Aged care research project overview of findings and key themes Public Service Research Group Aged care research project overview of findings and key themes A/Prof. Helen Dickinson, Director Public Service Research Group, UNSW, Canberra h.dickinson@adfa.edu.au @DrHDickinson https://helendickinson.wordpress.com/

Background Significant reform across aged care sector aiming to create greater national consistency and more integration across the care system. Changes will have significant implications for Local Government in terms of Home and Community Care Program and potentially a broad range of other services and interactions with the local community. Project sponsored by MAV and DHHS to better understand the range of potential mechanisms that may be employed in the funding and oversight of aged care and their implications in terms of efficiency and equity. First phase explores international literature around funding, contracting and organization of relationship with provider organizations in order to identify the various options available to governments in the aged care space. In the process of generating models of stewardship from this literature that will be tested at a number of roundtables with relevant stakeholders.

Drivers of reform This reform process is underpinned by two linked drivers of change that represent a move away from collective social welfare provision in favour of markets and individualised care. The idea is that by putting individuals in control of their own service needs and leveraging market mechanisms, this will produce services that are more effective and efficient and person-centred. The aged care reform process aims to “ensure that all older Australians needing care and support have access to person- centred services that can change as their needs change” (3: xxiv).

Strengths of the Victorian system Connections between community care, primary care and health services that work for the benefit of older people; The extensive involvement of local government in service delivery, as well as planning and funding services; A system-wide focus on promoting wellness, aimed at preventing decline and maintaining people’s independence in function; A strong assessment framework; and, System-wide reform initiatives such as person centred care and diversity planning and practice.

What the international evidence tells us Quality of evidence limited, need for more systematic research in this space. Some studies show improvements in satisfaction although concerns about administrative burden (Ottman et al, 2013) Glendinning et al (2008) found lower levels of wellbeing in individualized scheme in comparison to block-funded. Anxiety and stress about changes moderated potential gains around choice, control and transparency. Older people more resistant to these reforms than other user groups. How schemes are rolled out and individuals supported to make decisions crucial. Care co-ordination and planning support more intensive than younger groups. Packages also smaller than younger groups – less flexibility (Glendinning et al, 2011) Re-emergence of boundary debates and issues in relation to continuity of care (Moran et al, 2011). Impact on collective services (Needham, 2013) Equity considerations, ability to navigate systems (Netten et al, 2012)

Stewardship of the aged care system Productivity Commission (2016a) acknowledges, market forces and personalisation can have positive outcomes, “where exercised under sound stewardship arrangements” – i.e. benefits of markets, choice and competition do not simply flow from these arrangements.  Stewardship defined as: “range of functions governments undertake that help ensure service provision is effective at meeting policy objectives. This includes responsibility for ensuring arrangements for providing human services are continually improving. Ultimately, stewardship recognises that the overarching responsibility for ensuring that human services contribute toward the wellbeing of the community remains with government, even where non-government providers are responsible for service provision. The role governments take, including the functions they perform themselves or delegate to other authorities, depends on the characteristics of the service and on the objectives and outcomes that governments set for service provision” (Productivity Commission, 2016b: 9).

Monitoring and evaluation   Strategic planning Procurement Monitoring and evaluation Federal government Set national standards for care, based on outcomes rather than processes (acknowledging that local conditions will mean that different places will provide services in various ways depending on their specific characteristics and histories). Operate online platform providing information on expectations around care and process of how to access care services. Set the broad policy framework in which lower levels of government operate. Provide funding for defined services and align aged care provision across different mainstream services. Market management with a particular focus on assessing the quality of different local markets and ensuring that these are similarly contestable across different areas. Incentivise demand management and early intervention services. Set regulatory framework that aged care providers will operate within. Be responsive to the challenges that are raised through state and local government channels. Engage with a range of stakeholders to garner feedback about services and any potential system gaps. Work to ensure that services are equitable at the national level.

Hold providers to account within the regulatory framework.   Strategic planning Procurement Monitoring and evaluation State government Work to ensure that aged care services sit comfortably alongside mainstream services and identify any gaps that may emerge between different policy areas. Provide funding for defined services and align aged care provision across different mainstream services. Market management with a particular focus on boosting market areas that appear to be thin. Consider whether efficiencies of scale can be achieved through collective procurement, rather than spot contracting. Hold providers to account within the regulatory framework. Work with local government and other stakeholders to ensure that services are effective and identify gaps. Work to ensure that services are equitable at the state level.

Consider what services should be provided locally.   Strategic planning Procurement Monitoring and evaluation Local government Understand how various policy areas come together and the impact that they have on places. Identify overlaps and gaps and work with state/federal governments to address these. Consider what services should be provided locally. Develop comprehensive demand management and prevention/early intervention strategies. Obtain/provide funding Align aged care provision across different mainstream services. Service provision and procurement, considering balance of most appropriate providers. Market management with a particular focus on identifying areas that have thin markets and to work with partners to fill identified gaps. Consider whether efficiencies of scale can be achieved through collective procurement, rather than spot contracting. Understand local community and desires for services. Work with local communities to shape what services should look like. Flag issues with providers to state government. Work to ensure that services are equitable at the local level.