The Final Report

The final report from the Royal Commission into Aged Care Quality and Safety (Final Report) was tabled on 1 March 2021, and contains significant and sweeping proposals for reform of the aged care sector. This is the fifth of a series of articles by Kinny Legal examining what these proposed reforms are and how they might change the industry if implemented.

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The Final Report identified that most seniors want to remain living in their own homes instead of moving into residential aged care, which is made possible by home care services. Yet, the aged care system operates such that seniors often wait unacceptably long periods to access home care services.

The Commissioners expressed deep concern about carers being at increased risk of burnout, as well as seniors being at increased risk of declining function, preventable hospitalisation, premature entry to residential aged care, and death. The Final Report has recommended broad reforms to address these and other concerns about the current home care system. This article considers certain key recommendations and what home care providers may wish to do in response.

What the Final Report says

It is well known in the aged care industry (and now the broader public) that seniors often wait too long to gain access to home care services. For example, the Final Report observed that:

• in 2018–19, the waiting periods between a person being assessed as eligible for a Home Care Package to being assigned a package ranged from 7 months (for a Level 1 package) to 34 months (for a Level 4 package); and

• as at 30 June 2020, approximately 102,081 seniors were waiting for a package at their approved level.

The Final Report also states that when seniors eventually get access to home care services, they may receive less care than they need or not have access to specific services they require.

The Commissioners have recommended significant and widespread reforms to ensure that the amount and variety of home care services available to seniors increases, the Home Care Package waiting list backlog is cleared and prevented from recurring, and the quality of aged care workforce is improved, including by requiring appropriate training and increasing wages to attract and retain staff.

What the Final Report recommends

The following recommendations are of particular note, but are by no means an exhaustive list:

• As a matter of priority, the Australian Government should clear the Home Care Package waiting list backlog and make sure the backlog does not recur. In particular, the Australian Government should: publicly report on the waitlist status every quarter from 31 March 2021 to 1 July 2024; clear the backlog by 31 December 2021 by increasing the Home Care Packages available and allocating a package to all wait-listed people that do not yet have a package (at all or at their approved level); and keep the waitlist clear from 1 January 2022 to 1 July 2024 by allocating Home Care Packages at the approved level to all new entrants within one month of the date of their assessment.

• Home care providers should be paid from Home Care Packages on an accruals basis, after the services are delivered, rather than being paid subsidies each month in advance.

• By July 2021, the Australian Government should establish a scheme to improve the quality of the current aged care workforce by reimbursing home care providers for costs associated with the education and training of certain direct care employees.

• A new care at home category should be established, to facilitate services to support seniors to continue to live at home instead of pre-mature entry to long-term residential care. From July 2022, the Australian Government should ensure that seniors accessing the Home Care Packages Program can also access supports from this other category. From 1 December 2023, all seniors undergoing assessment should be assessed for a Home Care Package level as well as the equivalent classification in the new care at home category. And by 1 July 2024, the System Governor should be able to commence payment of subsidies for services provided under this new category.

• A standardised statement format for home care services and fees, which providers are to use to issue monthly statements to Home Care Package holders. This statement should be developed by the Australian Government and, from 1 July 2022, providers should be required to use it.

• By 1 July 2024, the new Aged Care Act 1997 (Cth) should require home care providers which provider care management, personal care, clinical care, enabling and therapeutic care, or palliative and end-of-life care services to be accredited as a condition to receiving subsidies. This would be additional to the current approved provider status requirement.

• On 11 May 2021, the Australian Government released the 2021 federal budget which allocates $17.7 billion in funding to aged care over the next five years, of which $6.5 billion is to be directed to releasing an additional 80,000 Home Care Packages over the next 2 years and of which $650 million has been allocated to targeted initiatives to grow and upskill the aged care workforce (including home care workers).

How to respond

The Final Report will almost certainly prompt broad regulatory changes in the home care sector. Aged care providers offering home care supports should make sure they are ready to respond to the various reforms. Appropriate steps to take include:

1. Developing and implementing a scale-up strategy, so your organisation is best-placed to offer services to a large influx of seniors who have waited a long time to be allocated a Home Care Package and want to take up services as soon as possible. 

2. Determining whether the organisation is willing and able to provide services pursuant to the proposed new care at home category, if the recommendation is adopted and as additional information about what is proposed becomes available.

3. Monitoring for Australian Government announcements of any education and training reimbursement schemes and identifying which employees ought to be referred for additional education and training pursuant to the scheme.

4. Monitoring for Australian Government announcements of any changes to subsidies, award wages and any other matter impacting the core ingoing and outgoings of the home care service.

5. Assessing what (if any) changes would need to be made in your organisation if the recommendations (including but not limited to the above) were implemented tomorrow.  

6. Determining what external help (if any) you would need to make those changes.  For example – lawyers, recruiters, education and training providers.

7. Assessing how confident you can be in each of your above assessments.  For example – how confident are you in the quality and comprehensiveness of the data you have used to make those assessments, and how often is this data being used as part of a continuous improvement strategy?

Need help?

We are repeatedly ranked as one of Australia’s top law firms in aged care, and regularly advise clients in relation to aged care compliance issues. If you need help addressing this issue or any other aged care compliance matter, please do not hesitate to call us on 02 9199 4563.

 This blog post does not constitute legal advice and should not be relied upon as such. It is a general commentary on matters that may be of interest to you.  Formal legal or other professional advice should be sought before acting or relying on any matter arising from this communication.