As at 30 March 2020, only 43% of the 211,029 Older Australians who had been assessed by the Government as needing care at home, were receiving care at their right levels.
151,958 people had access to a home care package, including:
- 92,381 people who were receiving the correct level of care based on their assessed needs,
- 44,528 people who were receiving a lower level of care that was below their assessed level of care
- 15,049 people who had been offered a package but had not yet started receiving care
59,071 people who had no home care package, including
- 7,400 people who had the highest level of need.
On top of these figures we know:
- around 840,000 Older Australians receive a small amount of support services to remain in their home.
- There is no official data on the waitlist for these CHSP services, but COTA continually hears of waits greater than 12 months for specific services in areas where capacity has been reached.
- At least 20% of people in residential aged care don’t need to be there. That’s 50,000 Older Australians who are forced to live in a nursing home because there weren’t enough adequate home care services.
- 19,000 Older Australians per year were taken off the home care list, as they were forced into a nursing home because there was no support for them to remain at home
- An additional 10,000 or more people die each year waiting for the care they need.
- An unknown additional number would prefer toasty at home and could with support and care, but the families know how long they waiting list is and go toa nursing home instead.
Right now,50,000 people in residential aged care don’t need to be there and over 100,000 more older Australians are waiting at home for the care they need to stay safer at home.
In 2018/19 19,000 Older Australians were forced into a nursing home because there was no support for them to remain at home– and an additional 12,000 died waiting for the care they need.
Australia is too heavily focused on an institutional care model. We moved away from this for others, such as people with disabilities, a fair while ago, but in aged care nursing homes are still a default option. The Royal Commission’s interim report criticised this “institutional” approach and noted that only aged care and prisons have such an approach.
Nearly 1 in 7 (14%) Australians over 80 years live in residential aged care facilities – one of the highest rates of all developed countries.
In order to receive care at home services, Older Australians are first assessed by a representative of the Australian Government to determine the amount of care each individual needs. Once this assessment is complete, we believe older Australians shouldn’t have to wait more than 30 days.
COTA recognises that additional time may be required for assessment which should ideally occur within 14 days of a request for assessment happening and no longer than 28 days in exceptional circumstances.
The Australian Government subsidises packages with a mix of care services through the Home Care Packages Program (HCPP) to provide home-based care that can improve senior Australians’ quality of life and help them to remain independent, active and connected to their communities.
Packages range from basic support to higher levels of personal and nursing care.
Since the 2018/19 budget the Australian Government has increased the number of home care packages by over 50,000, bringing the total cost for all packages to more than $3 billion. Already this financial year the Government has released 6,105 packages and has another 8,333 planned for release in the coming three years. While welcome, the number of additional packages currently planned will not come near to clearing the current 100,000 waitlist for care at home services and reducing the appalling fact that people wait 18 months for high level care .
Table 3: Number of allocated home care packages across the forward estimates
At 31 March 2020, there were 136,909 people receiving a Home Care package. This has increased by 38 percent since 31 March 2019.
There are also 15,049 people assigned a package and considering whether to take up the offer.
At 31 March 2020, 151,958 people had access to a home care package.
The estimated wait time for people assessed as needing a very basic level 1 package is 3 to 6 months. For low level, intermediate and high-level care needs, the officially estimated wait time is more than a year to receive an approved package that addresses level of assessed need. We know it is often much longer, regularly 18 months.
Table 2: Estimated wait time for people applying for Home Care packages (Government figures)
|Package level||First package assignment||Time to first package||Time to approved package|
|Level 1||Level 1||3-6 months||3-6 months|
|Level 2||Level 1||3-6 months||12+ months|
|Level 3||Level 1||3-6 months||12+ months|
|Level 4||Level 2||12+ months||12+ months|
All people approved for a home care package, and seeking services, can access their individual expected wait time to receive their first package, and their approved package in time bands. However, such wait times do not provide bands beyond 12+ months and COTA regularly receives individual reports of wait times greater than 18 months.
A person’s place in the waiting list is solely based on date of approval and priority for care
At 31 March 2020, there were a total of 103,599 people requiring a home care package who were not receiving the level of support that they need at home, including:
- 59,071 people seeking a home care package at their approved level, but who had not been offered any care package.
- 44,528 people who were waiting for their home care package at their approved level of care, but had been offered a lower level package.
In March 2019, the home care package waiting list reached a peak, with 129,038 older people seeking support not receiving a package at their approved level. an increase of 64.7 percent or 50,707 people in 2 years from March 2017.
Between March 2019 and March 2020, the number of people with unmet need declined by 19.7 percent from 129,038 people to 103,599 people.
However, the reduction in the waiting list is slowing. Between December 2019 and March 2020, the number of people with unmet need decreased by only 0.8 percent. In July 2020 the Government announced a further 6, 105 home care packages.
At 31 March 2020, there were 44,528 people who had been offered an interim home care package while they wait for a package at their approved level. Of these people:
- 27,776 people (62%) accepted the lower level package offer
- 8,787 people (20%) declined the offer
- 7,965 people (18%) had not yet accepted and are still considering the offer
There were 28,666 home care approvals in the March 2020 quarter (Table 3). This was 8.2 per cent (2,180) more than the approvals in the March 2019 quarter (26,486).
During 2019-20, the quarterly average for home care approvals was 28,471.
Yes, many people have approvals for both home and residential aged care, and some will choose to take up a residential care place instead of a home care package.
At 31 March 2020, 65.9 per cent (68,227) of people on the home care waiting list had dual approvals, having been approved for a permanent place in a residential aged care facility.
There were 922 approved home care providers at 31 March 2020. 52% of whom are not-for-profit organisations who enjoy a 72% market share by number of package holders. 36 of the home care providers are for-profit organisations enjoying a 22% market share and the remainder are government owned.
More than 1,450 providers funded to provide Commonwealth Home Support Program (CHSP) services, including 564 CHSP-funded respite providers in the financial year 2018/19.
There are four levels of home care packages to help meet senior Australian’s different levels of care need. Which level you get is determined by an aged care assessment.
Table 1: Home care package annual subsidy, by package level as at 1 September 2020
|Package level||Home care services for people with:||Annual subsidy amount paid by the Australian Government|
|1||Basic care needs||$8,927.90|
|2||Low-level care needs||$15,705.95|
|3||Intermediate care needs||$34,174.95|
|4||High-level care needs||$51, 808.10|
Note: The amounts in the table do not include additional supplements that a provider or consumer may be eligible for.
COTA Australia represents consumers, not providers or workers. Our interest is in making sure Older Australians get the best care but are also in control of their care. Currently too many older Australians are institutionalised. We understand the right ratios are one solution to improving the consistency of care in places where the problem is too few staff. Where the problem is different, the answer needs to be different as well. Which is why we don’t support a blunt ‘cookie-cutter’ approach to ratios. We want to make sure Older Australians get the care hours they need from the right mix of (1) nurses specifically trained in aged care, (2) well trained, qualified personal carers, and (3) allied health professionals.
For example, a nursing home specialising in residents with high clinical needs who might be largely bed bound and requiring assistance like tube feeding and breathing support will need a high percentage of qualified nurses. A dementia specific nursing home will need some nurses on every shift but teams of personal carers with specialised dementia training in enough numbers to give personal attention. A home with many physically frail people will also need a good mix of occupational therapists and physiotherapists to assist with maintaining strength and mobility.
There have been cases of abuse and poor care in residential aged care who had high staff and nursing ratios too. COTA Australia wants to see a reduction in the unnecessary institutionalisation of Older Australians and ensuring that Older Australians are the decision makers of their own care. Empowering older people to be the decision makers on their own care is the answer. That will solve the problem of neglect by under-staffing, but all the other issues of neglect and institutionalisation too.
The lead journalist of the ABC 4 Corners Program in 2018 which exposed many residential aged care problems stated they started their investigation expecting to find most problems within for-profit providers. However, they found that there were good not-for-profit and for-profit providers, and very poor ones in both groups.
All providers need to make a profit to stay in business and invest in future development. Some for-profit providers cut corners to make too high a profit and they should be called out for this; others settle for a reasonable return on the money they have invested in the business and do a good job. Some not-for -profits pay excess returns to their religious or community organisation owners.
COTA believes, and has long argued to the sector and government, that there should be clear, consistent and transparent accountability for the way public funds are spent by all providers, whether their ownership is not-for-profit, purpose-driven, community-owned, for-profit, private or public.
About 27% of older Australians over the age of 65 access some form of aged care supports. About two thirds of these people would access a basic, low level service, home support type service as currently offered in Commonwealth Home Support Program. Most older Australians live independently in the community without any formal supports or subsidised aged care. While having a supportive family is an asset, it doesn’t dictate whether you can live at home or not. Family is not a prerequisite in being able to live at home safely. Older Australians should have the choice to live at home.
There will always be people who need residential aged care because they have high clinical or other needs (such as severe behavioural issues with dementia) that cannot be met at home. That is not the issue we are pointing to here. Those people deserve and should get the best quality care in a specialised residential setting. We are concerned in this campaign about those older Australians who feel they are forced to go into residential aged care because they, and their families, feel they have no other choice. And even for those people who need residential care, what we find is there are still too many aged care homes that are more like institutions than homes.
Having a diagnosis of dementia doesn’t necessarily mean that a person is less interested or engaged in their own care. Dementia is the term used to describe the symptoms of a large group of illnesses which cause a progressive decline in a person’s functioning. There are an estimated 413,000 people living with dementia in Australia and an estimated 1.2 million people involved in the care of someone with dementia. The vast bulk of them are living in the community. Each person’s experience of dementia is individual. Some people with a diagnosis of dementia live in the community for a long time with small levels of support before needing Residential aged care services.
Some older people are vulnerable in the community, but that’s not a good reason to institutionalise them. Home and community care are the right way to respect and care for older people. Just like our society moved away from orphanages and mental health institutions, we should provide better for older people, and listen to what they want.
Elder abuse is a whole of community issue just like family violence and child protection requiring coordination between levels of government. Whilst more evidence is required in determining the prevalence of elder abuse and the most effective responses, sending older people to residential care should not be considered as an appropriate way in addressing the issue.
Aren’t older people just as vulnerable to COVID-19 in their homes, and we just are not hearing about it?
As of September 2, only 79 people receiving homecare are known to have contracted COVID-19. Seven have died. This compares to the many who have contracted and died from COVID-19 in residential aged care – the number continues to grow every day. The more significant risk for older Australians living at home is the withdrawal of vital services that support living at home and the impact of social isolation and loneliness. We see this happening with the current restrictions particularly in Victoria. Older Australians living at home have more choice and control over who enters their home, and how, compared to those living in residential aged care.
The risk in residential aged care is heightened where groups of people are living near each other, physical distancing is difficult and there is poor infection control in a home. In these circumstances older Australians are safer in their own homes.
This is a real concern. The Royal Commission has stated that the aged care system lacks transparency in communication, reporting and accountability. It is not built around the people. They have also argued that there is much that can be done to improve the accuracy, consistency and timeliness of information and communication about the current system.
COTA Australia has argued for some time that there should be total transparency regarding all aged care services including:
- pricing, on a comparable basis
- agreed descriptors of service
- staffing numbers and mix
- complaints process and outcomes
- quality performance – internal measures and external standards
- consumer experience, engagement and reporting
This will enable older Australians to make informed choices about their care. All costs should be transparent including additional fees for administration, travel and other indirect costs. Older people should also be able to assess the performance quality of services through a star rating system.
It is no longer permissible for providers of Home Care Packages to charge administration fees. It may be reasonable for home care providers to include the cost of administration and coordinating care delivery in the fee for a particular service, but these costs must be consistent and fully transparent. Older people should not be charged fees they do not understand or are not fully aware of.
This question must be addressed by the Royal Commission who is currently exploring the introduction of an Independent Pricing Authority to set prices for home care services. Transparency of information to consumers about all the costs providers charge for home care is a key step to allow informed choices.
We have been informed that some home care providers have been inconsistent in the charges of fees for services and have not provided information to consumers about this.
The level of unspent funds for home care packages is a real issue. We would argue that this is reflection of older people not receiving their individualised need, based on their assessment and developed into a care plan that the older person actively participates in developing. Some amounts reported as unspent funds are legitimate planning for ‘a rainy day’ or allocation towards a major purchase (e.g. home modifications).