The void of Support at Home reassessments is “bizarre” and damaging – aged care leader Adrian Morgan champions transparency, trust for seniors and sector that needs them to flourish

Adrian Morgan is the General Manager at Flexi Care and loves it. Having previously worked in disability, he had always looked to apply his pragmatic skills productively, to make a difference of substance. So when an opportunity to work in aged care came up, he went for it. However, more powerful than any glossy recruitment mag is the reason he remains in this industry, that is at times, exasperatingly tough. It’s a no-brainer, while “it continues to be challenging and interesting, there is another thing, the fabulous people who work in this industry”. It is from this stance, with conviction, character and alongside his “fabulous colleagues” and peers, that Morgan has stepped up to publicly call for a change in how the Support at Home program is run, particularly with reassessments. For many advocates naming policy consequences has gone from opportunity to moral and professional imperative to fight for an aged care sector that flourishes.

To facilitate the best care possible for the profoundly vulnerable people in aged care, leadership can champion for reality-led change. It is from this substance of care and leadership that Morgan brings to the fore an issue that is impeding what high-quality providers want to do, provide the best care. He is not alone in this concern. Reassessments for Support at Home packages continue to return downright “bizarre” assessments that have seniors and provider leadership and staff shocked. When the processes, that are integral gate-keepers to accessing resources, become opaque, the alarm must sound, loudly. Morgan hits on a growing trend that is causing despair for seniors, and blocking hard-working providers who wish to provide exactly what the new act requires, person-centred and dignified care.

“Bizarre” reassessments

From within his professional capacity at FlexiCare, Morgan has been tracking with staff and clients that have been through the ringer, in an increasingly strange development of process with Support at Home.

For the many advocates and provider leadership who have been becoming aware of the growing trend of reassessment for home care, understanding the consequences has only sharpened the need to understand and fight for transparency in the process of reassessments.

Morgan shares the story of client ‘Katherine’ who showcases the unsettling, bizarre and human impact of inhumane algorithmic processes.

“Katherine is in her late 70s. She has vascular dementia, she has diagnosed anxiety, she has diabetes. She was being supported through a home care package of level 3, which was the second highest in the old home care package.”

Morgan shares that the awareness that something in the reassessment system was very wrong dawned due to the proximity of tracking with clients, “we saw the support we could provide was insufficient because her circumstances were deteriorating, so we supported her to seek further help, and so she applied for reassessment.”

It is here the proverbial wheels came off and Morgan, their clientm and the whole team are dumbfounded, “when the reassessment came back, it said she had no impairment and no entitlement to any services at all.”

“She gave us a copy of it, we’ve seen it with our own eyes. While they didn’t take away the money she had been receiving, there was certainly language of being lucky for what she had.”

“This was a very clear case of somebody who had needs greater than were being paid for under her existing support, and yet she got that reassessment”, Morgan says.

“I call it bizarre.”

What is happening now

Morgan articulates what seniors and providers are dealing with all over the country, the opaque reasoning behind the “bizarre” reassessment means everyone, “is left guessing, ‘now why are we getting these very strange results?’”

He shares that paying attention has never been more important than ever. The consistency of seeking service excellence in the face of the seemingly relentless changes in policy has meant real-time insight into the fault lines in reality. Morgan notes that as a provider they only supported clients applying for reassessment when they knew and believed it was genuinely-entitled and evidence-backed. In reviewing the data, Morgan and his team have uncovered a telling and stark pivot point.

“Before October 31, we had almost all reassessments approved, post November 1, 38% of them have been rejected.”

And due to paying attention, in tracking with people like Katherine, Morgan and his team know how in the dark they are, “we just don’t understand why”.

“It’s not making sense, this opaqueness in the algorithmic mechanism, we can’t work out why they’ve been rejected.”

In response, Morgan and his team have had to come up with a reactive policy themselves to meet the moment, “for those of our clients who haven’t been reassessed, we are tracking with them very, very closely.”

“We’re now trying to analyse between those who haven’t and have been reassessed if it’s something in the way they’ve answered the questions.”

Morgan shares, “we’re starting to speculate, to get some ideas around it”. For many sincere leaders, this is all providers are able to do at present.

“It’s a guessing competition.”

It’s a common thread that’s growing, leadership across the country, like Morgan, are leaning into increased involvement and oversight of data, and proximity to clients, to try and uphold the new acts requirements. And due to sincere conviction, to provide and service excellent care in the face of this policy change.

Understanding the bigger picture

Many industry leaders believe current reform-needs require frankness and a pivot to overarching strategic scope. Morgan is frank, “it is very concerning basically”.

Morgan couches his concern, and that of many of his peers, in seeing the cross-sector impact of Support at Home blockages to care, “there are a lot of all the people who both now and in the future are going to need help to live well at home.” With the growing boomer cohort, the cracks in blocking care at home will only widen. 

“And we know that over 90% of people want to continue to live in their own home as much as we can. So to provide a small amount of support, or a larger amount, where required, which allows people to keep living in their own homes, seems to me like a no brainer.”

What experts like Morgan see are the macro consequences, refusing to smooth a system now will mean costly impacts both morally and financially down the line, “if they [seniors] end up early into residential aged care, not only do we not have places but it’s far more expensive for the government.”

“And people, the people simply don’t want it.” Policy must be functional to safeguard people staying in their homes, and staying healthy there.

Naming impacts

The industry has arrived at a point where heartfelt experts are weighing in from conscience and competence. For those that have poured themselves into this industry for decades, and walked alongside seniors in that time, it is from a position of seeing sparks fly off the ground as policy lands that reform calls burst. There is no better vantage point to know that current strategies aren’t fit-for-purpose.

Morgan shares where strategy should be aimed, “there are some people who want RAC, so let’s keep the places for them, we must avoid having them crowded out by people who really could and should be looked after in their own homes.”

From a provider perspective, Morgan sees that the current scheme as going through, “an attempt to save money within that program, within the supported home program.”

“However, it looks like the impact is going to be that more people will end up in that hospital emergency and in residential aged care that don’t need to be there.”

For Morgan and many others, it has come to a point where the consequences must be clearly named, without a softening of language or preamble. There needs to be a change for Support at Home, “if it was well designed, it would be an investment.”

“Not only in people’s quality of life but in terms of making sure the health system is not clogged with people who shouldn’t be there, and not doing well in that system.”

Morgan, as a professional and expert, shares what is actually happening in the hospital system, “it’s not good for a senior to be in hospital perpetually, they lose condition and are cut off from social support they need, and they go backwards.”

All of this has a financial cost, “it’ll end up costing you a lot of money, and they’ll only go backwards.”

“It’s crazy actually.”

Fault-lines deepening

In a showcasing of further cracks in the reassessment process, of the deepening of fault-lines from the potentially dangerous reliance on software and perhaps the buzzy new possibility of artificial intelligence the world is seeing at large, Morgan can speak from conversations with assessors, professionally stymied from not being allowed to override reassessment results.

“Assessors are not allowed to override an assessment even when they know it’s wrong.” From professional obstacles to impossible personal ethical difficulty, providers are hearing from assessors daily.

Morgan shares what providers across the country have come to realise, that current workings are quietly accepted current public policy, resulting in an opaque system partnered with impenetrability, “that decision to not allow reassesors to override results from the algorithm was announced very late in October to the assessors.”

He names what may yet be a deepening worry, the lack of transparency over these changes and their consequences, hampering the ability to even know what’s going on, “the decision wasn’t really announced to the industry.”

“We worked it out slowly, people kept being knocked back, and so we went directly to the reassessors and they were honest, they said I’m not allowed to correct it.”

For a sector that needs every ounce of transparency, accountability and pulling together from all parties to make it sustainable, functional and ethical, the movements away from clarity and those very elements of transparency is profoundly worrying, “it’s a black box”.

Current fallout

For the greater goals the health ministers have been passionately lobbying, such as de-clogging hospitals and building beds for those that rapidly need them, the immediate consequence of seniors being denied genuine reassessments is that, “people are not able to get assistance that they genuinely need.”

This is all, “coming with stress, because people simply don’t understand why they can’t get the assistance they require.”

Morgan shares a sobering reality he is hearing from clients, “people are too scared to apply for an upgrade because they’re scared they’ll lose what they have.”

What providers are seeing directly from clients is that people are deteriorating, and should be applying for a reassessment but simply aren’t due to fear.

“Ultimately more people will be living with a poor quality of life and becoming more vulnerable and ending up in hospital, and early entry in residential aged care, and those are already under pressure.”

The system is already dangerously strained, Morgan shares the Queensland government has investigated that “the equivalent of an entire hospital is currently occupied by older people who are medically fit for discharge”. There is little, if any, resilience in the system to receive the seniors whose reassessments are being rejected and their likely deterioration.

Openness

For those in the sector, who have sincerely and fervently been trying to support the delivery of excellence in care, the lack of openness from the government with changes like the reassessment methodology is not only frustrating, it’s hurtful and unnecessary.

Morgan shares the reality for much of aged care leadership, “aged care leaders have had to come independently to these realisations about the reassessment changes.”

“They’ve [the government] not been open.”

He notes alternative approaches could have been chosen, “it would have been a whole lot better if they had decided to change their policy and come out very openly with a statement about it.”

“It would have been more helpful for everything, with good news and with bad news, to factually share it, ‘this is where we are’”. 

“And particularly with challenges, if they are shared, often with the sector working collaboratively with the government and department, we could have come up with a solution.”

Morgan highlights, “when things are not shared, it’s very hard to work out what to do.”

Danger in denial

In an attempt to act,  to figure out next steps at the receiving end of an opaque system, Morgan wrote to Minister Rae for answers. Receiving them back last week he is able to share, “I got a response from the department.”

“They trust their assessment, and they don’t think there’s anything wrong with it, is basically the summary, they say lots of experts were involved in putting it together, they certainly didn’t acknowledge there’s a problem.”

It is here that, for many in the sector, the problems deepen, Morgan hits it on the head, “if they don’t acknowledge there’s a problem, they can’t start working on it.”

Diverted resources

For the many sincere and hard-working aged care leaders, and staff, this change has meant resources diverted. At the core of the sector’s directive is to provide excellent care to seniors in their time of need. The updates to the current systems of accessing aged care, particularly in the changes of Support at Home, has meant wasted resources for providers and care not getting to those it should.

“Things have become far more complex”, Morgan notes. “Home care packages weren’t perfect but they had a lot of strengths because they were flexible and it meant that providers and seniors could talk with each other for the best way to use the resources available.”

“It was collaborative and democratic, but that has all disappeared with Support at Home, it is now exceptionally complex to do very simple things.”

Morgan says, “to get bathroom rails installed, it used to be very simple, you had to ring up an OT to get a look, and then as long as some funding was in the package, off you go, but now it’s a long bureaucratic process of much, much waiting.”

“All the while during this waiting the person is at risk”, he says.

Morgan shares the sentiment widely shared, “it’s very hard to work out why they’ve created such a complex process.”

“They could have changed the CHSP allowance of perpetually accumulating unused funds, they could have easily changed that, for example, you can’t save more than two months of money, that would have been very easily done, and communicated well.”

He shares, “there could have received a lot of support from the industry from that pivot.”

The frustration in the sector is palpable, what could have been with smaller, easier changes to funding allowances. Through correcting a not-perfect but working system, policy reform could have been done quicker, with cost saving results, without the current repercussions of ballooning wait times, “bizarre” reassessments and resulting fear.

What many see now is policy implementing layers of obstacles, putting up barriers to accessing care and hamstringing the sector to do what they are charged to do by the government. The frustration is not only built on the increased difficulty as a result of policy in reassessments and lack of human overriding control. Providers are finding that due to interim funding, they are having to increasingly become gymnasts in stretching dollars to meet genuine need without all the requisite fuel to do so.

Interim funding results

Morgan confirms that they are seeing more and more clients being given interim funding, that is 60% of packages funded, to somehow cover 100% need.

“It’s a very significant issue because it means people are not getting the support they need.”

He speaks of the simple mathematics of it, “it’s simply insufficient.”

“Let’s assume the assessment is correct, then that’s what they need, they don’t need something less than that.”

He shares that stress has now been spread across the industry, “it’s stressful for the senior, and it’s stressful for the provider, as you try to work out what to do.”

“Well, what we have to ask is, what’s the best we can do with this inadequate funding?”

In resisting being reassessed, there are also complications to the system at large. For those on the previous CHSP packages, meant to cover those with a lower level of care with the intention to transition across to Support at Home, many are simply not moving on. “it’s causing chaos in the system”, Morgan notes.

People are on packages that don’t cover their needs but they’re too afraid to tangle with Support at Home, “there is so much stress.”

And then, in the face of hoping for the best, when seniors have applied for a reassessment to Support at Home, the interim funding is breaking trust further in a sector that desperately needs it to flourish.

The result? “What it means is that seniors are stressed by offers, they understood that when they became eligible for a higher level of funding, it would actually be a higher level, not 60%”.

“People are cross. Some people are angry. Some are saying that we tried to trick them because we’re only offering services at 60%”.

Breaking trust

Naming the results on the ground, for a sector that has struggled with trust is vital. While the legality of offering 60% “was in the act, it doesn’t mean they should do it.”

Providers are now contending with processes, “it’s taking twice as long as it used to, due to the sheer complexity of everything that has to be done.”

What is happening on the ground is a further erosion of trust. Providers are needing to fill in the slack. “it does mean more and more time has been taken up with explaining things to people rather than getting on with the care”.

What Morgan and his team have done is started an extensive newsletter to bring seniors and clients into what is happening in the industry, to try and translate legislative changes closely and clearly, to walk alongside confused and frustrated seniors. Providers are needing to step up in response to the fallout of policy, in an attempt to repair and maintain trust. Care has become more and more administrative.

Immediate policy reform

Morgan is clear, there are possible steps that can and must be taken to correct the ship in the immediate.

“Immediately switch off the algorithm. Or allow assessors to override it, where there is a need to do so, they could do either of those but I would prefer the former.”

“It [the algortithm] needs to be assessed for the authenticity of results. It needs to be switched off until its properly and independently assessed.”

He is encouraged by conversations with peers, “clearly something is going wrong, we are not the only ones who are pointing at this, others in the industry are vocal.”

“The other thing the government could do is stop providing at the 60%”, he understands that some may baulk at that, “now I know people would have to wait a bit longer for packages, but it would mean a smoother transition from commonwealth health support to Support at Home.”

He says, “or alternatively they could give people the option, that would be even better.”

He says the government must acknowledge how deep the systemic fault-lines have become, “because the assessment process is so central to the way Support at Home works, and with the current process not being functional, it is damaging to the whole foundation of the system.”

“They really could switch off the algorithm right away.”

He is not naïve, “there are many other changes that should be made to Support at Home but those two things could be done quickly.”

For provider leadership who entered into aged care to make a difference, to use their skills productively alongside fabulous colleagues, challenges are present and frustrating but to show up everyday is what many of these heart-felt leaders are doing.

Morgan and others like him will continue to walk alongside seniors in this time of turbulence, to speak out from their insights on the ground. Seniors and the sector must be underpinned by transparency and trust to flourish. The high-performing sincere professionals that seek to keep it running must continue to demand reform that is strategic, ethical and grounded in the intersection of making the sector work for now, and well into the future.