“It’s not just perverse, it’s cruel” – The shambles of Support at Home – From delayed to damaging, current policy is not smart or kind for seniors and the system

The push to get 20,000 Support at Home packages released early has been well documented. The cracks emerging in a strained health and aged care have equally been prevalent, from reports of record after record ambulance ramping, to seniors in hospital beds with nowhere to go, the crises are here and the time to enact dynamic and smart policy was yesterday.

Leaders and experts across the aged care and health sectors have been calling for reform for months. From academics to aged care CEOs, the recommendations have been clear, more Support at Home packages now, with updated pricing models, for sustainable impacts into the long-term.

A disconnected government

A recent communique from the government noted that, “the deferral of the commencement [Act and Support at Home Program] followed advice from the aged care sector, as well as advocacy and representative bodies.”

However, this not only confused many experts and leaders in the sectors but highlights a growing concern of disconnect between government and the sector. In WA, Juniper’s CEO, Russell Bricknell has been campaigning for increased equality and release of home care packages to help mitigate the growing cross-sector strain in aged care and hospitals. The limited amount of, and delay to, home care packages is of extreme concern to many in aged care leadership.

 “Juniper, Uniting Care Australia and many other providers all campaigned for there to be no delay to the release of home care packages from the moment that Act was passed in parliament”, he says.

“Our view was that a delay in package release was unjustified and would result in hardship for older Australians.”

Aged care leaders have been clear, “They chose to delay the new packages with the act delay. I think that was wrong.”

Short-sighted policy

While the daily government subsidy rate is changing under the new Support at Home scheme, when comparing to the grandfathered Home Care Package rates, it becomes clear as to the effectiveness of investing in services at home, rather than making those services harder and harder to access.

Under the Home Care Package, still in effect at present, a Level 4 Home Care Package will cost the taxpayer $173.81 per day. Comparing WA’s government figures, that place a hospital stay at over $3000 per day, the rising cost becomes starkly evident.

Aged care leadership have been adamant that the federal government be open to changing their attitude towards Support at Home package release. The time is now, to see it as a cost-saving investment for the long haul. Not only does it allow for more seniors to stay at home longer in an environment they love and are comfortable in, it can directly provide health support to prevent early admission into hospital.

Bricknell notes, “By not investing in aged care [at home], you are shifting cost into the acute sector. You go from $300 a day, to $3000 a day, and putting older people in an environment that’s detrimental to their wellbeing for long periods of time.”

“It’s not just perverse, it’s cruel.”

Tackle the source of the problem

Leadership across aged care and health care have been working to build a case for the release of more Support at Home packages in the immediate.

Juniper’s leadership team have spent extensive time gathering data from government verified sources and have found compelling evidence that points to the effectiveness of supporting at-home care.

Bricknell shares, “Looking at ambulance services in WA, 17,000 older people were admitted to hospital from aged care in the last financial year”.

“However, 43,000 seniors were admitted to hospital from their home. So the cost of home care for those 43,000 should be seen in light of the cost of them admitted to hospital.”

While the subsidy amount of Support at Home is not overtly clear at present, using the rough estimate of $173.81 a day:

• Around $7.47 million per day to have seniors directly supported at home, to minimize the likelihood of needing to be admitted in hospital. With the probability that not all seniors will be on the highest subsidy level, or need support every single day.
• If each of those 43,000 seniors only stayed in hospital for one day, the cost would have amounted to $129 million per day.

“If we don’t provide sufficient support for people in their homes, they’ll end up prematurely in hospital or residential aged care”, Bricknell says.

“Cost goes up, quality of life goes down.”

Support at Home pricing fears

Advocate Peter Willcocks has done extensive analysis assessing the cost structure of the upcoming Support at Home. If the typical full pensioner is on a level 7 package, they will be paying around 20% towards costs, and a part-pensioner will be paying 25% each fortnight.

Kathy Eagar, adjunct professor at UNSW and QUT says, “We are one of the wealthiest countries in the world. We should not be asking older people to choose between a shower and a meal. It’s unethical.”

Experts and leaders have been transparent, for those that have, paying for care is a no-brainer. Means testing in aged care is fair and an equitable way to spread the burden of cost. 

Yet it is for those with the least means, in a nation of such wealth, that advocates have been insistent. She says, “I have no problem requiring older people to contribute to the cost of their care according to their means. But this policy punishes frailty and will inevitably lead to people not being able to afford the services they need to live safely at home.”

“Wealthy people will be able to afford the new higher fees. Poor people won’t. Renters will be particularly hard hit because they need to pay rent out of their pensions.”

Eagar notes, “Imagine a full pensioner saying $80 a week for support at home. They have a fall and now need extra help with showering and dressing. Their fees increase. But their pension doesn’t.”

“In other words, the sicker and frailer you are, the more you are penalised.”

Systemic consequences

Eagar agrees with the many leaders and experts that have called for the government to see the big picture.

“When I say expensive and inefficient, I mean that it is penny wise pound stupid as it will result in increases in emergency department visits, hospital admissions and premature admissions to residential care.”

“The overall cost to taxpayers will increase at the very time that the baby boomers start hitting very old age.”

The ease of accessing services at home is becoming increasingly imperative for the already strained systems of aged and healthcare. It is in supporting the growing cohort of ageing boomers to stay at home longer, and stay healthy longer, that the uplifting of human dignity, and minimising of cost, can be powerfully entrenched for seniors, and all tax-payers, across the nation.

Supply and restructuring

Aged care experts and leaders continue to campaign for the release of more Support at Home packages, to start the work of policy investing in human and systemic safeguards.

As to the restructuring of the Support at Home policy, Eagar provides clear recommendations.

“Government should cap fees at around 10% of fortnightly income. People receiving support at home have the right to both a shower and a meal and shouldn’t have to make trade-offs about essential costs.”

“[They must] restructure the Clinical Care category to include personal care. People should not have to pay for help with hygiene.”

And lastly, “abolish the artificial distinction between Independence and Everyday living. If a person needs help with everyday living, the services they need are essential to their independence.”

Eagar recommends that, “the final policy would have only two categories – Clinical and Independence – with fees capped based on the older person’s capacity to pay.”