Senate Community Affairs Legislation Committee, , 2:12:08 to 2:49:00
The Inspector-General of Aged Care expresses grave concern over the lack of economic modeling and transparency regarding the program transition.
Topics: Social services, Government spending
Speakers: Natalie Siegel-Brown, Penny Allman-Payne, Hon Anne Ruston, Unknown Speaker
>> Welcome the Inspector General of Aged Care via video conference. Um, thank you very much for appearing before the committee today. Um, the Senate has resolved that an officer of a department of the Commonwealth or of a state shall not be asked to give opinions on matters of policy and shall be given reasonable opportunity to refer questions asked of the officer to superior officers or to a minister. This resolution does not preclude questions asking for explanations of policies or factual questions about when and how policies were adopted. Commonwealth officers appearing today are also reminded of the Senate order specifying the process by which a claim of public interest immunity should be raised. A copy of the order is available from the secretariat. For the Hansard record, could you please state your full name and the capacity in which you appear today?
My name is Natalie Siegel Brown and I'm the Inspector General of Aged Care. Uh,
thanks very much Siegel Brown. Um, I'm just going to invite you to make a short opening statement if you have one before we go to questions.
Thank you, Senator. And thank you to the committee for the opportunity to speak. I am really worried this transition could blow up what we have in place to keep people at home and connected to the community. That's what this new Aged Care Act is all about. CHSP is the primary opportunity we've got to realize that objective under the act of enabling people to age safely and independently at home and remain connected to their communities. But also for the budget, it reduces really avoidable demand for residential aged care. As you would know, in the last financial year, CHSP supported nearly 840,000 older Australians. That's more than half of the entire aged care population. Yet, CHSP is only 8% of the total Commonwealth budget for aged care. Unlike resi, which is 61% residential care, I should say. Yet, we're on the cusp of significant structural change without any clarity about why we're doing it, the evidence base, or any model to a supportive safe transition. The proposal is to merge it into Support at Home, which from my perspective is a program that is predictably bearing out serious problems in practice. Why would we merge these two programs before we've ironed out the issues with Support at Home? My inbox is becoming flooded with some of the problems we are now seeing as predicted about the impact of co-payments. So, I don't understand why we're undertaking the transition at all and if no one can explain the rationale for the transition 18 months out from D-Day, then should we be doing this transition at all? Because if this transition is mishandled, we risk losing the program's breadth and its very ability to delay entry into high acuity care like residential aged care and like hospitals. CHSP plays a really important role in keeping people out of hospitals. We risk longer wait times, accelerated deterioration, and we're going to put further strain on the residential aged care sector, which we know already is unlikely to meet the demand of the next few years. But we also risk undermining the intent of the Royal Commission. And most importantly, we could be creating real preventable harm to older Australians who want to age with dignity in their own homes. So, right now, providers, workers, and consumers are facing profound uncertainty about the transition of CHSP into Support at Home. They have no certainty about the time frames or the certainty of its core strengths. And that uncertainty right now, 18 months out from July 2027, is already constraining availability. People are wondering what the viability of their services issues like unclear unclear end of life arrangements, capped home modifications funding, and a potential to shift to a rigid co-contributions fee for service model. All of this could actually end up prematurely driving people into residential aged care. But before I finish, I just want to say that the flip side of all of these is that if we actually take a chance to strengthen the preventative impact of CHSP, we actually could make the finite aged care bucket that we've got go further by slowing growth of people coming into that higher cost care. So, if we get it right, it's literally the most immediate means that the government has to realize the act's promise of helping people remain independent, connected, and well for longer. Thank you very much and I welcome your questions. Um, thanks very
much, Ms. Siegel Brown. Um, I I guess my first question to you is you said in your opening statement that you're unclear on what the basis for the decision around the transition um, is. Has the government or the department given you any modeling or any information underpinning or to to to demonstrate the evidence base for why the decision to end CHSP has been made?
Thank you, Senator. I've received nothing to that effect and and to be really frank with you, I'd be worried if I'd received it and the sector and the public and community had not. Uh, I've received nothing about timelines, rationale, um, and I really want to emphasize that before the transition itself can even be orchestrated or planned, we need public information on the rationale and modeling assumptions for that transition decision. I literally have no details about how or what the transition will look like and it scares me that less than 18 months out from the drop-dead date, we have no idea on really simple stuff like how it will be staged, how it will be achieved without consulting older people in the sector on the implications. And you could say to me, "Look, it's all yet to come." But we're so late in the piece and we know how much consultation needs to happen. And my concern is that if we don't have that information soon enough, that consultation will end up being consultation on a foregone conclusion.
we've heard evidence from a number of witnesses this morning. Um, we've heard from Meals on Wheels who've told us that they couldn't actually operate under the Support at Home model, that the the post-service funding as opposed to block funding before services are delivered would mean it would be impossible for them to deliver their services. Um, we've also heard from um, uh, First Nations at NATSIAA saying that um, CHSP is actually delivering very well um, for a number of First Nations communities, particularly those in regional and remote areas. Um, and we've also heard from a provider of panel a panel of providers this morning um, who haven't necessarily said that the transition shouldn't happen, but they've certainly said that there are core components of CHSP that need to be retained such as block funding, um, making sure that service provision happens in thin markets and and the flexibility that that provides. Um, I guess my question to you would be um, are you hearing from uh, people and providers that people would actually like to retain CHSP? And if that's the case, um, could you maybe elaborate on that a little and then just come back to that other statement that you made about actually the opportunities that we might have if we invested more in CHSP?
Thanks, Senator. That's a a really good question with lots of parts. So, um, I'll try and reach all of those. Please just prompt me along if you need me to. CHSP is a highly cherished program and one of the benefits of it is that uh, because it's block funded, it can inhale and exhale very expediently, which is really important when you're thinking about end of life care for somebody where uh, at the moment somebody has to go through the Support at Home 16-week program and if that ends, they have to go through all this paperwork at a horrific time of life to try and get that funding extended where is those CHSP services that support that person around them when they're block funded they can they can be leveled for a person very quickly. grave concern I have is that demand for CHSP greatly exceeds supply at the moment. With the continued uncertainty that's only going to get worse because providers will just shut up shop if they've got no certainty as to their funding. And my very very strong concern is that when we're talking about regional and rural communities but also when we're talking about Aboriginal and Torres Strait Islander communities particularly outside of urban centers but even in urban centers where mainstream services are not appropriate are not culturally safe. These CHSP service providers can be the only providers we've got and we've got a lot of culturally and linguistically diverse service providers in CHSP. If they disappear we lose that core of culturally tailored programs. And in those thin markets and I'll refer to thin markets as not just being those markets that are regional remote but those that are specialized for people's culturally safe needs particularly the trauma aware and healing informed services. Many instances for particular groups of people that is the only service that they have available and it is a very like those services in those regional rural areas they're part of the community. We are going to lose a key part of the community that will keep people connected in those really hard to reach places. Now there is a thin markets grant under support at home but of course we've got no clarity as to whether our CHSP services will be part of that. And the other thing that I'm really really worried about is that because we don't know whether CHSP service delivery will be part of the co-contributions model are people going to have to pay for pay co-contribution? Now let's remember a whole bunch of these CHSP services provide that much broader suite of promises under the new aged care act around keeping you in community taking you out and making sure that you are a part of society. Now those what we call non-clinical needs they are the ones that attract the big co-contributions whether you are fully funded retiree or a full pensioner. That's the most expensive category. So we could actually be talking about services that are going to become from the most used and most loved to the most disincentivized by virtue of the highest
from earlier witnesses this morning that one of the advantages of the block funding is and because they can flex and you know services go up and down that CHSP providers in many instances have the flexibility also to wave payments from people who are the most vulnerable and is it and I expect that you know under an support at home model that wouldn't be able to happen in the same way. Would that be your understanding?
Absolutely Senator but also as I've said in my opening statement we have so many problems that are already very much showing their face with support at home around this co-contributions model. Senator people are writing to me saying they can no longer afford their continent pads. They can't go out in public because they've got no way of ensuring that there won't be any bladder or bowel leakage. I've got people constantly writing to me saying they they can't get showered because of the co-contributions model. These are things we predicted would happen and they're bearing out in practice. So if we merge CHSP into a program that has those problems where will we be? Mhm.
that's really important evidence and I I do note that we also have a parallel inquiry where we're going to be looking into support at home and those co-contributions so we'll certainly be coming back to you to get some more evidence around that. Um one thing that I've certainly heard from smaller providers people who are only providing CHSP services and and aren't sort of larger providers that provide CHSP and support at home is that under the support at home model they actually wouldn't be viable and some of them have either exited the market or have indicated that they will be. Is that a similar is that similar information that you're getting from smaller providers and particularly those that are CHSP only?
Senator that is very much aligned with what I'm hearing across the board and I'd have to say to you it's not just small providers
Okay. Thank you. I might share the call. Senator Ruston are you Yeah sure. I'm
thank you very much for your your testimony. Um it was very very useful. Um I'm just one of the things that has been sort of bothering me apart from you know the very obvious stuff that you've just put on the record around the inability for to actually transition when we don't even know what we're transitioning transitioning to um let alone having a a sensible time frame. Um I mean to your I mean in terms of the cost differentiation between the delivery of a service through support at home and this delivery of a service through CHSP. Do you have any line of sight over that through your work as the IG?
Senator this is something I'd very much like line of sight on and I will be continuing to pursue. We have no evidence around economic modeling at all. Um and I perhaps I'm surmising where your question's going here but what I think is desperately needed is before we even consider whether we do a transition at all we need to do a cost-benefit analysis of the preventative impacts that CHSP has in keeping people out of residential care for longer and out of hospitals for longer before and then compare that to the impact of them going to residential care sooner even if we're just looking at the narrow remit of the aged care budget and no other budget. And though that's why some of these cost comparisons but also that economic modeling is absolutely indispensable before you start thinking about this change. Mhm.
Yeah cuz I mean one of the things that that other witnesses have have alluded to is that you've got this big transition of the 200 plus thousand older Australians that are transitioning across to support at home and and the complexities of all that. The same time you've got 800,000 plus people on CHSP. If there is some sort of merging into a a single program where do those 800,000 people end up? Do they end up on the end of the wait list getting nothing because we already know that there are a lot of people who are currently waiting for the package that they've been assessed as needing who are on CHSP. So so is that the kind of work that would be an appropriate thing for the IG to undertake the that that cost-benefit analysis work that you've just described?
Senator some cost-benefit analysis work is already on our forward work plan and that's something we've started work on right away.
>> On CHSP?
Well we're looking at elements of CHSP because there are a few things that we are looking at that could actually have we think if you if you took the aged care funding bucket as it is didn't increase it but looked at where you could invest to keep people at home the longest. I've no doubt that there would be CHSP elements in there. There may be some other elements as well. I can tell you for example that there has been work going on it's not yet published that home modifications some particular home modifications can save up to 40% of direct care costs. So particular elements of CHSP there's already evidence out there that it could save a lot of money at that other end of the program. Senator you raised wait times. That is something we are monitoring but at the same time one thing I'm concerned about with the merger of these two programs without any further detail is we know that demand well exceeds supply and there are wait times for CHSP right now. Are people going to have to get reassessed? And if they get reassessed then how long's that wait time? And how long are they going to have to wait for that assessment? This could blow wait times out further and the stories I'm getting about people's deterioration before they can get reassessed when their needs have improved are absolutely heartbreaking.
Yeah. No thank you very much. Um
Ms. Segal Brown just in relation to that cost comparison cost benefit modeling work that's underway. Do you have a timeline for when you expect that that will be completed?
We're still doing the scoping Senator. I would really love to be able to give you a timeline on that. I'm looking at how comprehensive it can or can't be. So bearing in mind I'm an oversight body. This will become a tool against which I will be holding the department accountable for the way in which expenditure is
occurring. Mhm. So we're talking 12 months 2 years?
I wouldn't want it to go more than 12 months.
>> Yeah okay great. Thank you.
Please don't hold me to that because I'm despite my productivity commission history I'm a lawyer not an economist so I I wouldn't want to put it a time frame on those things, but um I would like it done sooner rather than later, even if it's at the highest level. Yeah. >> You know what I mean? Like not super
Thank you. Thanks, Senator.
>> No, no, look, I I'm fine. Your opening statement has sort of basically answered every single question I was going to ask you. So, that's fantastic. Thank you very much. Really appreciate it. Okay.
I'm going to go to Senator Cox.