Every year, almost a million elderly Australians need in-home care. Almost 1,000 organisations serve them.
Despite the federal government providing more cash to home care in the most recent budget, present home-care arrangements continue to have a slew of issues.
As we demonstrate in the new research, "Unfinished business: realistic policies for improved home care," the federal government places much too much focus on increasing the market for services and far too little attention on assisting individuals in accessing timely and high-quality services.
Home care assistance may vary from assistance with personal care and housekeeping to the provision of mobility aids and transportation to social activities and medical appointments.
People who need in-home care may look into their possibilities on the federal government's myagedcare website. They may then be evaluated, choose a local provider that meets their requirements, and manage their own treatment.
However, this approach is impersonal and inefficient.
The assessment of people's requirements is distinct from the planning of their services. As a result, older individuals get little guidance and help in locating resources, and those in need of more extensive and sophisticated care sometimes have to wait more than a year.
Administrative and coordination expenses are significant for the 200,000 persons who get home care packages, unregulated hourly service rates, and more than A$1.6 billion in unspent money might be utilised to deliver services.
The number of private services has skyrocketed, with little monitoring of quality and value for money.
At the same time, home-care employees continue to be underpaid and undervalued. As a result, training is sporadic, employment is often precarious, and there is little supervision, support, and employee development.
Not surprisingly, recruiting and retaining aged-care staff is becoming more challenging.
The federal government's response to the historic Royal Commission on Aged Care was significant, but it does not alter the principles of the home-care system. Instead, it broadens a market that is now underserving elderly people.
The government is betting on a centrally controlled market model dominated by commercial and non-government home-care providers.
Even with dramatically expanded home-care funding, the market may not be able to offer enough to cut waiting periods for treatments to less than a month, as recommended by the royal inquiry.
Currently, about 75,000 people are waiting for home care assistance, with some waiting up to nine months.
It is estimated that up to 15% more home-care spaces than anticipated may be required solely to clear the waiting list. The federal government to limit waiting periods to no more than 30 days.
The government's budget proposal does contain increased assistance to help elderly persons navigate the home-care system. However, evaluation, care planning, and coordination will remain fragmented.
In general, older adults will continue to be required to traverse a complicated system and make market decisions independently.
Australia needs a new home care model that offers far more personalised assistance to help older people acquire the services they require whilst also managing local service networks on their behalf.
It's impossible to envision this happening without competent regional aged-care offices. These offices must serve as a one-stop-shop for the elderly. They must, however, have the power and duty to establish and administer local services to ensure that older people have access to what they need.
The federal government is aware of the issue, but its reaction has been muted: a trial of tiny, regional offices of up to 10 employees to plan, monitor, and handle issues. However, those regional offices are not responsible for assisting older persons and cannot oversee service providers on their behalf.
The federal government create a network of regional aged-care offices around Australia to plan and develop programs, manage money, pay providers, and manage service agreements for specific older individuals who need care. In addition, these offices should include assessment teams and care finders to assist clients who are navigating the home-care system.
A well-qualified, secure, and appreciated team is essential for providing high-quality home care. Yet, again, the federal government is aware of the issue and has enacted only a limited set of worker changes. However, it has yet to agree to support better pay and working conditions, minimum certification levels, or a thorough registration process for personal-care employees.
As part of the new Elderly Care Act, the government should establish and execute a revitalised workforce strategy for aged care. Personal-care professionals must be registered and have the necessary minimal credentials.
The gvernment should also make it clear that it will finance the Fair Work Commission's findings investigating fair pay and working conditions for aged-care employees, which is anticipated to issue a judgment next year.
As Australia's population ages, many more individuals with complex needs will need care. The great majority will choose to be cared for at home. Expansion of home-care services without much better market control and a far more stable workforce is a danger that Australia should avoid.
