Redesigning and Expanding Provision under the Commonwealth Home Care Packages Program in a Small Rural Health Service Josie Gebert, Community Services Manager Fiona Vizard, Home Care Coordinator Andrea Dunlop, Manager Workforce & Service Development Hesse Rural Health

Session Overview Meet Charlie Consumer Directed Care Service opportunities for a smaller rural health service Achievements Unanticipated outcomes New challenges Lessons learned

But Charlie was not having a bar of it! Meet Charlie Charlie is 80 and lives at home alone in his rural farming property near Winchelsea. It’s 45 minutes into Geelong where his adult children live and work. He enjoys the farm wants to remain living there as long as possible but he no longer drives. He is isolated from social supports aside from a few neighbours who pop in from time to time. A recent health crisis meant additional demands on his children. They were considering Dad for residential aged care. But Charlie was not having a bar of it!

Home Care Packages – a service solution Increasing Choice in Home Care Consumer Directed Care - First Introduced in 2015 Greater Choice and Control Respectful Balanced Partnerships Participation in plan of care Independence Transparency

LIMITED HOME BASED OPTIONS Pre 2017 Service Solution Community Aged Care Packages (CACPS) Hesse Rural Health BUT All 4 existing packages utilised LIMITED HOME BASED OPTIONS

2017 ‘Increasing Choice in Home Care’ Package allocation to consumers not providers Consumers can: choose their provider choose level of control of funds and services (self manage their packaged funds or purchase provider assistance) change providers readily National allocation process based on assessed needs and wait list Level 1 package = basic level ($ 8,000) Level 2 package = low level ($14,500) Level 3 package = intermediate ($32,500) Level 4 package = high level ($49,500)

Good News ! Charlie Hesse Rural Health Could remain living at home with services he needed Choose Hesse as his preferred provider Hesse Rural Health No more unsuccessful ACAR applications

A Service Development Opportunity Integrated service with existing service profile Nursing, personal care and allied health workforce Well established reputation for quality care Established business mechanisms Providing local jobs to local people

Service Development Challenges Small start up base (the 4 allocated packages) Competition from new start up from corporate providers No funds for service growth Infrastructure needs – office space, vehicles, coordination Industrial climate – generous provisions within public sector EBA’s compared with private sector Unpredictable service levels, low volume, over resourcing Workforce retention due to non guaranteed work levels Program specific business viability

Expanding Services Board strategic target set – from 4 packages to 30 by June 2019 Incremental service growth Recruitment for Coordination – Registered Nurse Mixed brokerage and internal resourced model of care delivery Recruitment of Personal Care Workers – internally & externally Dual roles - Social support activities and Home Care Occupational Therapy support Expanded vehicle fleet – new investment & existing Leased a portable site office as a temporary base E Tools – aged care business systems software

Results to Date Five fold growth in 18 months. 15 clients. On target Waiting list (23), pending Commonwealth allocation Supporting clients with: personal care, domestic support, community access, respite, home maintenance, gardening, purchase of assisted living equipment and supplies Public sector recruitment advantage Provision of vehicle fleet also is attractive Satisfied staff Benefits to registered nursing supervision structure High levels of consumer satisfaction Good service continuity within an integrated service

Challenges Timely release of further Commonwealth packages ‘Time is money’ – a public health dichotomy My Aged Care – rural IT connectivity and computer literacy Inadequacy of existing Cert III and IV training Recruitment challenge – Home Care is not for all Working autonomously Independent problem solving/good observation skills Flexibility Professional boundaries (no direct supervision) Infrastructure investment without dedicated funding The unanticipated impact on residential aged care occupancy

Service Impact in 12 months Increase in Home Care Services (fivefold) Decrease in Residential Aged Occupancy from 98% - 88% ( -$ 600,000 )

Lessons Learned The impact of new services on existing ones Home Care Worker are not synonymous with Personal Care Worker A tailored education program is necessary Get ready for Consumer Directed Care into residential aged care Improve care planning and link it to resourcing New Aged Care Quality Standards increasing the focus on dignity and choice This is simply a training ground Change can happen very quickly

Charlie is happier, healthier and living better at home

Josie Gebert, Community Services Manager Good reference The impact of the home care reforms on the older person, the aged care workforce and the wider Health System Deeble Institute Issues Brief No. 27. Jorgensen M, Haddock R Canberra: Australian Healthcare and Hospitals Association; 2018. p. 45. https://ahha.asn.au/publication/health-policy-issue-briefs/deeble-issues-brief-no-27-impact-home-care-reforms-older Josie Gebert, Community Services Manager Hesse Rural Health Tel 5267 1200 jgebert@hesse.vic.gov.au