Support at Home is a complicated, opaque, inefficient scheme for all – part one: tropes of seniors and sector have no place in scheme mechanics

Support at Home has brought in sweeping changes to how home care operates across the sector, for hundreds of providers and staff, impacting seniors and wider society. Examining these in a series is to highlight the very real impacts of legislation on the ground, and the equally real need for reform.

Tumultuous is a word that starts to cover it. Unprepared is another. For leaders who have been persisting in the sector, on a particularly tiring day, absurd may just be the one to land. ‘It’ being how well Support at Home is landing in aged care, seemingly at odds with a vision of robust and sustainable progress now and fifty years yonder. Aged Care’s Royal Commission was held up as a point in time to definitively draw a line in the sand, for all collectively to pull to better. Akin to doing the splits however, Support at Home seems to be drawing further away from any meaningful impact of dignified care. Not just for seniors, but for home care providers who have striven to provide that care, through sincere conviction and cost challenges.

The growing tension is that the tools to do better, namely in the scheme of Support at Home (SaH), are pulling further away from Commission’s recommendations, and the sector’s ability to hold steady. For executives who have weathered their fair share of bumpy roads, and ups and downs, like Jean Claude van Damme, they feel the split widening between the objective, facilitating person-centred and dignified care, and the scheme provided to do it. Unlike Damme in the iconic ad, the power steering of the system is not holding steady. It’s worsening. Adrian Morgan is General Manager of a home care provider, Flexi Care, and what he shares is important because it makes transparent a snapshot of hundreds of home care providers across Australia. A weekly reality of hundreds of leadership teams, and clinical specialists and care partners reeling from a scheme that has made the objective harder, to keep seniors at home longer and healthier.

Insight outside of tropes

Away from the headlines, from the tropes that are used to swiftly and easily make a point, are the stories of hundreds of seniors and staff reeling and trying to adapt.

“Seniors are still discovering, and frustrated by the fact, that they have to make quite high personal contributions to the cost of services”, Morgan notes.

Part of the conversation about how Support at Home is not holding steady for the ecosystem of sector, provider and seniors, is the constraining ideas of boomers only being wealthy, or providers only besotted by profit. These do not hold true for the spectrum and substance of the demographic and industry.

Long before the changes came into effect, Morgan and his team knew that preparation, to inform, to equip seniors to weather the change as best they could, meant stepping in above and beyond. In many cases, with more clarity and consistency than government messaging.

“I know that we tried very hard to communicate to our client group, the people who were clients at the time, that this was coming. But often, the reality doesn’t actually hit you until you’re being confronted by a decision.”

Reality’s nuance

For everyday Australians that have been diligent, to the point of not wanting to be a ‘burden’ on the taxpayer and fund retirement themselves, Morgan shares an angle that hasn’t been a part of the conversation. He sees self-funded retirees grappling with unthinkable decisions, “‘will I accept a particular service and therefore have a personal contribution of potentially quite a substantial amount of money or…”

The fact that there is now an ‘or’, the fact that the narrative of aged care is framed largely in polarising tropes, bears witness to how the Support at Home program is not supporting seniors, of all stripes, to stay home where they want to be. Pulling away from supporting a sector to provide those services efficiency and cost-effectively.

The argument, industry experts say, is that Support at Home is not fit for purpose for all, for sector, for seniors and for society. If it clinks with more coins than previous schemes, if its internal mechanics are confusing and inconsistent, if it means resources go more towards paperwork than providing care, it quacks like a duck that needs change. Sector leaders argue it should be seen for what it is, a scheme that needs overhaul, now.

Part two to follow next week: Support at Home’s ineffective cost breakdown compared to CHSP is highlighted from provider data. In addition, the black box of IAT’s algorithm is causing further distrust and confusion.