Senate Community Affairs Legislation Committee, , 35:47 to 48:15
The Older Persons Advocacy Network and COTA Australia outline their conditions for integrating aged care programs and improving service access.
Topics: Social services, Health
Speakers: Craig Gear, Patricia Sparrow, Penny Allman-Payne, Cory Ionn, Unknown Speaker
>> Yeah, great. Thank you. Um, all right, I'm now going to welcome representatives from uh, Older Persons Advocacy Network. I understand they're appearing very via video conference uh, and COTA Australia who are here in the room. I'll just interruptions make it hard for me to Uh, thanks very much for appearing before the committee today. I might just check, do we have um, OPAN online? No, so we're still waiting for them.
>> Uh, yes, Craig Gear, Senator from the Older Persons Advocacy Network online.
Oh, good. Thanks, Craig. Um, okay. Um, I understand that information on parliamentary privilege and the protection of witnesses giving evidence to Senate committees has been provided to you. Uh, for the Hansard record, please state your full names and the capacity in which you appear today and I might start with Craig online and then I'll come to the witnesses at the table.
Uh, Craig Gear, the CEO of the Older Persons Advocacy Network which delivers the National Aged Care Advocacy Program on behalf of the Department.
Uh, thanks very much, Craig. And at the table, starting on my left.
Uh, Cory Ionn, Deputy Chief Executive, COTA Australia.
Patricia Sparrow, Chief Executive Officer, Council on the Aging Australia.
Uh, good morning and welcome. Um, I'm going to invite each organization to make a short opening statement conscious that we are only have a short amount of time with each witness, so if you could keep them brief so we do have time for questions. Uh, so I might start with Mr.
Uh, thank you, Senator, and thank you uh, committee for having us appear today um, on this important topic. Look, we've consulted with our member organizations, advocates and older people in preparation for this and I have to say that the in summary, the views are are mixed about the future of CHSP and the integration. Um, some people have emphasized that there's a lack of choice and control. There's limited service availability at the moment and there's access problems affecting CHSP and those people have supported it being fully merged into Support at Home program. But others have emphasized that the long waiting times, the admin burden and the financial impost of Support at Home and they uh, supportive keeping CHSP or some other separate program running in parallel with Support at Home so that older people would have choice about what program is them. But as a general summary, OPAN does support a greater integration of community-based aged care programs as recommended by the Royal Commission. We also support a streamlined and rapid assessment and rapid access to foundational actual supports so that older persons can maintain their function and their connection to community. And grants-based models uh, for some geographic regions and certain service types and diverse populations are probably best placed to do that and they need to be maintained. And this is probably where there is a clear that the individual budget market-driven individualized approach will just not be functional from a business viability perspective but more importantly from a community and older persons perspective. At the same time though, we do need to see reform in the grants-based approach because it needs to deal with the equity of access and the viability of the service system. Um, but the CHSP is providing that foundational community aged care infrastructure but currently stretched to breaking point. Um, we're calling for greater access of and equity of access and greater quality and oversight of CHSP services. Our advocates report that the availability and the cap nature of the CHSP services as you just previously heard means that people are I just not being able to find access to those services and those who are accessing services don't want to speak up because they're feeling that some service is better than nothing. So we would like to see some reform in this area and where programs are working well that they are maintained. It's about network members talking about where there is that investment in community particularly in remote locations and they have seen those block funded models work well where it's connected to community controlled models of aged care and it seems that individualized budget is the sole model in those locations will just not cut it and will exacerbate the failure of aged care to respond to those communities. So open supports in principle the continuation of plans for for a merger of CHSP with supported home programs but with the proviso that the Royal Commission's recommendations regarding block funding and activity based funding and individual funding components are are properly addressed. Five aspects which we just want to highlight from our submission is the increased funding for these programs. Needs to meet demand and it needs to support viability over the transition period but into the future based on geography, population growth and some service types. Some of those service types include the meals services, the community respite, community transport and this needs to be maintained. New model of funding needs to be developed and I actually should be charged with undertaking that. Thirdly, we think there needs to be a gap analysis of geographical need so that the reach is maintained for all communities. Separate funding stream for service provision for Aboriginal and Torres Strait Islander communities especially in regional remote locations needs to be developed. There needs to be improved system entry and navigation and we need to really really retain and enhance options for direct service pathways so that these services are easy to access and can be accessed in a timely fashion. We also emphasize that the there should be implementation of the Inspector General's recommendations in relation to My Aged Care. A really clear staged timeline is required and there must be co-designed for those communities that are affected. Finally, fixing the issues in relation to the viability and affordability of any co-contribution model has to be addressed. The lessons are being learned from the Support at Home that there needs to be a waiver of fees for certain groups and this should be automated and streamlined. And we need to think about the impact of fortnightly and monthly payments of those contributions and that needs to be limited to a cap not just in it at all program approach of the 130,000. One independent advocate said I think one system for everyone will be great rather than the two-tiered system we currently have but an old person did that we interviewed did caution it will be disaster in the same over-bureaucratic line demanding compliance criteria for it's just a roll out of Support at Home if those models applied. We must not let that happen. We need to maintain the community investment and community infrastructure that CHSP does deliver. Thank you.
Thanks very much Mr. Gear. I'll now go
to COTA. Good morning Senators. Thank you very much for your continued interest and focus on all things aged care. We agree with much of what our colleague from IPAN has just outlined. We remain committed to achieving a rights-based aged care system and that would include an integrated home care service but it needs to ensure that older people get the care and services they need from low level right through to more intensive levels of care within 30 days of them applying for services. It needs to deliver a continuum of care that can be scaled up and down to meet people's needs. Needs to be easy to find and navigate. Needs to be quality services, affordable services with transparent pricing and it needs to be flexible and responsive to individual community need. There are definitely positives of the CHSP program like the range of different services that you can get like that it's got a localized base and there's great community involvement but there are still negatives. It's a postcode lottery in terms of the types of service you might be able to get. They're unevenly distributed and there are widely different fee regimes in place and there are also hidden wait lists so no one really understands how long it might take them. We get older people telling us they get excited, they get an assessment, they think they're going to get a service straight away and then they wait but there's no clarity around that. We can't really look at an integrated program without having though a clear published transition plan. I think we should learn from Support at Home. So we think that in the 2026 budget there should be a plan announced that outlines the clear participant outcomes that would be delivered by creating the program that identifies phases and readiness conditions for providers and government to make the move and that they're publicly reported on. There should be clear time frames for consultation publishing final the final design, IT build, final rules and programs and guidelines because all of those things are actually needed to successfully transition and there should be quarterly milestones available to assess progress. We agree on program design that this doesn't mean that everything just gets rolled in and delivered in the same way as Support at Home. It's not all individualized. The Royal Commission and in fact COTA has always supported a blended approach with a number of services, the ones that Craig raised, meals and transport, social support and center respite etc. should continue to receive block funding. There are improvements that need to be made around the governance of those funding arrangements but nevertheless we recognize the need for that to occur. The readiness conditions would relate to a range of implementation and policy matters with the current Support at Home program which we would just like to briefly mention. That would include the wait time that people are currently waiting for assessment and services. It would include the need for clinical professionals being able to override the automated outcomes from the integrated assessment tool. We need to make sure people are being offered the full amount of their package rather than just 60% and ensure that if you're not taking up your 60% offer because you're better off staying with CHSP you don't lose your place in the queue. We need to address the higher than reasonable price increases that we've seen through Support at Home and we need a stronger regulatory response where the prices are proven to be unreasonable. We need to make sure the prices are published in the way that they were promised to be and while improvements have been made we're still not there yet. Self-management needs to be much better supported in an integrated program and we know that without the extra costs, Meals on Wheels colleagues were talking about that but you know we launched our State of the Older Nation report this week which I hope many of you have seen which does point out that a quarter of older people are living in poverty but nevertheless we've got another avalanche. We talk to older people every day. We've got another avalanche of examples. We think it's really important that one of the preconditions is that people can go through multiple providers rather than tying everything into one provider and I'll give you an example that came to us this week. We had a support worker contact us after hearing our chair Christopher Pyne's address saying that she's concerned because she would charge a client $40 per hour directly but if she was directly dealing with the individual but through the Support at Home approach which can only be through one provider the price that's actually charged to the client in the package is $100. So it's a $60 because of that so we need to make sure that those things aren't occurring. It's not affordable for the individual and it's not affordable for the taxpayer. So we do need to look at price caps and affordability overall. We would also say that we need to make sure that personal care particularly showering is addressed and should be treated as a clinical care service. And that so really we want to say design can't just be about everything rolls into Support at Home and it's rolled out of Support at Home. We need to address the issues that we've got with Support at Home. We need to have really clear time frames and outcomes that we want to achieve and we think that's the best way forward with this matter. Thank you.
Thanks very much for your opening statements.