The rise of precarious care

Perhaps the most damaging side effect of the Royal Commission into Aged Care Quality and Safety is that instead of dealing with the problems of the aged care system, we have a de facto policy of ‘wait and see’. Actions and policy initiatives we know are urgent are simply not happening.

In the meantime, although politicians often remind us that throwing money at a problem is no solution, that’s what they try to do.

The recent call from Commonwealth Home Support Programme providers for growth funding is a glaring case in point. After years of facing the chop, CHSP services are now expected to take up some of the growing queue for national Home Care Packages – at least until 2022 when their funding is again scheduled to be terminated.

In a gesture that is supposed to ease the problems of providers, CHSP providers were informed in September that they can apply for additional funding from a $150 million funding pool the government says will provide support to 18,000 people over the next 12 months. Applicants in areas where there is high demand, it is said, will be given priority. But in the era of CDC, doesn’t each individual count? Isn’t every person who misses out or who is forced to wait for a vacancy a high-demand case?

Of course providers welcome the chance for extra funding. However, even the ACSA has described the package as a ‘drip feed’ that will do little to tackle the waiting list problem in the Home Care Packages Program. Nor will it make up the funds CHSP services have previously missed out on.

Funding for CHSP services has clearly not kept pace with growth in demand over the past five years. In 2017–18, total government expenditure per client was just $2762 a year, about $55 a week down from the previous year.

As important as funding is, other approaches to policy design are also required. We need to think about innovative new approaches to service delivery and opportunities for real serviced innovation, better pay, as well as educational and career opportunities for staff and more security for their employment into the future. And I could go on.

But what do we get? A new home care assessment system, introduced without serious field trials and that seems designed to fail, frustrate and confuse. It makes simple access to basic services complicated. It focuses on eligibility at entry but ignores the importance of regular, ongoing reassessments.

The outcomes of assessments were always likely to be somewhat cautionary and uncertain in many, if not all cases. Where a need for support is assessed but there is doubt about what level of service might be required, the result is likely to be a ‘safe’ one, a decision-making process that was always likely to lead to an increased number of recommendations for access to a more comprehensive Home Care Package rather than a more specific and limited CHSP intervention.

Whatever the cause, the new assessment policies for Home Care and the CHSP have effectively funnelled an additional 800,000 consumers who use CHSP services each year into an assessment program that seems to have been designed for 90,000–100,000 Home Care users per year. Bottlenecks should have been expected.

Perhaps even more troubling, the emphasis placed on assessment at the point and time of admission to services is misplaced. Because the care needs of individual consumers change over time, regular, periodic follow-up reassessment is at least as important as assessment at the point of entry.

In many cases, the care needs for those at home may reduce over time as a result of reablement programs or recovery and recuperation following discharge from hospital admissions.

Reassessment is also important from a service provision perspective. Without the capacity to reassess consumer needs over time, turnover rates are minimal and services fill and lack capacity to accept new applicants.

Can it be left to consumer choice? When it is your turn, what would you choose? Under the existing system there is the possibility you might get what you need. But it’s also possible that you might miss out. Perhaps worst of all, you might actually be assessed and found eligible, only to have to wait a year or more. Who knows when a place will come free? Do you need to wait for someone else to die before you can take their place?

In the name of flexibility and competition, it seems we’ve gone from a search for security to the guarantee of an offer of precarious care in late old age.

In the 21st century, that seems to be what they call progress.

Michael Fine is an honorary professor of sociology at Macquarie University.

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