Funding boost for home care won't solve structural problems

Without structural reform on how home care is allocated, the home care waiting list is likely to grow, writes Dr Nicole Sutton.


The government has committed to releasing an additional 80,000 home care packages over the next two years, at the cost of $6.5 billion. The intent is to address the current waiting list of people waiting for home care services, funded at an appropriate level to match the complexity of their needs.


As of 31 December 2020, this queue comprised 96,859 people, including 60,456 individuals who had not been offered any package thus far. The time spent waiting for a package is substantial, with evidence from the Royal Commission indicating that those within the most complex needs wait for an average of 34 months - almost three years - for a Level 4 package.


In having to wait for this support, people often have to rely more heavily on the informal care provided by their loved ones, accept a package insufficient to meet their care needs or move into a residential care facility against their wishes.


If supply lags actual demand for services and consumers’ actual care needs, then the queue for home care grows.


The release of more home care packages goes some way to addressing Recommendation 39 of the Royal Commission, which prescribed the immediate increase of packages to eliminate the waiting list by 31 December 2021. Clearly, it will take longer than that, with 40,000 packages to be released in 2021-22 and 40,000 packages to be released in 2022-23.


This delay may prove useful, providing time to train and upskill more home care staff. The budget included $91 million to train an extra 13,000 workers, although the workforce requirements are likely to be much higher than that. Also, providing an additional $798 million for services for respite and informal carers addresses several related recommendations in the Royal Commission to add further support around individuals wishing to remain in their own homes.


There is some ambiguity about the level of funding for the newly promised packages. This can vary substantially from $8,900 for a Level 1 package to almost $52,000 for a Level 4, which radically alters the level of services individual receive, particularly care time from qualified staff each day. Thus, if insufficient Level 3 and 4 packages are released, the waiting list will likely remain.


However, the more significant looming issue is whether the government will change how home care packages are allocated from a system based on rationing to one based on need.


The Royal Commission recommended the scrapping of the Aged Care Provision Ratio, which has restricted the supply of subsidised aged care places to a government-imposed target. This rationing approach means any increases in home care services is reliant on annual budget commitments and the fiscal priorities of the government of the day. If supply lags actual demand for services and consumers’ actual care needs, then the queue for home care grows.


Australians strong preference to age in their homes and communities means the growth in demand for home care services will extend far beyond the budget’s forward estimates. As the modelling from the Aged Care Financing Authority shows, the projected demand for home care will likely outstrip the government’s total supply of 276,000 packages by 2029. Without structural reform on how home care is allocated, the waiting list for home care is likely to be a recurring problem.


22 June 2021.