Support at Home funding isn’t enough for ‘one shower a day’, an inquiry has heard. The committee also heard evidence from home care providers who say they are being ‘left with the crumbs’.
Support at Home is failed and broken, and leaving it the way it is would be “immoral”, the Senate inquiry in the Support at Home program heard today.
MND Australia CEO Clare Sullivan told the Community Affairs References Committee’s inquiry that people were prematurely dying, ending up stuck in hospital or being forced into aged care.
“Support at Home is not fit for purpose, and it is immoral for this program to continue as is,” Ms Sullivan said in her opening statement.
“Most people who need Support at Home are not affluent; they’re pensioners living just above the poverty line. Support at Home helps them with things like toilet seats so they can safely use the toilet, showering.
“For people with MND, they’re already facing the most horrendous disease: a rapid deterioration of their bodies, devastating impacts on their families, their carers, and of course themselves, and a torrent of medical bills.”
Ms Sullivan said the highest level of funding secured only two hours of care a day.
“That’s enough to get out of bed and a shower. No help with anything around the house. No respite for their carers. No help moving, being repositioned, or turning during the day.”
Ms Sullivan said getting “faster access to inadequate funding” would not solve the problem.
“The allocation is meaningless unless they can turn it into care,” she said.
“Provider prices and administrative charges are eroding the funding base.
“Our analysis found aged care prices for comparable services were between 24% and 94% higher than the NDIS rates.”
Support at Home has ‘failed’
Council on the Ageing CEO Gohar Yazdabadi told the hearing that the Support at Home program “has failed older Australians”.
“A system that leaves people waiting for essential care until their health deteriorates, they enter hospital and die has failed in its most basic responsibility,” Ms Yazdabadi said in her opening statement.
“Behind the waiting times are people going without the help that they need, and their families are trying to hold the arrangements together.
“Older people are spending sleepless nights stranded in hospital because there is no safe and supported way home. Promises of care have gone unfulfilled.”
Ms Yazdabadi said those failures “demand accountability”.
“Older people were entitled to expect that support would be there when they needed it. They should not have to reach crisis before the system responds. Yet, even when they reach crisis now, the system is not there to support them.”
Ms Yazdabadi told the hearing that price inflation was occurring “across the board”.
“We’re seeing that sort of inflation not just for assisted technology.
“People are coming to us and saying that the level of co-payments that we’re paying for under Support at Home, we could actually just take the copayment amount, go to a private provider, and get a service that would probably be much better and much better suited for us.”
When asked by opposition health and aged care spokesperson Senator Anne Ruston about cost inflation in the Support at Home program, Uniting NSW.ACT director of seniors services Saviour Buhagiar said the intent of the policy was not to spend $1200 on an OT assessment for a $50 pair of crutches.
But in reality, providers were interpreting the policy document in that way, he said.
“We end up spending $800 for that $50 pair of crutches because they’re going through the compliance process of having the documented evidence to need that piece of equipment to be able to then prescribe the right height, the right type of equipment, do all the safety checks, and have that documented.”
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The IAT needs informed human discretion
MND Australia’s Ms Sullivan added her voice to the cacophony telling the committee the integrated assessment tool was not working.
An analysis of 75 people with MND and their assessments by MND Australia found that 60% received level four or below, she said.
“That equates to four hours of care per week. That’s not even a shower every day,” Ms Sullivan said.
“We have broken one of our most basic social contracts: that people, as they age will be supported in their homes.
“Support at home is broken, and it is immoral if we don’t urgently fix it.”
Ms Sullivan said the integrated assessment tool did not reflect the needs of people with MND.
“Our analysis shows no correlation between the packages they’re allocated and their disease progression, their circumstance, their care needs.
“It just doesn’t marry up the assessments that people are getting to what we know they would need.”
Jayne Christian, whose mother Julie-Ann Christian has MND, said her mother was receiving a level eight package, equating to $78,000 of funding.
“That doesn’t even meet a third of the actual costs of living with MND, and in our lives, that looks like 90 minutes support four mornings a week, a half an hour session with a physio four days a week, and the lawn mowed once a month.
“Everything else we just have to work out ourselves.”
Ms Christian said the IAT must be informed by lived experience, and added that human discretion alone wasn’t enough.
“So often, I hear [federal minister for ageing] Sam Rae defend the system, and I don’t know what access to lived experience advice he has, but what he says most of the time doesn’t make sense.
“It’s not enough just to have a human applying discretion. Make sure it’s informed.”
Price caps under scrutiny
Ms Sullivan said the charges that someone receiving Support at Home funding would receive were “dramatically higher” than comparable services under NDIS funding.
“It would appear that prices are going up before the price caps come in,” she said.
Former chief economist of the NDIS Professor David Cullen told the hearing that “price caps don’t work”.
“Price caps have two effects. The first is they act as a magnet, and everybody moves towards them,” said Professor Cullen, appearing in his capacity as a non-executive director of aged care and home care service provider Hall & Prior.
“The second is that government then uses them as a way to cut funding and alter service quality.
“If you’re giving people choice and control, and if you’re respecting older people, then you’ve got to respect the fact that they can choose what they want.
“I don’t see why they shouldn’t be capable of making a judgment about the value of the care that they receive, just as they can make a judgment about the value of everything else that they purchase.”
Regional areas get the crumbs
When asked by Senator Ellie Whiteaker how workforce numbers could be boosted in regional areas, Hall & Prior co-founder and CEO Graeme Prior said their workforce had to be monitored and cared for, “because nothing is for granted”.
Mr Prior said all of WA – except Perth – was a “thin market”.
“We shouldn’t be looking for a viable, credible home care program in every country town in Western Australia.
“Every town in Pilbara won’t get a home care program. It’s just never going to happen.
“WA is a very tough place to operate a business, unless you’re BHP, Fortesque, Rio Tinto.
“We take up the crumbs on the table.”
Mr Prior added that the aged care sector was “notoriously inefficient”.
“[It is] run by too many firms … and there are no price signals in residential care.
“If you introduce a cap, that will destroy any chance of price signals coming into the marketplace.
“We have to continually help shape the aged care world to be highly efficient, provide excellent care, be very accountable, but at the same time very efficient.
“Otherwise, the Commonwealth will keep on paying for inefficient outcomes the whole time.”
“On means testing, I don’t personally understand why we don’t have more significant means testing requirements in the aged care program for our recipients. It’s almost a free ride.”
The committee is due to report on 24 November.