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HACC reform scheme plenty to discuss

The revised plan’s lack of information raises concerns for many stakeholders. 

In all the noisy and contentious debate that has surrounded the release of the 2014–15 federal Budget, you could be excused for not noticing that a major report of lasting significance for the community care sector has been released, with a short window of opportunity to provide comments.

The final discussion paper for what is now being called the Commonwealth Home Support Programme was released in the weeks following the Budget. And there is plenty in the report to worry those who have been working so hard to build the provisions we now take for granted as part of the existing Home and Community Care (HACC) program.

The new name tells us a lot, already. Apart from the European spelling and the removal of any reference to community in the title, there is now a simple subtitle used to indicate what it will all mean: Basic support for older people living at home.

The subtitle helps sum up what seem to be the main changes. The shift in emphasis is also evident in the program’s vision, which clearly states that funded services are to provide:

“basic support services centred around each person’s individual goals, preferences and choices – and underpinned by a strong emphasis on wellness and reablement”.

The emphasis on preventative and restorative approaches to care will entrench and extend developments that have recently been introduced to the HACC program in most states and territories. Such a development is, in my opinion, to be welcomed. If this is truly followed through we should also see the extension of services to include more preventative approaches, including fitness promotion and increased emphasis on activities. This holds out significant promise for a move to develop new services in addition to the traditional nursing and care approach that has been the focus of aged care for so long.

But a major concern arises when it is noted that older people with more complex needs will now be required “to transition over time to more appropriate levels of care, such as Home Care Packages”. Considering the existing waiting time for care packages is 12 months or more in many parts of the country, this has got be worrying for consumers and potential consumers.

Whilst the proposed common assessment procedures should help reduce the over-assessment of applicants, it is wishful thinking to believe the adoption of “greater contestability” amongst service providers will result in better client outcomes and improved value for money. Blind belief in increased competition is an ideology that is not typically borne out in the field of aged and community care. It is especially difficult to reduce the costs below the already minimal levels of so many of the not-for-profit, voluntary organisations in the field.

There are many exciting and attractive proposals outlined in the discussion paper – far too many to summarise here. But there are also a number of clearly worrying messages there, such as discussion of the future of case management and service co-ordination. These recommendations are hidden away under a section dedicated to “group two” services.

Similarly, the absence of information on funding arrangements, on clients and staff, and on projections of existing and future need are a big worry. Where is the hard data on future growth and on how differences between states and territories will be resolved?

If you work in community care, if you are a carer or think you may need to use support services to help you stay at home in the future, this report is important. Download it, read it – at least the introduction – and make your opinions known. At least until June 30, we’ve been invited to contribute to the discussion.

The paper can be accessed here: http://bit.ly/1tVDTss

Michael Fine is an adjunct professor in the department of sociology at Macquarie University.

The revised plan’s lack of information raises concerns for many stakeholders. By Michael Fine

In all the noisy and contentious debate that has surrounded the release of the 2014–15 federal Budget, you could be excused for not noticing that a major report of lasting significance for the community care sector has been released, with a short window of opportunity to provide comments.

The final discussion paper for what is now being called the Commonwealth Home Support Programme was released in the weeks following the Budget. And there is plenty in the report to worry those who have been working so hard to build the provisions we now take for granted as part of the existing Home and Community Care (HACC) program.

The new name tells us a lot, already. Apart from the European spelling and the removal of any reference to community in the title, there is now a simple subtitle used to indicate what it will all mean: Basic support for older people living at home.

The subtitle helps sum up what seem to be the main changes. The shift in emphasis is also evident in the program’s vision, which clearly states that funded services are to provide:

“basic support services centred around each person’s individual goals, preferences and choices – and underpinned by a strong emphasis on wellness and reablement”.

The emphasis on preventative and restorative approaches to care will entrench and extend developments that have recently been introduced to the HACC program in most states and territories. Such a development is, in my opinion, to be welcomed. If this is truly followed through we should also see the extension of services to include more preventative approaches, including fitness promotion and increased emphasis on activities. This holds out significant promise for a move to develop new services in addition to the traditional nursing and care approach that has been the focus of aged care for so long.

But a major concern arises when it is noted that older people with more complex needs will now be required “to transition over time to more appropriate levels of care, such as Home Care Packages”. Considering the existing waiting time for care packages is 12 months or more in many parts of the country, this has got be worrying for consumers and potential consumers.

Whilst the proposed common assessment procedures should help reduce the over-assessment of applicants, it is wishful thinking to believe the adoption of “greater contestability” amongst service providers will result in better client outcomes and improved value for money. Blind belief in increased competition is an ideology that is not typically borne out in the field of aged and community care. It is especially difficult to reduce the costs below the already minimal levels of so many of the not-for-profit, voluntary organisations in the field.

There are many exciting and attractive proposals outlined in the discussion paper – far too many to summarise here. But there are also a number of clearly worrying messages there, such as discussion of the future of case management and service co-ordination. These recommendations are hidden away under a section dedicated to “group two” services.

Similarly, the absence of information on funding arrangements, on clients and staff, and on projections of existing and future need are a big worry. Where is the hard data on future growth and on how differences between states and territories will be resolved?

If you work in community care, if you are a carer or think you may need to use support services to help you stay at home in the future, this report is important. Download it, read it – at least the introduction – and make your opinions known. At least until June 30, we’ve been invited to contribute to the discussion.

The paper can be accessed here: http://bit.ly/1tVDTss

Michael Fine is an adjunct professor in the department of sociology at Macquarie University.

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