Affordable, effective and quality care is essential to Australia’s ageing population and the growing number of older people choosing to age in place. The sector has seen a range of reforms in response to the Productivity Commission’s 2013 report, Caring for Older Australians. As a result of the Living Longer Living Better and Increasing Choice in Home Care reforms, home care is now assigned directly to the individual with the intent of enabling Home Care Package (HCP) recipients to control and better manage their own care, a Consumer Directed Care (CDC) model.
Introducing a CDC model for HCPs in an environment where older people face major changes to health, long term illness, cognitive decline, digital exclusion and/or social isolation creates a range of challenges. This has been reflected in the evidence put to the Royal Commission into Aged Care Quality and Safety (ACRC) during hearings to date, raised in submissions, as well as the various reviews of in-home care.
Consumer choice in markets is most effective when:
• barriers to choice and decision-making (such as digital exclusion or financial distress) are reduced or removed
• information disclosed about the quality and price of the product is transparent, accessible and comprehensible
• comparisons can be made simply and easily between alternatives
• costs of switching between providers is minimised both in terms of time or financial costs
• consumers are aware of how to access, assess and act on the available information, tools and supports.
Key research findings
HCP recipients seek assistance from trusted individuals when choosing providers
The majority of HCP recipients surveyed (60.9%) reported relying on a trusted individual in their support network, particularly health professionals, to assist them in selecting a HCP provider. Only one third of HCP recipients said that they selected a HCP provider unassisted. Health professionals also prompted HCP recipients surveyed to seek a HCP assessment; were key in providing them with information; and helped many with their final choice of provider and services. Major changes to health or illness were also identified as key reasons HCP recipients sought a HCP assessment, indicating the importance of health professionals at the assessment stage. HCP recipients surveyed also strongly endorsed proposals for independent advice and guidance to help them navigate the HCP system. For some, a health professional may be the only individual that can currently provide this role.
HCP recipients have difficulty understanding and accessing key information about both providers and their HCP
Around a third (33.2%) of HCP recipients reported that they received a HCP but could not identify what level of package funding they received. This raises significant questions about the ability of these HCP recipients to effectively manage their budget, and therefore services they should receive based on the assessment of their needs.
When choosing a provider, HCP recipients identified quality and cost as important. However almost 40% had some degree of difficulty understanding their fees and charges, and it is unclear how HCP recipients accessed information about the quality of providers. Moreover, a significant number (39%) of HCP recipients were not provided with a Care Plan or were unsure about this. Given a Care Plan enables a consumer to ensure their assessed needs are being met, it is unclear how they might effectively manage different services and hold providers to account without it. HCP recipients strongly endorsed proposals to improve and simplify information about quality, cost and the support offered by providers and ensure the presentation of this information is consistent.
Existing information and comparison tools are used far less than direct advice from health care professionals, family or friends
Few HCP recipients indicated they had used online resources (My Aged Care portal (6.8%) or the internet more generally (5.8%)) to find and compare information about their HCP. While the My Aged Care Contact Centre had higher patronage (25.3%), HCP recipients indicated a clear preference to talk to trusted individuals when making choices about their in-home care.
HCP recipients may be uninterested in switching and when they do, it’s difficult
The overwhelming majority (95.4%) of HCP recipients hadn’t switched provider and only a small proportion (9%) had even considered switching, which raises questions about the level of competitive pressure within a market model to deliver care in-home. Those who considered switching, but who ultimately didn’t, identified a range of non-financial barriers stopping them, including: difficult comparison, uncertainty, and loss aversion about aspects of their services they wanted to maintain.
Challenges with in-home care and underspending packages require improvements
Most HCP recipients indicated they could access all the services they wanted, support staff were well trained, and they hadn’t underspent their package funding. However, almost a third couldn’t access all the services they wanted, almost a quarter considered staff were “somewhat” to “not at all” trained, and nearly a third had underspent their package funding. This suggests a range of improvements may be required to ensure HCP recipients can access quality in-home care.
No “one size fits all” model for choice and control in delivery of Home Care Packages
When asked about preferred future delivery of HCPs, a key finding was HCP recipients’ views varied around how much choice and control they wanted. The largest group (41%) preferred enhanced support and guidance about package funding, while just over a quarter (26.3%) sought increased control over package funding to hire professionals directly. Two smaller groups sought to delegate choice about support and care to an independent trusted advisor (18%) or were ambivalent (14.5%). This demonstrates there is no “one size fits all” model. Instead, differing levels of choice and control might better enable HCP recipients to live longer and healthier in their own homes.