Repealing the ‘cannoli’ is not enough – states remain mired in reactive policy reform argument, preventative measures mean collectively braving the Support at Home debacle

The persistent argument being heard from the states, and not just Queensland at that, doesn’t go far enough to tackle the true issue at large for aged care. While “access to more beds” as Crisafulli has been championing is worthwhile, it does not go deep enough to avoid the likely grievous cost, both human and financial, to Australians across all demographics. Preventative strategy is keeping vulnerable seniors out of hospital at all. And to do so the states must tackle the beast of problem that aged care leaders, advocates and now increasingly every-day Australian seniors, are acutely aware of, the Support at Home scheme and the reality of its co-payment pricing model.

No more ‘cannoli diplomacy’

This week saw extensive reporting on Queensland premier, David Crisafulli’s, declaration of a cessation of “cannoli diplomacy”. Initially coined to honour his and Anthony Albanese’s shared Italian heritage, and willingness for his LNP government to collaborate with Labor in Canberra, the mood has decisively soured. Until Queensland reaches a funding reform deal with the Commonwealth regarding hospital funding, the pastry is off the table.

While not having cannoli to remove from the equation, SA’s health minister Chris Picton has still been vocal about his frustration at Canberra’s approach to health and aged care spending as well. In September he told reporters, “Right across the country, there are patients who are stranded, who are stuck in those hospital beds”.

“It’s not a good outcome for them to be stuck in hospital for months and months when they don’t need to be, but this is also an awful situation for other patients who need hospital care.

“This is the equivalent of 880,000 nights every year of our public hospitals taken out of the system, and the cost is about $1bn across the whole system. So this is an urgent issue.”

NSW health minister Ryan Park likewise commented, “[Hospitals] were never designed to be aged care homes. That’s not the way it works in this country.”

“We’ve got to get back to a situation where the Commonwealth takes the load for aged care, and we do the delivery of acute health services.”

Blinkers – only reactive hospital funding and rac builds

As underpinned by consistent messaging, the state’s main gripe has been surrounding the Commonwealth commitment to the funding increases agreed upon in December 2023, under the National Health Reform Agreement. Crisafulli, along with counterparts across the country remain adamant the Commonwealth honour its “commitment to fund 42.5 per cent of public hospitals costs by 2030 and 45 per cent by 2035.”

Federal minister Butler too acknowledges the need for a significant increase in RAC builds to accommodate the new boomer cohort starting to enter aged care, “We know we need to build enormous numbers of new facilities to accommodate the baby boomer generation, which is upon us now.”

While the increased funding for hospitals and reform funding for RAC builds is highly warranted, it must not be the only card to be played. The sheer numbers of boomers ageing into the system means drastic overhaul is needed to keep the pillars of both hospital and RAC in operational functionality.

The arguments of state players must turn to preventative measures to allow for hospitals to recover, as well as allowing the time for RAC builds to be underway and effective in the highly elevated figures needed.

Preventative over reactive

Across the country states have been publishing data to attempt to highlight the extent of the problem. Crisafulli has stated that 1100 long-term patients are currently occupying QLD acute care beds, remaining in hospital because they have nowhere to be discharged to.

September saw a South Australia report state the number was close to 2500 seniors stuck in hospital with nowhere to go. It is certainly incumbent on states to address the differing data sets that have been broadcast but the underlying issue remains, seniors are in hospital when they shouldn’t be.

Yet it is the repeated argument to only tackle the issue through increased funding to hospitals, and arguably less clear mentions of “supporting” increased bed builds, that is limiting the needed scope of reform.

What aged care leaders and advocates have been repeatedly calling for, many feel into the void, is an overhaul of waitlist processing, co-payment model and open market price flexibility for services when it comes to the new Support at Home program covering in-home care services.

Increasingly being seen is the prior warned disastrous impact to seniors health, and the worsening of hospital strain in consequence.

To ease the strain on hospital systems, and RAC facilities, the greater goal, perhaps more difficult because it demands collaboration between all levels of government, across multiple sectors and providers, is to enact effective and sustainable reform to support seniors to stay at home longer, to stay at home healthier.

From Juniper’s CEO Russell Bricknell, academic Kathy Eagar, and long-time advocate Peter Willcocks, among a host of others, the message has been clear; Invest in a scheme that seniors can access easily, and afford, and the reward to the system at large will be an eased and less costly health sector, and a less overwhelmed RAC.

Support at Home scheme consequences

Peter Willcocks, a retired businessman and now long-time advocate has done extensive calculations on the consequences on the new Support at Home pricing model. For everyday Australians, on full, part and self-funded pensions, the prognosis is dire.

His calculations paint a despairing picture, not only for seniors but for providers who are seeking to operate in the in-home services space.

Those not grandfathered into the CHSP scheme are likely to see huge increases in the co-payments that they must contribute in order to receive health supporting services, like hygiene activities of showering, or support to get to the GP.

Full pensioners could see co-payments rise to 22% of their weekly pension budget amount.

The situation worsens for self-funded retirees, with those on a level 7 or 8 package seeing 62% of their weekly budget needing to be spent to keep up with required co-payments.

Consequences for providers, hospitals and RAC

Already unfolding are the consequences of seniors having to make impossible decisions. Hello Leaders has heard from loved ones, overnight having to come to terms, plan for and support their seniors through huge weekly increases.

Yesterday, a daughter shared that her mother was given 72 hours, under the new Support at Home scheme, and the government’s willingness to allow prices to be freely set currently, to sign a new services agreement or her services would be withheld.

The senior was instructed to agree to a $36 per hour increase for social support and domestic help, from $88 per hour to $122.

Willcocks weighs in on this very situation, that where money is tight, with now fluctuating management fees within the service price, the inability to access services in a stable and routine manner has been utterly voided.

He notes that as seniors increasingly face situations like those mentioned, home care providers may increasingly run into issues of the viability of their services being used, with implications for cash-flows, as seniors start to seek alternative ways to cover their needs outside of the established market and scheme.

Yet it is in seeing that facilitating accessible in-home services, particularly services keeping seniors clean and free from infection, from being able to access allied health services to prevent falls, to being able to see GPs before conditions worsen, that state ministers must turn their collective focus.

Keeping seniors healthier at home longer means a reduction in early presentation to hospital, mitigating the pressure on beds, and freeing space for those across the nation who need to be there and nowhere else.

Seeing in-home care as a return on investment

Aged care leaders and advocates ask Canberra and the states to do the maths. At $3000-6000 a day, hospital care is profoundly pricey for the tax-payer.

Picton’s assessment of 880,000 nights of hospital care equating to a $1bn price tag may yet be undervaluing the current cost to the nation.

Perplexingly, in September, Minister Butler touched on the very argument advocates say is the strategic salvation of the cross-sector crisis, keeping seniors out of hospital in the first place.

He said, “we are providing record funding to state governments to support their hospital operations, and targeted investment to help older Australians either avoid having to go to hospital in the first place, if they can be cared for out in the community or, if they are in hospital, moving through the system as quickly as possible.”

“It’s not perfect, right now, we’ve got to do more, and I’m meeting with my state and territory health colleagues [today] to work through how we can do more.”

Advocates lament this apparent blind-spot when it comes to the current Support at Home waitlist blow-out and pricing models, in obstructing older Australians from avoiding having to go into hospital in the first place and smoothly accessing being care for out in the community.

The Support at Home scheme is that very vehicle to support seniors early, the Commonwealth messaging has been overt in that vein. It is worthwhile for actors to see the merit that it must be reformed, to mean that all seniors can access in-home care to prevent early admission into hospital.

Sustainable hospital and aged care is a unified goal-post

This issue is one for all demographics across Australia. Presenting to hospital should mean immediate and straightforward care as directed by need. Hospital stays need only be as short as possible. It is worthwhile for state ministers to collectively rally to enter into decisive talks to safeguard their seniors access to in-home care, an overhaul of the Support at Home waitlist and co-payments pricing model, as well as market led price-setting, so as to sow into a future for young and old alike, where the pillars of hospital and aged care work for all.