Aged care reforms - Interface CHSP & HCP Janice Poynton August 2017

Aged Care Reforms: what is changing? 2012 2015 2018 2022 2018: WA HACC program transitions - CHSP 2016: Victorian HACC program transitioned - CHSP What is changing Aged care reforms are being progressively implemented in three phases over 10 years. The changes are being implemented so that our aged care system can be sustainable and affordable, and be the best possible system for all Australians. 2012-13 and 2013-14 Years one and two delivered immediate, urgently needed improvements while laying the groundwork for further reform: new Home Care Packages and supplements introduced in home care and residential care My Aged Care including a national contact centre began operations the Australian Aged Care Quality Agency was established  2014-15 and 2015-16 Years three and four are delivering improved access and choice for consumers, and stronger system sustainability. The 2015-16 changes build on those already achieved, including: implementing the national voluntary quality indicators for aged care Introducing a national fee framework for the Commonwealth Home Support Programme 2016-17 to 2021-22 Changes to be implemented in this phase will be developed in consultation with the aged care sector. From February 2017, funding for HCP will follow the consumer – they are free to select any approved provider to deliver their care From July 2018, HCP and CHSP will be combined into a single integrated care at home program By 2022, Australia’s aged care system will: be sustainable and affordable, long into the future provide diverse and rewarding career options encourage aged care businesses to invest and grow offer greater choice and flexibility for consumers support people to stay at home, and part of their communities, for as long as possible.

2015: consolidation to form CHSP Commonwealth Home Support Program Commonwealth HACC Program Day Therapy Centres Program Assistance with Care & Housing for the Aged program Planned respite - National Respite for Carers Program

Wellness, Reablement & Restorative Care – Commonwealth Home Support Program To remain as independent as we can for as long as we can and prevent early or unnecessary admission to residential care. Can you see yourself or any of your clients here? I want to be the lady on the skate board.

February 2017: Increasing Choice reforms Funding for a home care package follows the consumer A national system for prioritising access to packages Simplified approved provider arrangements

Commonwealth Home Support Program / home care package Interface - Access & interactions

Commonwealth Home Support Program / Home Care Package interface General Principles: CHSP services must not be provided to people who are already receiving other government-subsidised services that are similar to service types funded through the CHSP. Any exceptions to these arrangements must not unfairly disadvantage other members of the CHSP target population. Page 63 CHSP Manual 2017

Commonwealth Home Support Program / Home Care Package interface My Aged Care is responsible for assessing and referring clients on home care packages to CHSP services where appropriate. All home care package clients must be assessed by My Aged Care (through a RAS) to receive these additional CHSP services.

Commonwealth Home Support Program / Home Care Package interface Circumstance 1 Where the HCP client’s budget is already fully allocated, a Level 1 or 2 HCP client can access additional, short-term or episodic Allied Health and Therapy services or Nursing services from the CHSP. Circumstance 2 Where the HCP client’s budget is already fully allocated, and a carer requires it, a HCP client can access additional planned respite services under the CHSP. Circumstance 3 In an emergency (such as when a carer is not able to maintain their caring role), where a HCP client’s budget is already fully allocated, additional services under the broader CHSP can be obtained on an emergency or short term basis. These instances should be time limited, monitored and reviewed.

Commonwealth Home Support Program / Home Care Package interface CHSP providers should only supply additional CHSP services to home care package clients where they have capacity to do so without disadvantaging other current or potential CHSP clients - that is: CHSP services should prioritise people who need CHSP support but do not have access to other support services over people who are already in receipt of a home care package.

Commonwealth Home Support Program / Home Care Package interface Where a new client has been assessed and approved as eligible for a HCP but is waiting to receive that Package, the client will be able to receive services under the CHSP as an interim arrangement, but only to an entry-level of support consistent with the CHSP, not at the level of support of the Package they are eligible for.

Commonwealth Home Support Program / other programs interface CHSP Residential care: Full cost recovery NDIS: 65yrs > if eligible CoS: Staged approach to transition Health System: NOT to replace or fund Short-term restorative Care: STRC to liaise Palliative Care: GP or hospital to coordinate Veterans: Eligible & NO duplication Residential Care: Full cost recovery NDIS: People who are not able to access the NDIS but have a disability and are aged 65 or over will be able to access the CHSP if they are eligible, but within its scope as the entry tier of aged care (see the Scenario at Section 2.2.1 of this Programme Manual as an example). CoS: older people who are currently receiving state-administered specialist disability services receive ongoing support, either through the new CoS Programme or an existing aged care programme such as the CHSP Health System: CHSP services are not intended to replace or fund supports funded and provided for under other systems including the health system. STRC: People receiving CHSP services may be eligible for STRC services. The STRC service provider is expected to liaise with the STRC recipient’s current supports (including CHSP providers where applicable) to ensure care is coordinated with existing support/services Palliative Care: CHSP clients are able to receive palliative care services from their local health system in addition to their home support services, but this needs to be arranged by the person’s GP, or treating hospital. As with any palliative care arrangement, the palliative care team would coordinate the skills and disciplines of many service providers to ensure appropriate care services. This would include working with the client’s CHSP service provider(s). Veterans: A person’s eligibility for Department of Veterans’ Affairs-funded services such as the Veterans’ Home Care Program, community nursing, transport or respite does not preclude that person from accessing services under the CHSP, so long as the client is eligible for services, the support required from the CHSP is entry-level, and there is no duplication in the specific services/assistance being provided.

Planning for the Future Aligning with the Roadmap

Understanding our environment GOVERNMENT: Increased focus on competition & market-based policy Increased emphasis on user pays SOCIETY: Increased expectations of service provision Continued desire to stay in the home MARKET: Increased competition, new entrants Recruitment & retention issues; increasing part time positions Changing nature of service provision – shorter duration

MORE REFORMS……….. 2020: Integrated Care at Home Program 2016 – 2017 Full rollout of NDIS Northern districts - What is the effect of loss of block funding for CCSP and disability programs? August 2017 Final report on Review of LLLB Reforms Scope of the Review Section 4 of the Act requires that the Review must be independent and address nine key matters: - whether unmet demand for residential and home care places has been reduced - whether the number and mix of places for residential care and home care should continue to be controlled - whether further steps could be taken to change key aged care services from a supply driven model to a consumer demand driven model - the effectiveness of means testing arrangements for aged care services, including an assessment of the alignment of charges across residential care and home care services - the effectiveness of arrangements for regulating prices for aged care accommodation - the effectiveness of arrangements for protecting equity of access to aged care services for different population groups - the effectiveness of workforce strategies in aged care services, including strategies for the education, recruitment, retention and funding of aged care workers - the effectiveness of arrangements for protecting refundable deposits and accommodation bonds - the effectiveness of arrangements for facilitating access to aged care services. July 2020 Amalgamation of CHSP and HCP into a single integrated program

Roadmap: Planning for the Future D1: Consumers empowered D9: Single regulatory framework D2: Single assessment process D8: Flexible workforce D3: Access D7: Sustainable aged care sector D4: Dementia as core business D6: Single provider registration system D5: Market based & consumer driven

Integrated care at home program: - Discussion Paper July 2017 Predominantly individualised funding that follows the consumer Additional government assistance where there is insufficient market response Block funding (grants to providers) where considered most appropriate / efficient A single assessment process for eligibility, care needs and funding levels Integrated fee arrangements

Now to June 2018: CHSP: New funding conditions to focus: Understanding strengths & goals Increased choice Independence & wellness Revised reporting Reflecting outcomes RAS: New funding conditions focus: Independence & wellness Effectiveness of assessment for regional & remote Outcomes of Legislated Review due August 2017 CHSP: The department will negotiate new funding conditions with existing CHSP providers. The changes to conditions will aim to ensure that service delivery is more focussed on understanding consumer strengths and goals, provides increased choice for consumers and a greater focus on pathways and activities to support independence and wellness. There will also be a stronger emphasis on reablement where appropriate. Details of the new conditions will be discussed with the sector over the coming months with input from the wellness and reablement project (section 4.5.1). Reporting requirements may also need to be revised to ensure they better reflect consumer outcomes and the new funding conditions RAS: The department will also negotiate new funding conditions with RAS to support the CHSP agreements and ensure a greater focus on supporting independence and wellness, including the effectiveness of assessment arrangements in regional and remote areas. Outcomes of the Legislated Review and evidence to date of the effectiveness of the model in remote Australia will be taken into account in considering future assessment arrangements and the timing of any changes. Co-design on the parameters and policy design for care at home reforms Legislated Review (due to report in August 2017)

July 2018 July 2018 – June 2020: Single Aged Care Quality Framework Transition from HACC to CHSP in Western Australia (July 2018) Single Aged Care Quality Framework Eight Standards: 1. Consumer dignity, autonomy and choice 2. Ongoing assessment and planning with consumers 3. Delivering personal care and clinical care 4. Delivering lifestyle services and supports 5. Service environment 6. Feedback and complaints 7. Human resources 8. Organisational governance July 2018

Plan for change….. What will be needed moving forward in the new world?

Strengths; weaknesses; Opportunities; and threats Your business sustainability

NFP Benchmark Survey Report - Pitcher Partners Accountants / Russell Kennedy Lawyers The survey highlights that many NFP organisations rely strongly on Government assistance – economically dependent There is a belief that there is a need for these organisation to develop alternate means of financing and social enterprise Organisations need to ensure that they can maintain solvency. Need to set aside monies for existing commitments; short term operations; and flexible enough to respond to changes in funding streams Necessary to consider the management of various tax status benefits to ensure no compliance issues arise

CHSP Client Contribution Framework No mandatory fees schedule – target of 15% of grant revenue by June 2018 1 July 2015 – 30 June 2018: Principles based approach to charging, collecting and reporting client contributions Objectives: National fairness and consistency Sustainability of CHSP over time Safeguards for financially disadvantaged clients Organisational Policy Simple means test and hardship provisions

Strategies to consider Aged Care Approved Provider NDIS Approved provider Pros Cons Ability to meet the needs of greater number of the community Increased income / greater sustainability Increased employment opportunities Skilled flexible workforce Competition Skilled flexible workforce / partnerships Administrative process Third Party Verification

Aged care system will be……. CONSUMER DRIVEN…..MARKET-BASED…..NATIONALLY CONSISTENT