Support at Home is a complicated, opaque, inefficient scheme for all – part three: wide impacts, unprofessional systemic blunders

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.

The most recent change to how Australia does aged care was touted as its most ambitious, “the most recent being our once-in-a-generation reform to the way older people are cared for”. From the degree of change, to how that change was to be paid for, Minister Rae and Labor have stressed the “transformative” nature of the new Aged Care Act. It is as the chapters progress on this new act that the twists in plot are coming to light, with seemingly more bumps than plain sailing. 

As Rae has offered, “we turned the page on a new era of aged care that finally puts the rights and dignity of older people at its core” but as the wait-times for Support at Home packages balloon, to be chased in many cases by interim funding at 60%, if and when packages are approved, it is not only seniors that are being impacted but working family members and providers reeling from a system that was not tested prior to launch. 

Adrian Morgan is General Manager at home care provider Flexi Care. What he shares is not abstracted macro commentary but acute insight from the offices, halls and homes of the organisation. These stories must hold the weight they deserve as they are echoed across the nation. Testament to seniors, families and providers, these micro moments are loud in their widespread collective. Of navigating a turned page to be sure, but of a scheme not fit-for-purpose. 

A society impacted

High-performing home care providers, who have earned trust for years alongside family, are in a unique position to see how SaH impacts across generations and demographics.

Experts and industry leaders have voiced their concerns to government; as the fault-lines of Support at Home widen, with wait-lists ballooning to over a year, with seniors worsening conditions ignored under opaque IAT re-assessments, there will be financial and societal costs spread out across the nation.

To hear government sources and some mainstream media comment on an uncaring and listless sector, when it comes to pushing for excellence in care, Morgan’s witness refutes this simply and transparently. The years of working with seniors and families, he shares, has meant earned trust and rapport, in many cases provider staff and clients have formed close bonds. It is within these bonds that providers and staff are hearing directly from seniors, more so, some muse, than government personnel saying they are “listening to seniors”. 

Morgan shares, “there has been an eroding of trust and sort of fairness with the opaque IAT system, in terms of seniors we have spoken to, it has made them distressed or angry”.

He shares further that the ramifications of a system not fit for purpose goes beyond seniors, the fault-lines are cracking through wider society, “it’s not just the seniors themselves, it can be their families”.

“Families are struggling on and within the current system and level of support, they are really struggling”.

Morgan shares, “we know of so many families, and adult children, trying to hold down jobs but the support for their ageing parents is lacking, more support is needed, and then its refused, and we have seen that lead to awful decisions, the whole family being pretty distressed. I’m talking about the whole family, not just seniors, this is impacting the whole family unit”. 

Morgan provides direct insight into this, “I’m aware of people who are contemplating either reducing the number of days of work or pulling out of work altogether because of rising responsibilities caused by these changes.”

At scale, economists say, this means a hit to public revenue, the very tax revenue vital to aged care funding. Sociologists attest further societal strain, whereby Support at Home is not working for seniors, rising informal care to meet SaH gaps will likely mean a disproportionate impact on women who have striven to carve out a professional place in the workforce.

Preventative aged care ignored

Aged care heads have consistently called for investment and policy to be guided by preventative measures. The efficacy of aged care models, experts and leaders attest, is in mitigating seniors from entering into residential aged care early, and particularly, from being ‘stranded’ in already strained hospitals.

Across the sector leaders have voiced, and Morgan agrees, “it’s very hard to understand why you wouldn’t be investing in prevention”.

“It doesn’t really make sense.”

This side of the changes to home care, in the wake of the pricing structures and fault-lines of Support at Home, the results are tangible and out of step with a sector and its professionals. Working alongside seniors to provide excellence in care, where it is strategic and humane to do so, at home, has long been the vision-cry of those on the ground.

“I know two people who are going into residential aged care nursing homes because they couldn’t get the help they need [from Support at Home]. They couldn’t get assistive technology they needed, simple things like a wheelchair and such. A senior needed a level upgrade, they did not get it.”

“Support at Home is having very tangible impacts, it’s not theoretical”.

Morgan shares what is lived by providers and seniors, “the program is meant to support them to live well in their own homes and communities. Yet I think that for many people, it feels more like putting barriers in the way than helping them.”

He directly calls out the consequences of policy failure on the ground, “what happens when we don’t support them to stay at home is that they deteriorate quicker and present to residential aged care, which is at capacity or hospitals which are already under strain.”

“We’ve certainly got examples of people who’ve not been able to leave hospital, they simply can’t get some assistive technology.”

“They’re stuck waiting”.

Systemic blunders were unprofessional

As the government’s SaH systems went live without testing, the blunders and errors started, “the systems hadn’t been tested, it was inevitable there’d be problems”.

“We knew in advance we would have to be ready to respond to the problems that occurred, and there were problems turning up almost every day.”

The unprepared government system has meant providers are ever more on the back foot in trying to keep operational excellence and stability, “different things we face with the systems, and the way they’re operating, we were lucky because our main client system and contractor did a good job in being ready”.

“But based on the information they’ve been given by Services Australia, I understand not every software provider had done that, they and their home care clients took the [worse] blow.”

For Morgan and his team, the system faults translate to real-world operational and care impacts, “we’re still taking far too long to reconcile the payments each month”.

“Processes that would have previously taken maybe two to three weeks are now taking more than eight”.

For Morgan, for home care providers that have diligently, unceasingly worked to build operational efficiencies of robust function, this is particularly galling, “client statements are going out far later than we want.”

“We were always on time with them before, but now we cannot issue the statement until we get everything to reconcile with Services Australia. And that is just taking weeks and weeks.”

“We’re trying to reduce the number of weeks it’s taking [on our side], but it’s still now taking about 8 weeks [through government], maybe even a touch more.”

Morgan echoes the nation-wide sentiment, most providers want to provide service and care they themselves would receive gladly, to have the landscape jolted by unprepared schemes is profoundly frustrating.

“The Department of Health and Services Australia underestimated the resources they would require to get this done and be ready”, Morgan shares.

“At the baseline, it is just simply unprofessional to not test processes prior to live functional expectations”.

For experts and leaders, seniors and advocates, all within the sector deserved, and deserves, better.

Part four to follow next week: Aged care leader Adrian Morgan shares how time spent caring for seniors directly is being ebbed away to deal with the mounting paperwork of an opaque and incomprehensible system. With $800 assistive technology requests refused or waited for to a point that seniors present to hospital, Morgan bears witness to a home care scheme unable to land its inherent and core promises.