Home | Industry+Policy | Post-COVID, post-royal commission, the future is home care

Post-COVID, post-royal commission, the future is home care

Home care has long been touted as a solution to the issues the aged care system is going through. As the Australian community grows and ages, the government and experts alike have spruiked the benefits of getting people to age in place.

One hurdle, or the hurdle, is the thousands of people on waitlists for the various home care packages.

Just this January, data released by the Productivity Commission showed that the highest-level home care package has an average wait of 34 months.

The wait times range from seven months for a level 1 package to 34 months for a level 4 package. The report states that “as approval processes for clients have changed significantly under the new arrangements, data are not comparable over time and data for 2018-19 should not be compared to previous years”.

Government data released last year puts the number of people with access to a home care package at 134,930. However, there were 62,942 people seeking a home care package at their approved level who had not yet been offered access to a lower level package.

The total number of people on the home care package waitlist currently sits at over 129,000.

However, with a pandemic ripping through aged care homes – and with providers accused of struggling to appropriately deal with the families of residents during outbreaks – the government will have to move quickly to cut these exorbitant wait times.

They have made some progress. In July another 6100 home care packages were released, but that still leaves 104,000 older Australians who have been approved for care but are still waiting for packages.

Nick McDonald, CEO of Prestige Inhome Care, has noticed an uptick in people choosing home care during the pandemic, as well as an increase in calls from families who want to move their loved ones out of residential care.

“I’ve been in this industry for over 20 years and it’s almost like once you go into a nursing home, that’s your last stop. So, the movement back the other way is really unique, but welcome in my opinion,” he said.

“Most people don’t want to be in a nursing home if they can avoid it. I think there’s also been an element of, whilst not necessarily people coming out of residential care into home care, it’s probably families that have been considering the residential care option that then choose home care instead. So, probably people that would have otherwise been in residential care would be getting higher levels of care in the home.”

McDonald says that people often find home care difficult to manage. Just like residential aged care, picking a provider can be difficult; there are so many with so little information available about how good they are at their job. But McDonald does suggest looking at how much a provider will use of a home care package on actual care as an indicator of a good place to go.

“I read an article just a week or two ago, there’s providers that are taking upwards of 50 per cent of the bucket to help run the package, and so it leaves you with a small amount to buy the actual care you need. So our approach was always, ‘Let’s just keep the fees as low as possible and leave them as much of the bucket as possible because hopefully they’ll then spend some of that bucket on services with us, which is what we’re in the business of doing.’

“In terms of shopping around, the fees is a really big one and we’re probably at the absolute low end. Our fees are 20 per cent of the package and, as I said, there are others that are over 50. Our advice would be to find someone that you like whose fees are down at 20 because it’ll leave you more for whatever sort of services or support it is you need.”

Home care providers have faced many of the same challenges as the residential providers of aged care during the pandemic, McDonald says. PPE sourcing and training has been an added pressure, as have the rules surrounding how many different places staff members can work.

Eve Shoulder has been a care worker with Prestige Inhome Care for the past 20 years and she admits that the pandemic has been challenging, for her and her clients.

“For a lot of clients, there’s a lot of uncertainty and lots of confusion as to what’s going on. Some of them can’t really comprehend the enormity of COVID and we’ve all just had to be more vigilant in terms of washing our hands and wearing masks and being very careful about we do with our clients and how we treat them,” she says.

“The workload has differently shot up. I do maybe 40 hours a week, so I don’t accept any more shifts than that. But if I wanted more work, there’s no doubt it’s there, but certainly we’re all busy at the moment without a doubt.”

Shoulder says she has seen first-hand the influx of people moving from residential care to home care and while the industry has always been busy, this has increased workloads.

“I guess in the industry that we’re in, it’s always a busy workload, but now I think even more so because some clients have moved from residential care,” she says.

“The families are definitely relieved and the clients that I have dealt with are… I can’t really say, but I think they’ve made the transition very well. But the families are definitely very relieved.”

Over her time in the industry, Shoulder has seen home care improve dramatically and she thinks that it is ready for an increase in clients.

“We’re all more professional now, where once upon a time you didn’t really have to be qualified you could just be anyone doing the job. But now, there’s a lot more to it. It’s a profession now and a recognised profession. You need to be qualified. You need to understand the clients that you’re working with and the co-morbidities that they might have. It’s just more professional all around and run from the top right down to the bottom much more efficiently. It’s evolving and improving every year, all the time, which is a fantastic thing.”

An increase in capacity for home care could well put pressure on the industry and McDonald cautions against relying too heavily on less experienced providers using the new gig economy models, as seen with Mable – who have been heavily criticised of late. McDonald says the decision to award Mable a large contract to provide a surge workforce has proved to be a poor one and their Uber-style model of staffing could be a problem.

“If a staff member does something wrong, I assume Mable say, ‘Hey, that’s not us. They’re independent contractors, they should know what they’re doing. They take that responsibility themselves.’ Whereas any of our staff do anything wrong, my head’s on the chopping block. So I will have to take responsibility for whatever they’re doing. As a result of that, you’re very motivated to make sure what they’re doing is brilliant. The other thing that is the most interesting to me about Mable is how there was just a handout to them. And I can’t remember what it was, $5 million or something?

“You cannot rely on one [company]. You might have 20 organisations like ours that you can sort of pick and choose from depending on who’s got capacity in what areas and who’s dealing with challenges themselves,” he says.

“Clearly they weren’t able to deliver the product that they were paid for. A, because the world didn’t quite end the way that we thought it might in terms of all areas of aged care. But B, because even when they did have to do something, they didn’t really have the staff to deliver it. So where’s the rest of the millions? Just sitting in their bank account or helping them with their own business development, which seems grossly unfair.”

The future, post-COVID and post-royal commission, is going to rely heavily on home care, says McDonald, and that is a good thing for older Australians.

“I think there’ll be way more people wanting to get their care at home. Both traditional kind of aged care, if you like, but all the palliative care,” he says.

“Which I love because I always think, ‘Well, where would you want to be in your final days? In your own home with your grandkids around you and your family and all your bits and pieces? In your own bed? Or in some sterile hospital room with people coming in for the set visiting hours or what have you? It’s sort of a no brainer. So to be able to give that gift to families, not just the person that is palliative, but all their loved ones that are so intimately connected to that process. It’s beautiful.”

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