Aged care: access, and care and support in the home


Budget Review 2021–22 Index

Rebecca Storen

The 2021–22 Budget provides the Australian Government’s response to the Royal Commission into Aged Care Quality and Safety (the royal commission) and a generational plan for aged care in Australia. This $17.7 billion package over five years (from 2020–21) is set out under five pillars:

  • home care—$7.5 billion, with the majority of funding, at $6.5 billion, being provided for the release of 80,000 home care packages over two years from 2021–22 (p. 100)
  • residential aged care services and sustainability—$7.8 billion, with $3.9 billion over four years from 2021–22 to increase the time staff spend with each resident, each day (p. 102)
  • residential aged care quality and safety—$942 million, with $365.7 million to improve residents’ access to primary care and other health services (p. 101)
  • workforce—$652.1 million, with $228.2 million for establishing a single aged care assessment workforce for residential care from October 2022 and home care from July 2023 (p. 103) and
  • governance and regional access—$698.3 million, with the majority of this funding, at $630.2 million, being used to improve service delivery for special needs groups (p. 99).

Stakeholders have broadly welcomed the Australian Government’s response to the royal commission and the associated $17.7 billion reform packages. The Australian Aged Care Collaborative (AACC) said the reforms provided a pathway to ‘a transformed aged care system’, with resourcing to meet the needs of older Australians. Council on the Ageing (COTA) Australia identified the aged care reform package as a ‘serious and meaningful response’ (p. 1) to the royal commission.

There are several significant announcements in the Budget and the accompanying government plan for aged care. This is one of three articles which provide an overview of the aged care budget measures with reference to the relevant elements of the response to the royal commission. The articles should be read in conjunction with one another. Information on stakeholder views has been split across the three articles but, except where specified, their commentary should be viewed in the context of to the whole package.

This article focuses on access to aged care, and care and support in the home. The other two articles cover:

  • quality and governance and
  • residential aged care and the workforce.

For an overview of the fundamental elements that the commissioners recommend in the royal commission’s Final Report, refer to the Parliamentary Library’s publication, Final Report of the Royal Commission into Aged Care Quality and Safety: a Quick Guide.

Access

‘My Aged Care’ was introduced in July 2013 in response to the Productivity Commission’s Caring for Older Australians report. It is intended to be the single entry point to aged care to make it easier for people to access information, have their needs assessed, and locate and access aged care services. The functions of My Aged Care have expanded over time, including the introduction in 2015 of electronic referrals for services and in 2020, the ability to apply for an assessment online.

Concerns have been raised around the accessibility of the My Aged Care system, with the royal commission’s Interim Report stating that many older people find the system ‘confronting’ (p. 2). These concerns, raised by the royal commission and others, include the lack of a face-to-face option for people who may require, or would prefer, support to access My Aged Care, and a lack of information to help answer their questions about the aged care sector (for example, see p. 132 of the Legislated Review of Aged Care 2017 (Tune Review)). In the royal commission’s Final Report, Commissioner Briggs recommended a workforce of care finders be established to assist people to access and understand information about aged care, and provide support to interact and follow up with aged care services (pp. 153–4). The Australian Government’s response to the royal commission seeks to address the concerns identified by extending or introducing several measures to better support people to access and interact with the aged care system.

Engaging with the aged care system

This Budget provides $86.4 million to introduce face-to-face services in Services Australia service centres to support people to engage with the aged care system (p. 11). In addition, $7 million will be provided (p. [109]) to extend the existing Aged Care System Navigator measure, which was announced in the
2018–19 Budget, until December 2022. This face-to-face support will be replaced by the establishment of a $93.7 million network of Community Care Finders, which will seek to engage and support people to access aged care as well as connect with health and social supports (p. 11).

The Budget provides $65.2 million for additional translating and interpreting services. It is estimated that this will support more than 75,000 older people from culturally and linguistically diverse backgrounds. Around $9.6 million will be provided to certify over 2,000 providers that offer specific services to meet diverse needs (p. 11). Further details on this certification process are not available in the Budget or the response to the royal commission.

My Aged Care

The Budget provides $28.5 million in 2021–22 for the continued operation of My Aged Care (p. 100).

As part of the measures to improve access to the aged care system, the My Aged Care and Services Australia call centres will be linked so calls can be more easily transferred between the two services (p. 108).

New tools will be available on My Aged Care with the introduction of a cost calculator and price comparator function as part of the price transparency measure home care packages (p. 106). In addition, the new star ratings of residential aged care services will be published on My Aged Care by the end of 2022 (p. 132).

Single aged care assessment workforce

Following the initial screening by My Aged Care, people can be referred for an assessment to determine their care needs and service eligibility. There are two different types of assessment—a home support assessment undertaken by a Regional Assessment Service (RAS) and a more comprehensive assessment conducted by an Aged Care Assessment Team (ACAT).

The 2017 Tune Review recommended that the RAS and ACAT assessment workforces should be combined, with additional consideration given to integrating the residential care funding assessment into one assessment workforce. In the 2018–19 Budget, the Australian Government announced it would integrate the RAS and ACAT assessment workforces from 2020. The introduction of this single assessment workforce was postponed (pp. 2–3) following concerns and criticisms from stakeholders.

The 2021–22 Budget announces that the one assessment workforce will commence from October 2022, and, unlike the previous proposed changes, it will not only include the current RAS and ACAT, but will also be responsible for undertaking assessments for residential aged care funding under the new Australian National Aged Care Classification (AN-ACC) funding model (p. 137). The introduction of a single assessment workforce will occur in two stages, commencing from October 2022 for residential aged care and from July 2023 for the new support-at-home program. From July 2023, Aboriginal and Torres Strait Islander assessment organisations will be involved to support First Nations people to engage with and access aged care in an effort to improve the historically low uptake of aged care services (p. 141). As identified in the royal commission’s Final Report, Aboriginal and Torres Strait Islander people are able to access aged care services from 50 years of age due to their experience of earlier onset of age-related conditions and disability compared to the general population (p. 239).

Improving access

The 2021–22 Budget provides $630.2 million over four years to improve access to services for Aboriginal and Torres Strait Islander people, people living in regional, rural and remotes areas and other special needs groups (p. 99). There are three key elements to this measure:

  • $397 million over five years for capital investment for providers to make necessary improvements to their buildings and to build new services in areas where the population does not have access to an existing service or where care staff do not have suitable housing (p. 152). As part of its response to the royal commission’s Recommendation 54, the Australian Government will procure research to better understand the service gaps and identify options to address thin markets in regional, rural and remote locations, with a particular focus on the needs of Aboriginal and Torres Strait Islander communities (p. 39).
  • $125.7 million over four years (p. 21) for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program and the Multi-Purpose Services (MPS) Program. Both programs are designed to assist with the high costs associated with the remote locations of the services. MPS is jointly funded with state or Northern Territory governments, which are responsible for infrastructure and capital funding. In response to Recommendation 55 from the royal commission, the Australian Government has stated that MPS providers will be eligible to access other aged care funding, including capital grants. In addition, the Australian Government will consult with the state and territory governments to develop a co-contribution model for capital funding for new MPS (p. 39).
  • $106 million over four years to establish a 250-strong Aboriginal and Torres Strait Islander workforce (p. 153) to commence in December 2021 (p. 35). People working in these roles will assist Aboriginal and Torres Strait Islander people to access care, and support them with their RAS and ACAT assessments, both initially and when people have reviews in response to their changing needs (p. 153).

Care and support in the home

The royal commission raised concerns about the adequacy of the support and care available to assist people to remain in their own home, going so far as to call it ‘neglect’ (p. 162). Among the issues identified were:

  • waiting times people experienced while waiting for an appropriate home care package
  • limitations on the services, particularly the care, able to be purchased with the funding
  • transparency and administration costs
  • need for proper support for carers and
  • quality and capacity of the home care market.

Additional home care packages

One of the flagship measures of the aged care package is $6.5 billion for an additional 80,000 home care packages (p.100), to be released in two parts, 40,000 packages each year in 2021–22 and 2022–23. The royal commission recommended that the Australian Government should provide enough home care packages to clear the waiting list immediately (p. 102).

Details on the package levels were not provided in the Budget nor in the Government’s response to the royal commission. The Government does state that the measure will clear the existing waiting list of 86,797 people (as at 18 April 2021) (p. 102). However, it should be noted these packages will be made available through a staged rollout over two years. This staged release may, at least in part, be in response to the increased demand on the workforce and systems to support bringing these new packages online.

Merging programs into a support at home program

The Australian Government will introduce a new support-at-home program from 1 July 2023 (p. 8). This program will replace home care packages, the Commonwealth Home Support Programme (CHSP), short-term restorative care and residential respite programs (p. 8). The Budget provides $10.8 million for
2021–22 towards activities to introduce this program and will extend the existing CHSP to 30 June 2023 (p. 105). In 2015, the Government announced it would explore options to merge the CHSP and home care packages program from 2018. This merge was later delayed in 2017, with the 2017–18 Budget extending the CHSP until July 2020. CHSP funding was again extended for existing service providers in the 2019–20 Budget, until 30 June 2022.

The announcement of a support-at-home program goes part of the way towards meeting Recommendation 25 of the royal commission, which recommended a new aged care program be implemented by July 2024 that combines CHSP, the home care packages program and the residential aged care program, including respite care and short- term restorative care.

Support for carers

The Budget provides $798.3 million for carers who support older people (p. 100), with three of the five funded measures focusing on respite services (pp. 110–11):

  • $134.9 million for CHSP respite from January 2022, estimated to support an additional 8,400 people each year
  • $441.4 million for additional residential respite services, which is estimated to provide services for up to 67,000 people per year and
  • $60.1 million to improve respite through enhanced care planning for people living with dementia and training for residential care providers to implement these care plans and improve dementia care respite models.

In addition, the measures include further funding to provide early intervention assistance to people who have recently been diagnosed with dementia (p. 110), and support for the National Dementia Helpline.

To enhance the Carer Gateway, $103.4 million will be provided to enable aged care assessors to refer people directly (with their permission) to the Carer Gateway, which will make contact with the carer directly (p. 111).

In response to Recommendation 43 of the royal commission, the Australian Government will also ask the Productivity Commission to examine the likely impact of amending the National Employment Standards to introduce unpaid carer’s leave (p. 10).

Stakeholder reactions

A AACC representative, Patricia Sparrow, stated the Budget ‘gives real hope’ (p. 1) to the people accessing aged care services. COTA Australia’s CEO, Ian Yates, stated COTA is pleased the Government has responded to calls for a better home care program that ‘makes consumers genuine partners in design and delivery of their care’ (p. 1). National Seniors Australia has stated it will wait to see if the changes result in the culture change needed in both the policy and the day-to-day operation of the sector. National Seniors noted that the Australian Government’s postponement until 2023 of the decision whether to establish a Senior Dental Benefit Scheme will be disappointing to many older Australians.

Carers Australia CEO, Liz Callaghan, welcomed the Budget and the extent to which carers are embedded in the aged care reform package. Dementia Australia has also welcomed the budget measures that will ‘transform dementia care in Australia’, including the respite services and increase in Home Care Packages.