Level 5 home care packages and fee changes amongst Tune recommendations

The long-awaited aged care legislative review led by David Tune AO has been tabled in Parliament and released publicly, with 38 recommendations that mostly relate to supply for both residential and home care services and increased Government investment.

The introduction of a level 5 home care package, changes to means testing and fees in residential care and mandatory minimum daily care fees are amongst the recommendations.

A need for more high-level care at home and greater flexibility to ultimately enable the removal of supply controls are key themes within the report.

While the report confirms additional Government investment will be required to meet demand, exactly how much investment and how much demand remains unknown given “accurate assessments of demand are yet to be developed.”

The review also found that several important recommendations from the Productivity Commission’s 2011 report were not implemented but remain at the centre of aged care policy discussion, particularly the issue of ‘uncapping supply’ – the removal of regulatory restrictions on the number of aged care places and packages made available to the community.

The scope of the review, which was carried out between September 2016 and July 2017 and informed by 145 submissions, was confined to aspects of the Living Longer Living Better reforms rather than the broader aged care system and did not cover in depth quality and safety issues, ACFI, the Commonwealth Home Support Programme or palliative care.

It did cover demand and supply, means testing, accommodation payments in residential care, lump sum accommodation payments, access to services, equity of access and the aged care workforce.

The recommendations include:

1. That the government review the management policy regarding offline residential care places and, if required, implement changes that maximise their availability to consumers.
2. That the government, in the medium term, continue to maintain control over the number and mix of aged care places (residential care and home care), in line with the improvements detailed in Recommendations 3–10.
3. That, as soon as possible, the government discontinue the Aged Care Approvals Round for residential care places, instead assigning places directly to the consumers within the residential care cap, with changes to take effect two years after announcement by government.
4. That a government announcement on discontinuation of Aged Care Approvals Round (Recommendation 3) be accompanied by appropriate provisions to ensure continuing supply of residential care services in areas with limited choice and competition.
5. That the government re-balance the distribution of home care packages, by increasing the proportion that are high care packages, without a change in the overall home care ratio.
6. That the government further increase access to high level home care packages to better reflect current demand by allowing for the temporary allocation of a home care package where there is a residential care place that is not being used.
7. That the government introduce a level 5 home care package to allow people with higher care needs to stay at home longer, with the level of assistance being no higher than the average costs of care in residential care.
8. That the government:
   a) in the short-term, review the existing respite arrangements to ensure that its objectives are being met.
   b) in the medium term, in discontinuing the Aged Care Approvals Round for residential care (Recommendation 3), review how best to ensure adequate supply and equitable access to residential respite care.
9. That the government change the Aged Care Provision Ratio to the population cohort aged 75 years and over, following achievement of the 125 Ratio in 2021–22, to better meet future demand.
10. That the government, in implementing Recommendation 9, consider whether a change in the mix of places within the new Ratio is required to better reflect demand, and that it consider further opportunities for removing supply controls.
11. That government and providers work together to determine how to ensure comparability of home care pricing for consumers and how best to publish on My Aged Care.
12. That the government should revise the naming and structure of fees to:
    a) Rename the ‘basic daily fee’ as a ‘basic care fee’ in home care.
    b) Require that providers charge the ‘basic care fee’ in home care.
    c) Require that providers charge the income-tested care fee in home care.
    d) Make the value of the basic care fee proportionate to the value of the home care package, retaining an upper limit relating to the value of the single aged pension.
13. That the government include the full value of the owner’s home in the means test for residential care when there is no protected person in that home.
14. That the government:
    a) Require that providers charge the minimum basic daily fee in residential care;
    b) Retain the cap on the value of the basic daily fee in residential care for low means (fully and partially supported) residents;
    c) Allow providers to charge a higher basic daily fee to non-low means residents, with amounts over $100 to be approved by the Aged Care Pricing Commissioner;
    d) Require that the maximum basic daily fee be published on the My Aged Care website, the provider’s website and in written materials to be given to prospective residents.
15. That the government abolish the annual and lifetime caps on income-tested care fees in home care and means-tested care fees in residential care.
16. That the government introduce mandatory consumer contributions for services under the Commonwealth Home Support Programme. Consumer contributions should be standardised according to an individual’s financial capacity.
17. That the government inform consumers of the value of the subsidy that is provided for their care.
18. That the government improve the transparency of fees for residents by requiring providers to publish information on My Aged Care in a way that assists informed choice by consumers.
19. That the government retain and reform the role of the Aged Care Pricing Commissioner by:
    a) increasing the maximum accommodation payment, above which approval by the Pricing Commissioner must be sought, from a refundable deposit of $550,000 to $750,000 (or equivalent daily payment);
    b) implement an automatic link between the future maximum accommodation payment and median house prices; and
    c) expand the Pricing Commissioner’s role to include providing independent assessment of other fees, e.g. additional service fees and uncapped basic daily fees (see Recommendation 8).
20. That the government maintain the Bond Guarantee Scheme, but reform it to improve certainty and to ensure that aged care providers make contributions where the benefits outweigh the costs. This would include that the government:
    a) announce a date after which it will require that non-government residential aged care providers be levied to recoup all of the costs of default events, where the total amount of those events exceeds, say, $5 million in any fiscal year.
    b) introduce a formal process for notifying the sector of defaults that have occurred that exceed that threshold, and the cost of the levy that will be applied.
    c) declare that the costs to the Scheme of provider insolvency events that were triggered prior to the reform commencement date will not be recouped.
21. That the government reform prudential standards and oversight, taking account of the recommendations in the independent review of prudential standards conducted by Ernst and Young to:

• correct gaps in prudential information received by the government
• strengthen the standards to improve liquidity, capital adequacy and disclosure requirements
• strengthen governance standards.

22. That the government improve the functionality and performance of the My Aged Care ICT platform with particular emphasis on improving information-sharing between My Aged Care and other government agency and provider ICT systems.
23. That the government introduce aged care system navigator and outreach services to assist consumers who have difficulty engaging through the existing channels to effectively engage with My Aged Care. The services should be funded by the government and not be delivered by the government or aged care providers.
24. That the government invest in regular advertising and awareness activities for My Aged Care, to explain the process for accessing government-funded aged care services.
25. That the government continues to improve the My Aged Care website for consumers and providers by making the design and layout easier to use and providing information in more accessible, plain-English formats.
26. That the government trial a simplified My Aged Care assessment process for consumers seeking a short-term single, simple service.
27. That the government integrate the RAS and ACAT assessment workforces.
28. That, following review of ACFI, the government integrate residential aged care funding assessment with the combined RAS and ACAT functions, independent of aged care providers.
29. That the government and providers work to improve access to wellness and reablement activities to provide greater choice and better support for consumers to live independently, including by:

• increasing access to short-term reablement supports and/or episodic care, rather than the provision of ongoing care, including an increased focus on the use of assistive technology
• enabling better integration with other available support systems such as the health care system and community-based support
• supporting staff and consumers to better understand and access information about wellness, reablement and restorative care
• providing aged care assessors with training on wellness, reablement and restorative

30. That the government immediately review the National Screening and Assessment Form.
31. The government expand the NATSIFACP to better support Aboriginal and Torres Strait Islander people.
32. That the government engage with state and territory governments and service providers to review the MPS Program to better align its service delivery model with mainstream aged care programs, where appropriate, to ensure greater consistency of services for aged care consumers and providers, and to consider the location of services to ensure that MPS funding is properly targeted.
33. That the government review whether further ways of assisting in the delivery of improved services to homeless people are needed in the context of reform to home care and residential care.
34. That the Australian, state and territory governments work together to resolve current issues with the provision of aids and equipment for older people.
35. That the government give consumers the opportunity to identify as belonging to a population group with special needs as part of their client record.
36. That the government enhance the capacity of My Aged Care to provide information that meets consumers’ special needs by:
    a) allowing ‘pre-qualified’ providers to indicate that they have expertise in delivering services to particular population groups; and
    b) adding a search function on My Aged Care to allow consumers to search providers by population group.
37. That the aged care sector, in collaboration with the vocational education and training, and tertiary education sectors, should act to ensure education and training is responsive to the sector’s needs including:

• identifying the scope of training required for on the-job training, continuing professional development, and specialised training
• exploring a range of options to deliver what is required, e.g. partnerships, cooperative models or arrangements with existing non-aged-care training providers
• promoting and encouraging ageing and aged care as a specialisation in nursing education
• making effective use of allied health workers.

38. That the aged care sector, in developing a workforce strategy, ensure that the strategy:

• reflects that primary responsibility for workforce rests with providers, with government providing support
• draws on engagement with relevant sector and interest groups to ensure that all workforce groups are included
• results in actions that can be sustained by the sector, including particular focus on the areas of pay, education and training, developing retention, recruitment and workforce growth, improving the sector’s image, and considering cross-sectoral workforce linkages

View the full report here