Chapter 6 - Community care programs
...significant reform is
needed to Australia's community care system if it is to meet the expectation
placed on it of assuming an increasingly significant role in the future of our
care system and if it is to continue to provide high quality care services to
This chapter discusses the adequacy of community care
programs in meeting the current and projected needs of the elderly. Community
care programs are aimed at enabling frail older people and people with a disability
to remain in their own homes for as long as possible. The flexibility of
community care means that a well funded program can deliver a service that is
tailored to individual needs and provides continuity of care as recipients'
The provision of high quality community care that helps
people live in their own homes longer has several advantages:
most people prefer to live in their own home
rather than moving to a residential care facility;
- community care helps people retain their independence
- it is the sign of a healthy society to have more
assistance provided to people living in the general community for as long as
- provision of high quality community care uses
less health and aged care resources as it avoids costly admission to
residential aged care and acute care.
The demand for community care programs is
expected to increase over coming decades. The Department of Health and Ageing (DoHA)
estimated that based on current service use patterns, the number of people over
85 years who rely on community care programs will rise from 81 000 people
in 2002 to 140 000 people in 2019. It is estimated that the number of
people across all age groups who rely on community care programs will increase
from approximately 650 000 people per annum in 2002 to approximately
970 000 people in the year 2019.
Community care services
A number of community care programs provide a range of
services including the Home and Community Care (HACC) Program, Community Aged
Care Packages (CACPs), the Extended Aged Care at Home (EACH) program and
Veterans' Home Care (VHC). Other services include respite care, including the
National Respite for Carers Program (NRCP) and support for carers. Of the total
number of Australians aged 70 and over, 15.1 percent use HACC services, 7.8
percent are in residential care and 1.5 percent receive CACPs. 
The main differences between HACC, CACPs and EACH
programs are summarised in table 6.1.
Table 6.1: Features of HACC,
CACPs and EACH programs
Range of services
range of services available
range of services available
range of services available
Relationship to residential
to prevent premature or inappropriate admission
for a low care residential place
for a high care residential place
assessment not mandatory
shared by the Commonwealth, State and Territory governments and client
by the Commonwealth Government and client contributions
by the Commonwealth Government and client contributions
Target client groups
to people with a greater range of care needs
people with care needs similar to low level residential care
people with care needs similar to high level residential care
Size of program
billion funding in 2003-04
707 207 clients in 2003-04
million funding in 2003-04
operational places in 2003-04
million funding in 2003-04
operational places at 30 June 2004
Source: Productivity Commission, Report
on Government Services 2005, Vol.2, p.12.18.
The HACC program, which provides the main community
care program, is described in some detail below. CACPs provide an alternative
home-based service for older people who Aged Care Assessment Teams (ACATs)
assess as eligible for care equivalent to low level residential care. EACH
provides a community alternative to high level residential aged care services.
The program provides individually planned and coordinated packages of care
designed to meet older people's daily care needs in the community. The EACH
program differs from the CACP program in that it targets frail older people who
would otherwise be eligible for high level residential aged care. An EACH
package typically provides 15-20 hours of direct assistance each week. The
services of the VHC program target veterans and war widows/widowers with low
care needs. The program provides home support services, including domestic
assistance, personal care, home and garden maintenance, and respite care. Other
services, such as community transport and delivered meals are also available
under Department of Veterans' Affairs arrangements with State governments.
Home and Community Care Program
The Home and Community Care (HACC) Program provides a
range of services including:
domestic assistance – help with cleaning,
cooking, washing and ironing;
- personal care – bathing and dressing;
- food services – meals on wheels, centre based
meals, help with shopping;
- community respite – to give carers a break or
for frail older people living alone;
- transport – practical assistance with individual
- home maintenance or modification – assistance to
maintain a person's home, garden or yard to keep it safe; and
- home/community nursing – provided by trained
nurses on a regular or one-off basis, in home or from a community centre.
Aids and appliances is one of the ‘excluded services’ for
HACC funding because funding is already provided for these services through
other government programs.
HACC is a jointly funded program. States and
Territories are required to match the Australian Government annual offer of
funding. The previous year’s HACC funding for a State/Territory forms the basis
of the next year’s funding plus whatever growth is provided for in the
Commonwealth Government Budget. The annual growth component has been set at
cost indexation plus a real growth of 6 per cent for some years now.
The Commonwealth Government contributes approximately
60 per cent of Program funding and maintains a broad strategic policy role while
State and Territory Governments funded the remainder. State and Territory
Governments are responsible for the day-to-day management of the HACC Program. Total
national expenditure on HACC was of $1.2 billion in 2003-04 consisting of
$732.4 million from the Commonwealth Government and $471.3 million from State
and Territory Governments.
Table 6.2 provides details of total Commonwealth and
States' HACC expenditures from 1995-96 to 2003-04.
Table 6.2: Expenditure on the HACC Program, 1995-96 to 2003-04
Source: Submission 191, p.43 (DoHA).
The number of clients accessing HACC services has
increased from 375 000 in 1995-96 to 700 000 in 2002-03 – however
this only represents 40 per cent of the HACC target population. Client numbers increased to
707 200 in 2003-04. The HACC target population comprises people with
moderate, severe and profound disabilities, as defined by the ABS Survey of
Disability, Ageing and Carers. Identified special needs groups within the HACC
target population include: people from culturally and linguistically diverse
backgrounds, Indigenous Australians, people with dementia, financially
disadvantaged people, and people living in remote or isolated areas. Carers of
people in the HACC target group can also receive support through the HACC
Program's respite care and counselling services.
Community and voluntary organisations, religious and
charitable organisations, commercial organisations in some States, as well as
State and Territory Government agencies and Local Government may provide HACC
Concerns were expressed at the adequacy of funding
levels to meet the current and future demand for HACC services. Submissions noted that demand for
HACC services is likely to increase significantly in the medium to longer term
as a result of:
increasing numbers of older people due the
ageing of the population and increased life expectancy;
- increasing rates of 'core activity restriction'
among older people as a result of people living longer with more long-term
health conditions and frailties; and
- increasing preferences for community based
services over residential care services as older people seek to remain in their
own homes for as long as possible, resulting in demand for high level community
projections of the HACC target group, comprising people with moderate, severe
and profound disabilities, over coming years based on ABS population
projections indicate the numbers of persons involved will increase by about 2
per cent per year which is about twice the rate of the general population. The
HACC client base continues to increase as the number of persons aged 70 and
over increases relative to the general Australian population. DoHA
stated that the current 6 per cent annual real growth in funding for HACC
is considerably higher than the current projection that the HACC target population
will increase by around 2 per cent per annum.
Commonwealth Government funding for HACC has continued
to increase. Over the nine years from 1995-96 to 2004-05, the Commonwealth has
increased the funding available for HACC services by 87 per cent, or
approximately $369 million. Total Commonwealth
and State Governments HACC funding in 2003-04 was $1.2 billion.
In relation to unmet need for HACC services, DoHA
noted that the ABS Survey of Disability, Ageing and Carers 1998 identified a
group of some 4 per cent of those people with a moderate, severe or
profound disability (the definition of the HACC target population) who were in
need of services but were not currently receiving any services. A further 32
per cent of this HACC target group indicated that though they were in receipt
of services, they would like more services. These survey results have been
taken as a broad measure of the unmet demand for community care services.
...additional upwards pressure on demand for services is expected
to continue. The ongoing increase in demand will result from the relative
increase in the number of people who are 70 years of age and over, an increase
in the care needs of the increasing number of older aged persons, and the
continuing decline in the availability of informal care.
A number of groups argued that HACC funding needs to be
increased by an initial 20 per cent and at least 6 per cent per annum (plus
indexation) each year to ensure that a more appropriate level of care can be
provided to existing clients and to ensure sufficient growth in funding to
match future growth in demand.
argued that funding for HACC services should be increased by at least
30 per cent to meet unmet demand.
Submissions also argued that the indexation method for
the HACC programs, through the Commonwealth Own Purpose Outlays (COPO), is
inadequate and fails to keep pace with the rising costs of providing community
care. Aged and Community Services
Australia (ACSA) suggested that, in the longer term, community care providers
should be funded to a level which supports the actual costs of providing care.
This could be best be achieved by linking community care funding to an
appropriate index of health sector wages.
6.20 That, while welcoming
the increases in Commonwealth and State and Territory funding for the Home and
Community Care Program over recent years, the Commonwealth and State and
Territory Governments increase funding for HACC services to ensure more
comprehensive levels of care can be provided to existing clients and to ensure
sufficient growth in funding to match growth in demand.
6.21 That the Commonwealth review the indexation
arrangements for the Home and Community Care Program to reflect the real costs
of providing care.
Special needs groups
Evidence indicated that within the HACC target population
there are several groups that find it more difficult to access services. These
people from culturally and linguistically
diverse (CALD) backgrounds;
- Aboriginal and Torres Strait Islander people;
- people with dementia;
- financially disadvantaged people; and
- people living in remote and isolated areas.
People from culturally and
linguistically diverse backgrounds
Submissions noted that people from CALD backgrounds are
relatively underrepresented in using core HACC services such as home care,
delivered meals and personal care compared with people whose first language is
English. Data indicate that approximately 25 per cent of HACC clients are
people whose birthplace is outside Australia,
with 9.2 per cent speaking a language other than English at home. It was argued that it is essential
that people from CALD communities have fair and equitable access to HACC
Groups representing CALD communities argued that there
needs to be:
increased flexibility in the design of HACC
services to meet the particular needs of CALD communities;
- increased funding to support ethno-specific
delivery of HACC services, especially social support programs;
- increased support and funding for the HACC
in-home respite care program, the value of which is underated for CALD
- the development of a uniform national framework
to deliver culturally competent care;
- the creation of planning and funding allocation
benchmarks and targets to improve CALD communities' access to services;
- cultural competence training across the HACC
sector and evaluation of programs in relation to their cultural
- improved data collection and reporting.
Submissions also argued that CALD ageing communities
require specialised intervention strategies such as the availability of
bi-lingual assessment and care workers and extensive information initiatives to
better inform particular communities of the availability of HACC services.
Aboriginal and Torres
Strait Islander people
Submissions noted that there is a need to improve the
accessibility and appropriateness of community care services for Aboriginal
people. Some 2.4 per cent of all HACC clients are from an Indigenous
background. It was noted that the low
utilisation of residential aged care by Aboriginal people places an increased emphasis
on the provision of culturally-appropriate community-based supports. It was
also argued that funding for community care services needs to take account of
the fact that Indigenous people have a much poorer health status and die at a
younger age than the general population.
Submissions argued that there is a need to provide
Aboriginal-specific services delivered by appropriately trained Aboriginal
people – such services are at present inadequate and ad hoc. Submissions also
noted the need to provide training to ensure that culturally appropriate staff
are employed by mainstream services to ensure services cater for the particular needs of
People with dementia
Submissions noted that with the ageing of the population,
the number of people living with dementia will increase significantly. This
increase in numbers will represent a significant driver in the growing demand
for additional community care services. While some people with dementia will
need support from specialist services, the bulk of the support will need to
come from mainstream community care services.
Submissions argued that many homeless people or people
at risk of homelessness suffer from premature ageing and require the intensive
care services appropriate to older people, such as HACC or CACP services, but
they are often excluded from these services because they do not meet the age
criterion. The Brotherhood of St Laurence (BSL) suggested that the HACC
guidelines need to be amended so that homeless people are recognised as a
special needs group so that these people would be eligible for HACC services
due to premature ageing.
People living in remote areas
Submissions noted that HACC services are more limited
in many rural and remote areas. The distribution of HACC clients among remote
and very remote areas is 1.6 per cent and 0.7 per cent respectively. While many
people in these areas are eligible for HACC and other community care programs
there are often long waiting lists. For those receiving services there is often
difficulty moving through the various levels of care as their needs change. In
rural and remote areas, with relatively more limited access to residential aged
care, it is important to ensure people can access community care services.
Submissions noted that HACC providers in rural and
remote areas are disadvantaged financially in operating services. For
residential care providers a supplement to assist with viability is applied
according to the geographical remoteness of the service. Extra costs associated
with travel and operational costs are not taken into consideration in subsidy
levels for HACC services. Aged Care Qld argued that the Commonwealth should
extend the viability supplementation to the community care programs that it
Evidence indicates that additional resources need to be
provided to special needs groups within the HACC target population to ensure
equitable access to HACC services. The Committee also believes that the
particular needs of homeless people need to be more adequately recognised under
the HACC program. The Committee also considers that a funding supplement should
be available for community care services operating in regional and rural areas.
6.33 That the Commonwealth
and States and Territories substantially increase funding for identified
special needs groups within the HACC target population including people from
culturally and linguistically diverse backgrounds; Aboriginal and Torres Strait
Islander people; people with dementia; financially disadvantaged people; and
people living in remote or isolated areas.
6.34 That the HACC guidelines be amended to recognise
homeless people or people at risk of homelessness as a special needs group.
6.35 That the Commonwealth
introduce a funding supplement to reflect the additional costs of proving
community care services in regional, rural and remote areas.
Other community care programs
Community Aged Care Packages
As noted above, the CACP program is a community
alternative for older people with complex care needs who wish to remain living
in their own homes with care and community support. The program provides individually
tailored packages of care services that are planned and managed by an approved
provider. The services provided as a part of a CACP are designed to meet
people’s daily care needs and may vary as an individual’s care needs change.
The funding for the CACP program for 2004-05 is $327.4
million, with an additional $2.4 million for CACP Establishment Grants. A
further 6635 Community Aged Care Places will be made available through
Approvals Round over the next three years, including 2020 through the 2004 Aged
Care Approvals Round. DoHA
stated that the CACP program will continue to receive increased funding to
ensure the future needs of the elderly in the community are met.
Extended Aged Care at Home
As discussed above, the Extended Aged Care at Home
(EACH) program aims to provide an alternative to high level residential care
for frail older people living in their homes, with the objective of improving
the quality of life for the frail older people and reducing inappropriate
access to both acute and residential care settings.
EACH packages are individually tailored, coordinated
and planned packages of care, targeted at the frail aged whose care needs are
assessed as equivalent to those who require high level residential care, but
have expressed a preference to live at home.
The initial number of packages during the pilot stage
was 290 packages. In the 2002 Aged Care Approvals Round (ACAR), a further 160
EACH packages were made available to provide for a moderate expansion of the
EACH Program. This expansion aimed to build provider familiarity with the
program and provide an Australian-wide base for program development. In the
2003 ACAR, an additional 474 new places were made available bringing the total
places to 924.
EACH packages are currently funded at an average of
$107 per day, which is equivalent to the Resident Classification Scale level 2
of high residential care. This is an average of $39 055 per annum per
package. Expenditure for the EACH program in 2004-05 is estimated to be some
that the EACH program continues to receive increased funding to ensure the
future needs of the elderly in the community are met. To support continued
strong growth in community care, 900 additional EACH places will be made
available in 2004-05. In 2004-05 the number of EACH places will increase to 1824
Views on programs
Generally, the evidence indicated that these community
care programs provide valuable services but need further resources so that more
services can be provided. The Committee received only limited evidence
commenting on specific programs. One submission noted that while EACH is a
laudable program the differences in level of care available under CACP funding
and EACH packages creates problems in maintaining clients in their own homes
because of the very different levels of care able to be provided under the
different programs. Another
submission noted that CACPs and EACH packages are now seen as a way for HACC
providers to 'offload' high user clients that in the past managed well with
A recent House of Representatives report into ageing noted
the growing demand for EACH places and the need for further resources to
increase the number of these packages to enable people to have the chance of
receiving high care at home.
Many submissions argued that funding for these
community care programs should be increased by 10 per cent to address past
underfunding of these programs.
In the 2004-05 Budget the Government changed the aged
care planning ratio to increase the number of CACPs from 10 per 1000 over the
age of 70 years to 20 per 1000 people over the age of 70. Submissions generally welcomed these changes.
That, while welcoming
the increases in Commonwealth funding for Community Aged Care Packages and Extended Aged Care at Home packages
over recent years, the Commonwealth increase funding for these programs to meet
demand for these programs and to provide viable alternatives to residential
Adequacy of community care programs
While there is widespread acknowledgement of the
significant contribution community care programs make in enabling older people
remain in their own homes, evidence indicated concerns about the adequacy of
some aspects of current arrangements. The Victorian Association of Health &
Extended Care noted:
Community Care as well as being preventative, is the most
economically efficient and socially effective model of care. It improves
people's lives and prevents admissions to residential care facilities. It
literally is the way of the future.
Evidence indicates that the community care system is
not meeting all the needs of Australians who currently require it. Specific problems
identified include the following:
there are inadequate levels of service provision
– 'For some years the Queensland Government has been concerned about the
adequacy of community aged care, the multiplicity of Commonwealth Government
programs and the absence of choice for frail older people'.
- services are fragmented – currently there are 17
separate Commonwealth funded programs providing community based care services.
In addition the States fund separate programs – in Victoria alone there are 42
different State and Commonwealth funded programs.
- services are often difficult to access and they
are unevenly distributed across the country;
- there is a complex mix of services that are
difficult to access;
- there is evidence of considerable unmet need and
there are waiting lists for many services;
- there is a lack of case management of clients to
follow through with care plans.
Submissions commented on the complexity of community
Community care is a complex matrix of services and funding
streams that is difficult for the most experienced person to negotiate. At a
time when we are encouraging our older people and people with disabilities to
plan their own care, or remain in their own homes and communities it is
becoming more difficult to do so. The system is confusing for people to access
and is administratively inefficient for Governments and service providers. 
The sheer complexity of the community care system and its
plethora of programs can be defeating for people needing to access the system....This
complexity for consumers is a barrier in itself and creates unnecessary
hardship, inequities and inconsistencies for consumers and families.
Submissions noted that average levels of service
provision under HACC is very low. In 2002-03, individuals on average received
38 minutes of domestic service per week, 67 minutes of personal care, 108
minutes of respite care and 16 minutes of nursing care. In terms of service intensity, data
indicate that in 2002-03, 45 per cent of HACC clients received only one type of
assistance; a further 24 per cent of clients received two assistance types and
only 14 per cent received three assistance types. Data for 2003-04 indicate no change
with regard to service intensity compared with 2002-03 figures.
These figures graphically illustrate the inability of
the community care system to provide adequate support for those currently
requiring assistance. Instead, the rationale appears to be to limit the time
available to each client in order to provide as many people as possible with
some service. Pensioner groups reported that many older people are either
unable to access necessary services or have had their services cut back. COTA
National Seniors stated that seniors report that they have difficulty in
obtaining services, especially household support, community transport, gardening
and home maintenance and essential home modification.
Evidence indicated that HACC services are in danger of
losing their preventative focus. One submission commented on 'the lack of
capacity to provide preventative services for low care clients because of the
necessity to attend to those with higher care needs who are unable or do not wish
to access residential services'.
Another submission noted that HACC services are often now responding to crisis
situations rather than responding to the ongoing needs of clients.
Submissions noted that the level of services are
inadequate for those with more complex needs.
The Aged Care Assessment Service Victoria commented that there has been 'a
progressive reduction of flexibility in the provision of generic HACC services
as provider agencies move towards setting limits on the number of hours of
service clients can expect from the HACC system. This has meant there are now
limits to HACC services for high need clients that prevent them from remaining
Submissions also noted that many prospective clients in
regional and rural areas in particular have limited or no knowledge of the
range of HACC services that are available.
Other potential clients are not receiving services. Carers Australia
reported that many carers are missing out on services, along with the people
that they support, in preference to people without carers – 'it appears, in an
environment of resource constraint, people with no family support are being
given greater priority for HACC services'. 
A significant concern for providers, especially smaller
providers, is the onerous reporting requirements. ASCA noted that there is a
growing array of community programs which have created separate reporting
requirements. Often the same organisations provide a mix of community care
programs and must complete multiple sets of essentially similar information.
These different requirements are inhibiting the provision of quality care to
individuals while adding to management overhead costs. Submissions noted that some small
organisations are reassessing their commitment to providing services due to the
reporting requirements for grants.
Community care review
Evidence to this inquiry as well as previous reviews of
community care indicates that significant reform is needed to the community
care system. In 2002 the
Commonwealth Government initiated a review of community care programs to
identify strategies that would simplify and streamline current arrangements for
the administration and delivery of community care services. The focus of the
review is to ensure a community care system in which it is easier for people to
access the care they need and within which community care programs are well
aligned and interlinked, offering an appropriate continuum of care that is of
high quality, affordable and accessible.
Following a review and consultation process, the Commonwealth
Government released A New Strategy for
Community Care – The Way Forward in August 2004, which outlines a series of
steps for reshaping and improving community care. Four broad areas of action
have been identified:
addressing gaps and overlaps in service delivery
– including the development of common arrangements for community care programs
within a national framework; development of administrative arrangements for the
allocation of HACC funds across a three-tiered community care system, based on
different levels of care and support; improved alignment of CACP and EACH
packages with other services; and development of consistent eligibility
criteria for community care programs.
- easier access to services – including the development of nationally consistent intake assessment for
HACC and other community care services; and identification of entry points for
easy access by consumers seeking community care services.
- enhanced service management – including the development
of a standard financial reporting tool; implementing a quality assurance model
for community care programs; and a nationally consistent approach to consumer
- streamlining of Commonwealth Government funded
programs – including the alignment of EACH within community care programs;
development of a single national contract for dementia initiatives; better
integration of initiatives under the Continence Management Strategy; merging
the functions of the Aged Care Assessment Team and Dementia Support for Assessment
Programs; and applying common arrangements to respite services funded under the
National Respite for Carers Program.
The Way Forward
is based on the adoption of a common approach across all community care
programs in key areas such as access, eligibility, common assessment,
accountability and quality assurance. The Way
Forward also involves the development of a new HACC Agreement with the
State and Territory Governments, which will be underpinned by the principle of
common arrangements. DoHA advised
that discussions with the States are continuing in relation to the Agreement
and that a draft Agreement is expected to go to Cabinet for consideration in
July-August 2005. State
Governments argued that any new HACC Agreement needs to address certain issues
such as the need to improve viability for service providers, reduce administrative
burdens and provide sufficient funding to meet future demand for services.
Evidence to the inquiry generally welcomed the
Government's proposals for reform of community care programs arguing that they
address many of the deficiencies identified in current programs. One submission
noted that within the community care sector there exists:
...in principle agreement with much of the shape of reform proposed...and
an urgent need for reform which creates a sensible and flexible program
structure to meet consumer needs, reduce consumer confusion and time wasted by
services on reporting on, and managing multiple programs.
However, submissions pointed to the need for the
Commonwealth to provide a detailed implementation plan and timetable for the
advised that major implementation of the reforms will begin in 2006, with some
pilot programs and development work being implemented in 2005. Evidence also pointed to the need
for the Commonwealth and the States to work collaboratively in implementing the
Evidence indicated that a particularly glaring omission
in the Way Forward is that it fails
to adequately address the need for effective interface between ageing and
disability services. ACROD stated that:
At present, bureaucratic and jurisdictional boundaries impede
effective service delivery to people with disabilities. For some with long-term
disabilities who are growing old, this is particularly so. Such people often
search in vain for effective pathways between Commonwealth and State disability
service systems, and between aged care and disability service systems.
The implementation of The Way Forward has involved the establishment of compulsory
competitive tendering for three respite care programs. Evidence was strongly
critical of the process arguing that it was disruptive to services and
counterproductive to the development of more integrated service provision. The
BSL stated that it 'is causing quite a deal of distress amongst our service
users and staff and, again, a lot of paperwork and extra work, taking people
away from the direct care requirements'.
Witnesses noted that competitive tendering does not
actually support the client negotiating the myriad services currently available
as providers who previously would have collaborated to serve that client are
now in a competitive situation, so their desire to collaborate is diminished. ACSA submitted that 'it certainly
cannot in principle lead to better integrated services on the ground. They are
already integrated. This is disintegrating them – or at least caries that risk.
It is an expensive process'. The
Victorian Healthcare Association argued that 'it does not get us any closer to
a system that is actually focussed on providing better care for the individual...
Tendering...distracts from that'.
Evidence to the inquiry indicated that community care
programs provide a range of very valuable services to enable older people to
live at home. It is, however, evident that significant reform of community care
programs is required to achieve a system that better responds to the needs of
consumers, care workers and service providers. Evidence indicated that the
current system is not providing adequate levels of service; services are
fragmented; and there is a complex mix of services that are often difficult to
The Committee notes that the community care review, The Way
Forward, outlines, in very broad terms, a series of steps for reshaping and
improving community care. The Committee supports the aims of the review in
addressing gaps and overlaps in service delivery; providing for easier access
to services; enhancing service management, including financial reporting; and
streamlining of programs. The Committee considers, however, that the
Commonwealth needs to provide a comprehensive implementation plan and timetable
for the reforms. The Committee also believes that the Way Forward strategy needs
to address the need for a more effective interface between ageing and
disability services. The Committee also considers that the Commonwealth and
States and Territories should assess the appropriateness of compulsory
competitive tendering for future programs as part of The Way Forward strategy.
6.67 That the Commonwealth
provide a clearly defined timetable for implementing all aspects of A New Strategy for Community Care: The Way
6.68 That, in supporting the
approach in The Way Forward for implementing a more streamlined and coordinated
community care system, the Commonwealth address the need for improved service
linkages between aged care and disability services.
That the Commonwealth
and State and Territory Governments assess the appropriateness of the compulsory competitive tendering process
for future programs as part of the implementation of The Way Forward strategy.
Evidence to the inquiry indicated that access to
informal care plays a critical role in helping individuals who require
assistance and support because they are frail, chronically ill or too disabled
to remain living in their homes and communities. Most community care occurs in
the home, making informal carers the backbone of the Australian community care
The ABS estimates that there are 2.3 million carers in Australia
– of these some 450 900 are classed as 'primary carers'. A primary carer
is a person of any age who provides the most informal assistance to a person
with one or more disabilities.
The Commonwealth funds two community care programs
specifically for carers – the National Respite for Carers Program (NRCP) and
the Carer Information and Support Program (CISP).
Under the National Respite for Carers Program, the
following services are provided:
Commonwealth Carer Resource Centres – These
provide information, support and advice to carers on a range of issues.
- Commonwealth Carer Respite Centres – These were originally established in
each HACC region across Australia and have the capacity to arrange respite for
carers through existing services. There are currently 61 Centres (with 89
outlets in all). These Centres have a pool of funds, called brokerage, to be
used to purchase or subsidise short term or emergency respite care.
- Respite services – There are currently 432 community-based respite services
delivered to carers and the people for whom they care in a variety of settings,
including in-home, day centre, host family, residential overnight cottage-style
accommodation and as holiday breaks. In 2003-04 the number of carers assisted
by respite services was estimated to be 28 000.
- National Carer Counselling Program – The aim of the program is to address
issues specific to carers such as carer stress, grief and loss, coping skills
and transition issues. Counselling is provided on a sessional basis by
Overall, Commonwealth funding for the NRCP has increased
more than five-fold from $19 million in 1996-97 to an estimated total of $104.9
million in 2004-05. The Commonwealth also funds CISP. This program provides
carers with information and practical advice about services that can help them
in their caring role. Funding for this program for 2004-05 is $2 million. 
In the 2005-06 Budget, the Commonwealth announced that
it will provide $207.6 million over four years to support carers by improving
access to respite care including increasing the number of respite care services
available for carers in paid employment; paying an incentive to encourage
residential aged care providers to provide high care residential respite; and
increasing the level of respite services available to carers in rural and
remote areas. Support for carers
is an essential component of the Commonwealth's community care policy which
aims to give people the choice of remaining at home for as long as possible.
The NRCP complements other services funded by the
Commonwealth, aimed at supporting the frail aged and people with disabilities
to continue to live in the community, for example the HACC program. While
carers are a focus of HACC, as noted above, the NRCP and the CISP are the only
two community care programs for which the carer is identified as the main
Submissions stated that the needs of carers need to be
more fully recognised and addressed. The work that carers do in their caring
role is constant and exhausting and without assistance carer burnout is likely
to lead to increased numbers of older people relying on the formal care system.
In particular, the Carers Australia noted that:
Carer recognition and support needs to be
central to The Way Forward strategy. Any community care strategy must address the
needs of carers by ensuring that community care systems can respond to
individual care situations. The Way Forward strategy also needs to
address the needs of carers of workforce age – the bulk of the carer
- Carers have a dual role in the system – they
have their own needs for support and assistance to sustain their caring role
and they are also key providers of essential services in an unpaid capacity.
- Governments need to address the problem of fewer
primary carers and greater numbers of people needing care over the next
decades, due to the ageing of the population. This will lead to greater demand
and reliance on formal community services to fill the gap in service provision.
- While the uptake of respite services has
increased in recent years and resite is delivered in a more flexible manner
some problems still exists, especially the need to book respite services often
12 months in advance in some States.
Submissions noted that that the aged care system is
dependent on carers to provide ongoing support for older people – without them
the costs of providing care and support to older people would be substantially
higher. NSW Health noted that lack of an informal carer, that is, a person
living alone, is the single most common trigger for an older person moving into
residential care – 'any changes to the balance of care for older people must
therefore consider adequate carer supports, together with social changes (such
as workforce participation) that impact on people's availability to fulfil the
role of "carer"'.
ACROD also noted that as well as increased support for
formal services, a strategy to respond to demand growth for services should
include increased support for unpaid carers, without whom demand would be much
6.80 That The Way
Forward implementation strategy
recognise the central role of carers in the community care system.
6.81 That, while welcoming
the increases in Commonwealth funding for carer-specific programs over recent
years, the Commonwealth increase funding for these programs through the
National Respite for Carers Program and the Carer Information and Support
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