Home care for the elderly must keep to funding rules

The Home Care Package scheme that enables 275,000 elderly Australians to live safely in their homes is one of the best features of the nation’s aged-care system. Packages cost taxpayers about $6.5bn a year. But they save far more on residential aged-care costs and reduce the incidence of hospital care. The most important benefit is social, allowing couples and individuals to remain in their homes, often closer to family, friends and local communities. The scheme is popular, with waiting lists of three to six months, despite successive governments increasing the number of packages. For all its benefits, however, the scheme needs a reboot, especially in accountability and administration. That is clear from problems revealed in a Department of Health review, reported on Monday’s front page.

Despite clear guidelines, some service providers are gaming the system to gain advantages over competitors in signing up and holding on to their vulnerable clients by helping them claim “excluded’’ items in Home Care Packages. That includes flights, holiday accommodation, fuel gift cards, entertainment, home renovations, TVs and groceries, the report notes. As a consequence, providers doing the right thing and sticking to the rules are losing out on clients to more “generous’’ providers, who approve excluded items. The problem is widespread, with more than nine out of 10 home-care providers falling short of the government’s minimum price transparency requirements. And some elderly people on government-funded packages are losing as much as 60 per cent of the value of those packages in management fees creamed off by providers.

Aged Care Minister Anika Wells, for good reason, is concerned about the sector’s widespread lack of transparency in relation to how billions of dollars in taxpayers’ money is being spent. “I am not surprised but very frustrated that 91 out of the 100 reviewed providers were not giving care recipients the required level of pricing transparency, despite these requirements being clear and longstanding,” Ms Wells told The Australian. Effective oversight and accountability are essential. And they need to be achieved soon, given the number of ageing baby boomers whose demands for home care are likely to force a vast expansion of the scheme in the next few years. This will occur just as budget repair is critical in order to accumulate a buffer against future economic or health shocks,

That said, the government needs to ensure the guidelines provide aged-care residents with excellent care while delivering good value. The rules for home care are generous, covering personal assistance with bathing and dressing, nursing, mobility assistance, cleaning, laundry, gardening, home modifications to improve access and safety, transport to shopping and social activities, emergency support, therapies and rehabilitative care. While the guidelines exclude furniture such as beds, mattresses and airconditioners, there is an argument that those items, especially airconditioners, which are not expensive, would greatly improve recipients’ quality of life if home care recipients cannot afford them and cannot rely on family to provide them. The challenge for government is balancing services and items provided with what is sustainable as costs rise and the number of Australians relying on the scheme increases.

That is why it is unacceptable that providers are seeking a commercial advantage, at taxpayers’ expense, and offering clients more than the scheme allows. However popular this may be with clients and their families, it is bad practice. Over the medium to long term it will drive honest providers out of the sector and jeopardise the viability of home care. That is why action must be taken to stop the trend.