the
Municipal Association of Victoria (MAV), the
peak body representing Victoria's 79 local
councils, said one of the strengths of HACC
has been the rather 'loose' definition of
"This has allowed for judgement and
urgent or important individual needs to be
accommodated, when there are no other
options." she said.
Wilson said the CHSP would need to
accommodate a wide range of service types
and intensities, including early intervention,
dynamic, short-term and intensive restorative
care, low level episodic and longer term use
of one or a few services, as well as supporting
those with higher needs requiring and
transitioning to home care packages.
In an encouraging sign, the department's
Regional Assessment Service tender
documents recognised this broader
definition and referred to assessment
services for people requiring either ongoing
low intensity services or episodic short-
term higher intensity support.
To retain a focus on community support
services, there was also some support
within submissions for the program to
be renamed the Home and Community
A stronger focus on addressing equity
within the home support system was MAV
said there was no acknowledgement of
how priority access is to be managed,
or recognition that there is already
considerable inequity in access across
service types in different jurisdictions.
COTA said inequitable service access and
provision is a significant issue within rural,
regional and remote areas. n
See page 20 for reablement and page 28
for case management under the CHSP.
aaa community care review | 19
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