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

2. 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.
and
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 
and
Years three and four are delivering improved access and choice for consumers, and stronger system sustainability. The 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 to
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.

3. 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

4. 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.

5. 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

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

7. 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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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 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.

13. Planning for the Future
Aligning with the Roadmap

14. 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

15. 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

16. 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

17. 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

18. 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)

19. 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

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

21. Strengths; weaknesses; Opportunities; and threats
Your business sustainability

22. 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

23. 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

24. 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

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