The home care sector — services for seniors so they can live at home and not in residential care — is a crucial component of our handling of the stresses an ageing population will place on the beleaguered residential aged care sector. But a new report from the Grattan Institute has found profound problems.
Home care has grown rapidly in recent years as the government has come under pressure to reduce waiting lists for packages. It announced an extra $2.4 billion a year for packages in its aged care royal commission response this year alone, bringing its investment to about $7 billion a year.
Grattan’s team, led by Stephen Duckett, acknowledges the significant additional funding from the Morrison government. But with demand predicted to increase by 22% by 2025, it wants to see about $800 million a year extra to reduce waiting times and keep them down.
But lack of money isn’t the biggest problem — indeed, the big increase in government funding in the past couple of years and the forthcoming additional funding might have exacerbated existing problems. The extra money being pumped in is luring large numbers of for-profit providers, whose numbers have increased by about 50% since 2017, while the number of non-profit and government providers has declined.
This means large amounts of taxpayer dollars are being wasted, with services like gardening and cleaning being charged at $60 an hour, and about a quarter of costs going to management fees even for the most basic level one services (the government has belatedly announced a review of high administration fees in the sector).
There’s a $10,000 a year difference in costs between the highest and lowest cost providers of level four services. Registration of providers is purely a desk-top exercise “that provides only administrative checks on quality and competence”.
And despite the constant rhetoric of aged care being “consumer directed” — a buzzword for more than a decade — it is poorly regulated, for-profit providers who “set prices, service levels and schedules, and administrative and coordination arrangements. As a result, older people’s home care choices continue to be limited.”
The government has committed funding to regional offices to help people connect to home care services but the report urges a stewardship model, in which people expert at navigating the system act on behalf of consumers to identify what they really need, and who is best placed to provide it — provided there are sufficient service providers available, which may not be the case in regional areas.
Governments have naively relied on market mechanisms to meet consumer needs. Markets don’t work well when there is poor information to assist choice, the product is hard to define, there is poor regulation of providers, and a limited range of providers to choose from.
Home care thus represents the downside of when governments respond to constant demands for more funding while there’s a lack of appropriate regulation and user navigability. It hands power not to consumers, but providers, who can then increase fees to reap the benefits of extra funding.
The other important part of the report is the subject that aged care must always default back to: workforce. There are already high levels of vacancies in the personal care sector. Despite clear evidence for years that pay needs to substantially increase for aged care nursing and personal care workers, casualisation has increased significantly over the past decade (which also affects consumers who want or need continuity of care).
Just to keep up with existing growth in home care packages, the report says, another 58,000 care workers or nurses are needed — a 46% increase. Meantime, the application for a significant increase in pay that has been before the Fair Work Commission for more than a year won’t be heard until mid-2022.
As has been seen in residential aged care, simply tipping in more government money in the hope it makes its way down to the workforce, making it a more attractive place to seek employment, doesn’t work — regulation is required to make sure it reaches workers, and to ensure it leads to improved quality of care, not just improved bottom lines.
We’re spending a lot more money on aged care than we used to, and that’s a welcome change, but we’re still not regulating the sector properly.
“The extra money being pumped in is luring large numbers of for-profit providers, whose numbers have increased by about 50% since 2017, while the number of non-profit and government providers has declined.”
And that’s the whole point. As usual the objective is to pump vast amounts of money into corporate pockets. The corporate beneficiaries will express their gratitude in the usual ways and the politicians will prosper. The government is not doing any of this to help aged and vulnerable Australians or their carers. Why would it? It despises the little people, and the worse things get in the sector the louder the calls for more money, which simply increases the opportunities to throw cash to their mates.
wot SSR sed.
My husband is 93 and I am 82 in 9 days time. We live at home on 2h. We are lucky, but we could do with a bit of housekeeping, yard maintenance, gutter cleaning, etc. While we keep reasonable health we can cope. I tried in 2020 to register for some sort of package, but none of the wonderful for-profit providers would touch us. No non-profits seemed to work in our area.
Our needs weren’t great enough to be bothered with. For-profits don’t want just one “need”, they want 3 or more, it seems, to make it worth their financial while to take us on. So who is getting the assistance? Not the elderly, but ScoMo’s sacred ‘business’ cohort.
We have taken matters into our own hands by dividing our house in half and renting one side. The rent pays for a cleaner for 2 hours a week and a maintenance man every so often. We are very lucky to be in this position. not every one is in the position to do this. Take note government…we are saving you the cost of a package!
When I want my blood pressure to rise I just think of our wonderful services by private enterprise enabled by small government philosophy….watch out….I’m about to burst!!
Paid ‘companions’ were once the norm – not servants per se.
As the asset rich/child poor cohort ages there could be a real opening for live-in help who would benefit from a living and then a pay-out in the will.
Just saying.
we are only 75, but I am a paraplegic – too old for NDIS, so get pretty much nothing, except the local health service to change catgheter monthly. Impossible to find an easy way into accessing the govt’s largesse – but not being a pensioner puts you out of the race. Should be a simple public service system rather than all these private suppliers – health care been americanised to a high degree byu the neocons.
Vital reporting on a grossly underreported care and labour (& by default, women’s issue) for Australia and the world. According to the US Bureau of Labour Statistics, home care workers will be the most common occupation the country by the end of the decade. Similar trends will play out here and in all high income countries. Yet care labour receives a fraction of the attention of other sectors, particularly construction and mining (not they do not deserve attention). As Keane & the Grattan report show, the vultures are circling to the detriment of the cared for and the care labourers themselves—& this in all forms of care, from disability, aged care, mental health, etc.
Up to and over 30% of the funds allocated for in-home care is taken by the service providers, and some ex-politicians are CEO`S of these for-profit organizations on high wages and lavish expense accounts, an incoming Labor government must hold a public inquiry into the whole aged care system and clean out these politically appointed leeches and restore the system to provide help to the elderly and not just a milch cow for retired politicians and their political mates and donors
Maybe it’s time for state governments to insist the funding gets returned to them, and in turn put the funding into actual employed care workers who can carry out the duties at a market rate with less overheads. The outsourcing experiment has failed.
No it hasn’t! It’s made mates very wealthy indeed, and in return they donate very generously to the two parties. It’s been a roaring success- just not for the aged, their workers and the community.