The Grattan Institute has released a new report, entitled “Unfinished business: practical policies for better care at home”, which examines how to give Australians better aged care at home.
Below is the Overview of the report, alongside key charts and data:
Overview
Care at home is essential for older people to live meaningful lives in the community when they need support. But it is hard to get, disorganised, and can be expensive.
The Royal Commission into Aged Care Quality and Safety heard distressing stories about the problems with aged care, and made sweeping reform recommendations.
The Federal Government has made significant and welcome commitments to address many of the shortcomings identified by the Royal Commission. A new care-at-home program is being introduced from mid-2023. The number of Home Care Packages is being increased by nearly 50 per cent, care finders are being employed to help people find services, and small regional offices are being established. But despite committing more than $2.44 billion of additional funding each year to home care places, the Government’s response leaves unfinished business.
Firstly, the additional funding the Government is providing for home care will be spent in a poorly regulated market where consumers get a bad deal. The Government should do more to help older people find their way through the home care system from assessment to getting needed services, by establishing regionally-based agents with a role in guiding and assisting people to get the care they need. These new ‘agents’, or system stewards, should have a role in overseeing the local service system and the quality of care.
Secondly, the Government still has not committed to keeping waiting times for home care to less than a month. Up to 15 per cent more home care places than planned could be needed to eliminate the waiting list by the time the new home care program is introduced in 2023, with more required after that as the number of older people needing care increases.
Thirdly, there is no clear plan to meet future workforce requirements. Home care staff are underpaid for what they do. Their work is often insecure, and many want more hours. Not surprisingly, it is hard to attract and retain staff, and many employers have vacancies and high turnover rates. We calculate that 46 per cent more staff – about 58,000 more carers – will be needed just to meet the planned increase in home care places. To attract and retain home care workers, they should get better pay and conditions.
An improved home care system would cost the taxpayer more. How much depends in large part on determinations of the independent arbiter, the Fair Work Commission. Better wages and conditions for staff – the likely outcome of a current case before the Fair Work Commission – will add significantly to government spending on the sector. Costs of growth of home care supply may be in part offset by reduced administrative costs and reduced demand for residential care.
For improved regulation and care navigation support, necessary to get better value for money from the system, we estimate that it will cost $400 million per year more than what is already provided in budget forward estimates.
This report shows how that money would improve the lives of older people who need support at home.
Recommendations
1. Improve stewardship of the home care market.
The new Aged Care Act should introduce a new approach to regional stewardship to protect the rights of older people and make sure they get the home care services they need.
The Federal Government should establish 31 regional offices across Australia, co-located with Primary Health Networks, to act as stewards that plan and develop local aged care services and hold funds, pay providers, and administer service agreements on behalf of individual service users.
The Government should expand and strengthen the role of care finders, to act as agents for older people trying to navigate the system.
2. Clear the waiting list for home care.
The Government should commit to ending waiting lists, and keep waiting times for care at home down to 30 days or fewer when the new home care model is introduced from mid-2023.
3. Expand and develop the home care workforce.
The Government should explicitly state that it will fund – partially or fully – the flow-on implications of an independently-assessed fair wage for aged care workers.
The Government, in consultation with the Aged Care Workforce Industry Council, should develop and implement a workforce plan for aged care as part of the new Aged Care Act.
The Government should develop and strengthen leadership, coordination, and service delivery roles, such as ‘advanced personal care workers’ and ‘home care team leaders’, for home and community team-based care for older people with complex needs.
The Government should require personal care workers to be registered and to hold suitable minimum qualifications such as a Certificate III in individual support.
Leith van Onselen is Chief Economist at the MB Fund and MB Super. He is also a co-founder of MacroBusiness.
Leith has previously worked at the Australian Treasury, Victorian Treasury and Goldman Sachs.
