Reforming in-home aged care update – 18 May 2023

Dr Nick Hartland:                                                

Good afternoon everybody. Welcome to our Reforming In-Home Aged Care webinar. I’m Nick Hartland, the First Assistant Secretary of the Home and Residential Division of the Aged Care Group at the Department of Health and Aged Care. We’re really pleased to see so many people attending the webinar today. So it’s great there’s such an interest in the new program.

Before we begin I’d like to acknowledge the traditional owners and custodians of the lands on which we’re meeting today which for us in Canberra is the Ngunnawal and Ngambri people. I’d like to pay my respects to Elders past, present and emerging and I’d also like to extend that acknowledgement and respect to any Aboriginal or Torres Strait Islander peoples who are with us here today.

I’m joined today by Nick Morgan, the Assistant Secretary of the Support at Home Branch, Russell Herald, the Assistant Secretary of the Home Operations Support Branch, Julia Atkinson, the Assistant Secretary of the Home Care and Assessments Branch, Mel Metz, the Assistant Secretary of the Legislative Reform Branch, Caroline Turnour, the Assistant Secretary of the Harmonisation and Regulatory Strategy Branch and Josh Maldon, the Assistant Secretary of the Choice and Transparency Branch.

In terms of support for you today we will have Auslan presenters joining us. So I’d like to acknowledge their contribution. Live captions are also available. So there was a link that was in your event reminder. Please use that. And if you’d like more information about how to watch the webinar you can find them on our Department’s website.

Just before we start a couple of things. So we will make this PowerPoint available via the website to you. So of course please take notes but don’t feel that you need to capture every point that we make because that will be available to you to digest at your leisure. You’ll also have an opportunity at the end of the webinar to ask questions of the panel. And so to ask the panel questions you should be able to find a Slido tab on the right hand side of your screen. Just type in a question and hit ‘Enter’ and it will be sent to us. We won’t be able to answer every question but we’ll do as many as we can within the time limit. So please be patient with us if we don’t get to your question. But even if we don’t get to your questions we’ll roll them up to create a frequently asked questions document for the in-home care reforms and make that available to you. And we do look forward to the questions. We always enjoy them.

So first up I’d like to introduce Nick Morgan who will be providing an update on in-home care reform. Over to you Nick.

Nick Morgan:                                                       

Good afternoon everyone. I’m Nick Morgan and I look after the Support at Home Reform Branch in the Department. Today I’ll give an update on the Government’s decision about timing for the reforms to in-home aged care and touch on some of the areas where we are continuing to progress the program design.

[Visual of slide with text saying ‘Reforming in-home aged care’, ‘Nick Morgan’, ‘Assistant Secretary’, ‘Support at Home Branch’]

So the Budget included some key decisions about the reforms to in-home aged care. Firstly the Government committed to introduce a single assessment system from July 2024. In relation to the Support at Home Program the Government has decided to postpone the implementation of the new program to July 2025. Other decisions were taken in relation to the timing of the new Aged Care Act and regulatory arrangements which my colleagues will discuss later in this webinar. I’ll talk about these two particular decisions today and what they mean for the aged care sector.

So if we go to the next slide. Let’s start with the single assessment system that will start from July 2024.

[Visual of slide with text saying ‘A single assessment system’, ‘From July 2024’]

All right. I’ll begin by explaining what we mean by a single assessment system and why it’s important to achieve. So this slide summarises the current assessment arrangements. Older Australians are currently screened to different aged care assessment organisations based on an initial determination of whether they have either simple needs or complex needs. People deemed to have simple needs are referred to a Regional Assessment Service that can only assess people to receive services under the Commonwealth Home Support Program.

Okay. People deemed to have more complex needs are referred to an Aged Care Assessment Team which can assess for all aged care services. If someone goes into residential aged care they will undergo another assessment by a third type of assessment organisation to determine the funding that the residential facility is eligible for. So that’s the AN-ACC Assessment Organisations. And really people have told us that this model is cumbersome. When the screening gets it wrong they are bounced between assessment organisations. When their needs change and they have to be reassessed they have to start again with a new organisation. And at the moment there are also wait times for assessments in some areas.

So when we talk about a single assessment system what we mean is that all assessment organisations can assess for all aged care services and residential funding. And this is going to simplify arrangements for older people as they enter and move through the aged care system. We’ll be looking to have more than one organisation in any particular location apart from perhaps the remote areas so that if one organisation starts to develop wait times for assessments the assessments can be allocated to a different organisation to be able to complete them.

So the plan is to establish a single assessment system with the existing assessment organisations and to add new Indigenous assessment providers. So we’ll be shortly talking to assessment organisations about how we will progress this work and within the Department my colleague Julia Atkinson who will be giving an update in this webinar on home care packages is going to be leading that work.

So at the moment ACATs or ACAS in Victoria are run by states and territories and will be working with jurisdictions to ensure they are able to assess more people with simple needs that are currently assessed by the RAS. ACATs will also continue to assess people in hospitals where many of the ACAT teams are based. And then we’ll be running a limited tender for assessment services with the existing RAS and AN-ACC assessment organisations. And then in addition we’ll be looking to run an approach to market to establish new Indigenous specific assessment organisations to help boost the access to aged care by First Nations Elders.

So one of the questions that I’ve been asked already since the Budget is whether the new Integrated Assessment Tool that we’re currently trialling will be used from July 2024 if the Support at Home Program doesn’t start for another year. And the answer is yes. We plan for the new assessment workforce to use the new tool however for the first year the tool will be used to assess people for in-home care under the existing aged care programs. And what that means is the tool will then need to be updated ahead of the start of the Support at Home Program to enable assessment into the new program.

So that brings me to the new Integrated Assessment Tool. We’re currently trialling a prototype of the new tool which was developed over the past couple of years. In terms of how we got there we commissioned an organisation called HealthConsult to help develop the prototype and they started with the National Screening and Assessment Form or NSAF that is currently used for aged care assessments. And they then reviewed a range of different assessment instruments from around the world and convened a working group with experts to help develop the new tool. And then once we had that initial prototype it was used to collect data from around 2,000 people who were already in receipt of aged care services so that we could compare the results of the assessment to their actual services. The tool was then further refined through another small scale trial last year and we’re currently trialling the latest version of the tool which I’ll talk about in a sec.

So what does the tool look like. Well there are 18 sections in the tool listed on the slide there, starting with collecting personal details and carer profile and then collecting information about the person’s aged care needs and setting out service recommendations. So you can see there are sections on social interactions, functional abilities, frailty, cognitive issues, psychological issues, health and medical conditions as well as the goals of the person being assessed. The physical environment of the home is also considered. Number 15 on this slide support considerations offers people the opportunity to identify characteristics such as CALD status, Indigenous status, LGBTI status and whether they are a care leaver.

I’m going to just run quickly through some of the questions to give you a flavour of the sort of information collected. So let’s look at the function section. This section uses instruments such as the OARS IADL and the Barthel Index to collect information about how people go with the normal activities of daily living. So scores are generally on a three point scale. Can you do the activity with no help, with some help or are you completely unable? And you’ll see the questions cover physical activities like walking, climbing stairs, bathing, doing the housework, preparing meals and so on but it also asks about other activities of daily living like using the telephone and the computer and handling money and going shopping. So that’s the function section.

Section 8 of the tool looks at frailty. So it asks about recent falls, weight loss, difficulty with more strenuous activity as well as other issues like communication difficulties, problems with swallowing and pain.

Then if we move on I think it’s also worth highlighting that the tool isn’t only about the things that people have problems with. So section 17 asks about what matters to the older person and what sort of things might help to achieve their goals. And you might think that section 17 of 18 seems a bit late in the piece for an assessor to be asking about goals but certainly assessors can easily navigate between these different sections and we have already had some feedback from the trial we’re running at the moment about changing the default order of questions and in particular talking about goals earlier in the assessment.

Okay. So a trial of the prototype tool I’ve mentioned is currently underway. It’s being done with all ACATs and Regional Assessment Services participating across the country. We’re aiming for around 20,000 assessments to be done using the tool by mid to the end of July. At last count we were sitting somewhere around 3,500 assessments having been completed. And the way the trial works is the information is collected in the new Integrated Assessment Tool and then assessors can just push a button to transfer that information into the current National Screening and Assessment Form and finish the assessment as normal. But all of the data from those assessments is collected in a database that we can analyse to get a really good picture of the needs across the population. And the trial’s also going to give us some great feedback from assessors about how we can improve the usability of the tool itself.

[Visual of slide with text saying ‘Support at Home’, ‘Commencing 1 July 2025’]

So that was some detail on the single assessment arrangements that will be starting in July 2024. Now let’s turn to the Support at Home Program that is due to commence from July 2025.

So the Government has announced that the start date for the program is postponed to July 2025 and I’ll start with that. Why postpone? Well I don’t think there would be too many service providers asking that question. They’ve been telling me for some time that they need a lot more detail to be able to prepare for the changes that are to come. And so moving the start date to July ’25 gives us time to get down to that next level of detail. In some cases that will be developed through advice from experts who will provide that advice to the Government on things like efficient prices. In other areas the details will be informed by trials like the assessment trial I just mentioned. And there will also be more time for the Department to continue the consultation we’ve been doing over the past year or so to refine different aspects of the Support at Home model as well as setting the new regulatory arrangements for the program.

Now the postponement doesn’t change the overarching goal to better support people to stay independent in their homes. And we want people to have access to high quality services when and where they need them. We want a system that is efficient and affordable and which adds social value through things like volunteering in the community. And we want a program that responds as people’s needs change without being overly complicated.

So the picture on this slide may be familiar to many of you. A version of it was in the discussion paper we released last October and I believe I’ve spoken to a version of this slide in a webinar before. I’m putting it up because it remains the program design that we are working on and refining. And very briefly it involves independent assessment as I’ve discussed which generates a support plan that will specify short term supports and/or a quarterly budget that can be used for ongoing services. Short term supports includes assistive technology and home modifications, short term restorative services like coordinated allied health after a fall for example, and specialised support services like dementia and vision advice.

Ongoing supports include clinical services like nursing and allied health as well as help with things like meals and transport, cleaning, home maintenance, personal care in there as well. Importantly it also includes respite.

Part of the ongoing support under the program will also be care partners to check in with older people and provide advice on clinical support and service needs. This will include helping a person to get a reassessment when their needs change significantly for example.

Now we’re still in terms of funding looking at quarantined funding for short term supports and a mixed funding model involving payments per hour or unit of service delivered and supplementary payments or grants for services where additional support is needed. So that’s like in remote areas and for service types like transport, meals, respite and group social support.

So today I’m going to provide a little bit more detail on three particular areas. So first I’ll talk about the classification system that will determine the quarterly budgets. Second I’ll talk about the assistive technology and home modifications scheme and where we’re up to on that. And then third I’ll talk about the short term supports pathway.

So quarterly budgets for ongoing services will be set for different classifications under Support at Home. Well what do I mean by classifications? Well the answers collected at assessment that I just went through will be used to determine a classification for each person in the new program. Each of those classifications will have a quarterly budget associated with it. So the intention is to group people with similar characteristics to ensure they are getting the right level of services. So just as we have a prototype assessment tool we have a prototype classification system that has 11 classifications that are up on this slide. Broadly speaking it groups people according to firstly their functional scores and then their cognitive scores. And then thirdly by a complexity score and it's made up of other factors like frailty, social connection, medical, living alone scores and so on.

And so the table on the right shows a summary of the classes in order from lowest at the bottom, lowest need at the bottom to highest need at the top. The percentages on the table are the proportion of people from our initial data study of around 2,000 people who fell into each of those classifications.

Now I called this a prototype and we are continuing to refine these classifications ahead of the July 2025 start date. So firstly we’re looking at the bottom classes that are currently based on having minor physical limitations. However we know from the dataset that some of these people may have cognitive issues and that they may need to be in a higher classification. So we’re reviewing that.

Secondly we’re looking at the importance of service frequency rather than just the total scores on the assessment instruments. So in other words are there some answers at assessment that suggest services are needed daily rather than weekly, for example if someone is completely unable to dress themselves or take daily medications. So that may mean they require more frequent assistance than someone who has a similar total score but whose needs are less frequent like house cleaning. So that’s an area that we’re exploring at the moment.

Thirdly we’re looking again at the complexity score. It really bundles up a lot of different things. And this is what the statisticians who looked at the data for us felt was the best way to determine the level of services people might need in terms of grouping but we’re also looking at that again and thinking about whether there are some things like living alone that really should be considered separately.

And then finally we’re currently commissioning a clinical consultancy to do some validation of the classifications for us. And so we’re putting together a set of around ten personas from each classification based on all of the assessment data that we’ve got and we’ll get a clinical team to essentially case conference each of those deidentified personas to rank them and consider the ongoing supports that they might need. And then we’ll then compare that to the classification structure to determine how things might need to be adjusted. So that’s a kind of clinical validation process.

So the second area of the Support at Home Program that I’d like to talk about is the assistive technology and home modifications scheme. So there’s a paper available on our website summarising the codesign process that we commenced last year. The scheme we’re developing in line with that paper would provide upfront access to assistive technology and home modifications following assessment. So we’re planning to have a comprehensive inclusions and exclusions list which we’re currently getting some advice on which will go to a new aged care taskforce to consider. We think there should be a defined exceptions process in terms of circumstances where items not on the inclusions list may need to be considered and in the same light the list should be reviewed over time as new technologies and so on emerge.

In addition to services we’ve heard how important it is to have equipment set up with training and for some items maintenance included. There’s no value of equipment sitting in the back of a cupboard because it was just dumped on someone with no follow up, so set up and so on is very important. A key component of the new scheme is expected to also be a loans program for equipment that is suitable for loan and refurbishment. And we’re talking to states and territories about delivering loans through their existing schemes and we’ve also received $10.9 million in the Budget to run a trial of a loan scheme. We’re currently talking to New South Wales about running a trial from early 2024.

The Support at Home Program will have short term services in addition to assistive technology and home modifications and we’re looking at two different short term pathways. A restorative pathway that provides a combination of different clinical supports for a person recovering from a setback. This multidisciplinary approach will involve a coordinator who brings together different allied health and other professionals as needed for up to 12 weeks to put in place a program to help them. And these short term supports may conclude with ongoing maintenance through things like group exercise programs. We’re also proposing a short term pathway that provides temporary in-home help when needed for someone who maybe just gets assessed and only needs something on a short term basis.

[Visual of slide with text saying ‘Work plan to finalise the Support at Home program design’]

So I’ll finish up today by highlighting some of the work that we’ll now be doing to finalise the Support at Home Program. So firstly the Government will be establishing a new aged care taskforce that will provide advice in some critical areas including consumer contribution arrangements, finalising a service list for Support at Home and looking at funding arrangements that support innovation under the program.

There are also several studies that are underway to further inform program design over the next 12 months. These include a pricing study being conducted by the independent – or costing study to inform prices, and that’s being conducted by the Independent Health and Aged Care Pricing Authority, a study to develop a draft inclusions and exclusions list for the assistive technology and home modifications scheme that would be provided to the aged care taskforce. We’re also doing a study into the provision of higher levels of care in the home. And in addition to that I’ve mentioned the clinical review of the personas to inform the classification structure that I mentioned earlier.

Now we’ll also be progressing two trials that I previously mentioned. The trial of the new assessment tool that is currently underway and a trial of the assistive technology loan scheme with one or two states and territories. And I’ve mentioned we’re talking to New South Wales currently about that.

There are various areas where we’ll also continue to consult directly to develop the next level of detail about the program. Some of the key areas are how care management will operate including really clear definitions around functions and a flexible funding model, setting details about how self-management would work for older Australians and service providers, clarifying arrangements for adjusting services for temporary needs, but continuing to refine the model delivering short term restorative care that I talked about earlier including the right criteria for people accessing those services, providing details for service providers about how the funding model works including arrangements for invoicing and payments, and then arrangements for pooling budgets in congregate settings is another thing that we’re currently exploring.

So we expect to continue and start a new round of discussions with different stakeholder groups particularly older people and we will continue discussions with First Nations stakeholders following a roadshow conducted for us by Winangali earlier this year. We’ll also be talking to stakeholders from cohorts with diverse needs. Last week I committed to a workshop with the National Aged Care Round Table for Forgotten Australians and there are other groups that we’ll need to schedule some time with. So look out for opportunities on the Department’s Consultation Hub because we have another year to talk and learn and refine the program.

So for more information you can visit our website or contact us via the Support at Home implementation inbox. And look we will be posting some information on the Consultation Hub to give people a heads up of the consultations coming. We’re replanning that at the moment. That will be available in the coming weeks.

All right. Thank you. That’s it from me but I’d now like to introduce Russell Herald who will be providing an update today on the Commonwealth Home Support Program.

[Visual of slide with text saying ‘Thank you’, ‘For more information, you can contact:’, ‘Email: SAH.implementation@health.gov.au’, ‘Website: reforming in-home aged care’, ‘Visit the website’, with an image of a QR Code, ‘agedcareengagement.health.gov.au’, ’18 May 2023’]

Russell Herald:                                                   

[Visual of slide with text saying ‘Commonwealth Home Support Programme’, ‘Russell Herald’, ‘Assistant Secretary’, Home Support Operations’]

Thanks Nick. As Nick said I’m Russell Herald, the Assistant Secretary of the Home Support Operations Branch. Just a quick update on Commonwealth Home Support Program. So I’m pleased to advise we’re in the final stages of the next CHSP extension process from 1 July 2023 where we’re recontracting about 1,300 providers which will ensure we keep the availability of services for about 818,000 clients. Most of these CHSP providers should have received their contract for execution by now but if not that will come through in the not too distant future for signing before 30 June. So that’s obviously a big piece of work that is coming to a close.

We will be issuing a new CHSP manual in the coming few weeks in front of 1 July where there will be a couple of minor adjustments. One which you should be familiar with though, we’ll have an updated schedule of prices. Second we will be providing some guidance around the flexibility provisions or some clarity there. Whilst flexibility is staying there’s just a few guardrails that we need to monitor and clarify so that we can just make sure that it operates as effectively as possible. The last thing is we’ll make some minor changes to some of our sub-programs including assistance with care and housing and sector support and development and specialised support services. There’s nothing overly significant in those changes that providers wouldn’t already know about or have been consulted on but obviously good for providers to make sure they’re aware of those changes come 1 July.

The other thing I just wanted to make clear for providers is a bit of clarity that any unspent funds as at 30 June 2023 will be recovered, similar to the unspent funds as at 30 June 2022. So don’t be surprised following any acquittals of any recovery notices that come through. But that being said if you have any concerns around that particularly around viability please talk to your funding arrangement manager in the Grants Hub and we can work all of that through.

The Department is aware at the moment that there is a significant amount of demand for CHSP services and there are some challenges with supply, workforce being one major part of that equation. We are getting increasing feedback about the accuracy of the Find a Provider tool, the service availability information. It would be wonderful if providers could make sure that they update that regularly so that clients aren’t ringing around when they don’t need to. We are behind the scenes looking at further work that we can do to improve the accuracy of that tool but it may take some time to work through.

The next one that I want to take you through is the Fair Work Commission wage increase. So yes the Government has announced the injection of additional funding for CHSP providers, around about $300 million over the next period of time to pay for the actual cost of the Fair Work 15% on providers. It is a new grant opportunity that will come through with funding to be available by the end of December. Obviously it takes a bit of time to put out a grant opportunity for providers to calculate costs of the impact of the changes and for us to then process it. So we are taking that into account. I will say that the grant applications are based on the award wage as at 29 June which is the day before the increase takes effect.

So what we’ll be doing in recognition that the wage takes effect from 30 June but the grant won’t come through until maybe December, or the end of the year, we are going to temporarily suspend the payment in arrears model and all CHSP providers will receive their first six months of payment in July. So that will ensure a cashflow benefit for providers until we work through the administration with every affected provider. Now I will say that it is the actual increase for the Fair Work Commission costs not a straight 15% on wages. So it is on those who are on those awards or on EBAs that are underpinned by those awards in order to get them to the new minimum requirement under the award.

So that’s the process we’re going through at the moment. We’re just going through the processes at the moment to publish that grant. At this point I would expect if everything goes smoothly it will open in July or thereabouts. But obviously as it’s based on wages as at 29 June there is a bit of time for providers to calculate those figures. But with any questions on that obviously you can come and approach your funding manager as well and we can try and help you through that in the meantime.

So lastly what I want to talk through is what we’re doing from 1 July 2024 with the postponement of Support at Home by 12 months. So we’re obviously now going to roll over CHSP for a further one year, go through the cycle again. And as with the current cycle we would be looking at doing that at basically the same arrangements but we will be trying to do a few things in parallel to try and ease some of the issues within CHSP at the moment including supply and pricing issues such as options to increase the CHSP provider market, an open growth round in certain areas. We know that there’s a few pressures out there for instance in domestic assistance and home maintenance. We’ll look to trial within the block funding model some alternative pricing models for some service types and we’re also looking at the national consistency or funding equity of a couple of service types that we want to try and get more consistency across the country.

So that’s sort of where we are going. And more advice once that is locked down will hopefully come out sort of July/August so that providers are aware of all of the grants and the adjustments that we are going through and can apply accordingly.

So I think that’s it from me. So thank you for that. And now I can introduce Julia Atkinson who will be providing an update today on home care packages.

[Visual of slide with text saying ‘Thank you’, ‘For more information, you can contact:’, ‘Email: chspprogram@health.gov.au’, ‘Website: Commonwealth Home Support Programme’, ‘Visit the website’, with image of QR code, ‘agedcareengagement.health.gov.au’, ’18 May 2023’]

Julia Atkinson:                                                    

[Visual of slide with text saying ‘Home Care Packages’, ‘Julia Atkinson’, ‘Assistant Secretary’, ‘Home Care & Assessment Branch’]

Thanks Russell.

Hi everybody. Good afternoon. My name’s Julia Atkinson and I’m the Acting Assistant Secretary of the Home Care and Assessments Branch. My branch manages the day to day operations of the Home Care Packages Program often known as HCP.

So today I will be giving a short update on some of the work that my branch has been undertaking recently on the Home Care Packages Program. What I’ll talk about today includes some of the recent communications that we’ve done on the program including some information about recently developed resources that we’ve put out into the public sphere, and a lot of this is focused on inclusions and exclusions. I’ll also talk about the fair wage subsidy increase that was announced on the 4th of May and I’ll talk about the additional home care places which were announced in the 2023-24 Budget.

So in recent months we’ve had a big focus on communications for the program and this has been about improving the community and providers’ understanding of how Home Care Packages Program works and also how it fits into the broader aged care and social support system. In January of this year we issued an update to our program manual. This update included new content on inclusions and exclusions, capping of care and package management charges – and this is something that came into effect in January of this year – we included some further guidance on home care pricing, unspent funds, also how Home Care Packages interfaces with other programs like residential care and palliative care. We also included some information about the Serious Incident Response Scheme which came into effect in the Home Care Packages Program in December 2022.

We’ve also been working recently with our colleagues in the Program Assurance Branch to support a provider community of practice. This is an online forum where providers can share their knowledge and ask questions of us and of each other.

On the 4th of April this year we hosted a webinar targeted at home care providers. This webinar was recorded. It was on the 4th of April and it covered the general program scope with a big focus on inclusions and exclusions especially those clarified in the program manual updates. The webinar recording is published on the health.gov.au website for those who missed it and are interested to have a look.

On the 6th of April following the webinar we issued a Frequently Asked Questions fact sheet and this includes quite a bit of detail which was covered in the webinar and a little bit more and this fact sheet is also published on the health.gov.au website.

Later that month on the 18th of April I joined OPAN for a webinar focused on older Australians and their families in the Home Care Packages Program. In the webinar I talked about the price capping measure and what it means for older Australians. I talked about inclusions and exclusions and I also talked a little bit about the Fair Work wage subsidy increase. We recorded a live Q&A and this has also been published on OPAN’s website if you’re interested to have a look.

We’ve received some pretty positive feedback over the last few months which reinforces that we did need to do more and it’s a good investment of our time and yours to communicate more about the program.

And so we’re going to plan some more webinars coming up in the second half of this year.

We’re also planning more fact sheets and updates to web content as needed so watch this space as more information will be coming as it’s available.

So now I want to talk a little bit about the Fair Work wage increase. What is it? So you’ll be interested to know the Government is funding the Fair Work Commission’s decision for the aged care work value case of a 15% increase to award wages for registered nurses, enrolled nurses, assistants in nursing, personal care workers and home care workers, head chefs and cooks and recreational activities officers or lifestyle workers. And the Government recently committed $2.2 billion over four years to support this wage increase. The wage increase applies to workers who are on the Aged Care Award 2010, the Nurses Award 2020 and the Social Community and Home Care and Disability Services Industry Award of 2010.

The Fair Work Commission is also looking further at other wage increase claims in the sector including for administrative and support staff and we are waiting to see that decision.

So you’re probably wondering how is the wage increase going to be passed on. In the Home Care Packages Program what we’ll be doing is increasing the Home Care Packages subsidy base funding through the Home Care Packages subsidy rates. What this will mean is that everybody’s package funding will go up and this will give providers the additional funding they need in order to increase wages for their workers. This funding will be in addition to the usual increase for indexation. The Government is funding the wage increase.

We are aware that there are a small percentage of people on Level 4 packages who use lots of labour services who are a bit worried about not having enough funding in their package. And I want to assure you that should this occur it would be quite rare but there will be options for providers with clients in these circumstances. There will be a grant program available to support those who have high labour needs and are on a high level Level 4 package. And more information about that will be provided later this year.

So what do providers need to do? Firstly providers need to communicate these changes to their workers and ensure they’re paying their workers as per the legislation. We are really wanting to see the money passed on to workers through the Home Care Packages subsidy increase. Secondly providers need to communicate these changes to their care recipients and in many cases they will need to obtain consent from their care recipients to increase prices to access the additional subsidy funding.

We will note that these are normal processes similar to the annual indexation process that providers generally undertake on an annual or biannual basis. This year there is additional funding to support the wage increase and so we’d ask that providers ensure that they make this clear to their care recipients and are open and transparent about the additional funding and where it will be going.

So in communicating these changes to care recipients providers need to think about the following things. They should discuss with care recipients how care and services delivered by some workers may need to change in terms of pricing, why prices will change, what those prices include and when those prices will start. They need to renegotiate their prices with care recipients, being clear about why those prices are increasing and that the subsidy funding is available in the package. Once agreement is reached providers should update their Home Care Agreements and their pricing schedules and they should update their published prices on the My Aged Care website.

Providers must set reasonable and justifiable prices for care and services and they should be value for money and reflect the resources it takes to provide a care or service. Prices should be clear and understandable and transparent and in the best interests of their care recipients. They should be in line with the program requirements and legislation and directly related to delivering or coordinating allowable care and services or purchasing goods to meet the care recipient’s assessed needs and goals. There is some guiding information on the health.gov.au website about the wage subsidy increase and more information will continue to be provided.

So what about older people and their families? What do they need to do? Care recipients will have to consent to the price changes for them to be operational. And so what does that mean for you? Care recipients should expect that their provider will contact them about this issue and have a conversation with them about their prices and what changes they would need to make to those prices in order to pass on the wage increase to their workers.

Care recipients should feel comfortable to ask questions of their providers if they don’t understand what the new prices mean or there is a lack of clarity. And providers should be clearly explaining the changes and ensuring care recipients understand the changes.

So what will the Government do to support providers to communicate with their care recipients. We will be doing a mailout to all care recipients. So we know that there are lots of different ways to reach people and one of the preferences of older people is in writing, a written letter. And so we will have a mailout in early June for all older Australians in the program and their authorised representatives to inform them of what the changes are and give them the information they need.

We’re also planning additional fact sheets and updated web content. So this is broadly available for everyone obviously but noting that we’re going through as many channels as we can to reach care recipients and providers. We’re also planning more webinars. So we’re looking at a provider focused webinar in mid-June on the Fair Work increase and we’re also talking with OPAN again about looking at a consumer focused webinar on the increase at the end of June. So please feel free to register for those webinars as they become available if that’s your preferred way to get information.

So on a positive and exciting note in the recent Budget the Government announced an additional 9,500 places in the Home Care Packages Program for 2023-24 and this is an investment of $166.8 million. It’s going to benefit those who are currently waiting for a package or are in line to be assessed for a package in the coming year. By June 2024 there will be around 285,100 home care packages available for older Australians.

And updated wait times will be available on the My Aged Care website.

So that is all from me today. Thank you for listening. If you have any questions please put them in the Slido or you are also welcome to email my team and myself at the hcpmanualsfeedback@health.gov.au inbox. And this is where we manage a lot of our communications around the Home Care Packages Program. Please read and share our resources which are linked on the slide.

If you’re a provider talk with your care recipients about the recent and upcoming changes. We definitely are putting a focus on communications from the Department but we also appreciate what a great relationship and contact that providers have with care recipients and that great opportunity to share information there as well.

Finally please stay up to date by signing up for our newsletter or the Engage consumer newsletter.

[Visual of slide with text saying ‘Next steps’, ‘If you have questions:’, ‘Leave your questions on Slido’, ‘Email us on hcpmanualsfeedback@health.gov.au’, ‘Read and share resources from Home Care Packages’, ‘Stay up to date through aged care newsletters’, ‘Visit the website’ with image of QR Code, ‘agedcareengagement.health.gov.au’, ’18 May 2023’]

Okay. So that’s all from me. And next I’d like to introduce my colleague Mel Metz who will be providing an update today on legislative reform.

Mel Metz:                                                              

[Visual of slide with text saying ‘Legislation Reform’, ‘Mel Metz’, ‘Assistant Secretary’, ‘Legislative Reform Branch’]

Thanks very much Julia. I’m Mel Metz the Assistant Secretary for the Legislative Reform Branch and I have responsibility for the Aged Care Legislative Reform Program which includes delivery of the new Aged Care Act. At the moment we’re consulting with a number of groups on aspects of the proposed new Aged Care Act and we’re really interested in hearing your views.

So today I’m going to cover a couple of topics. Really keen to hear your views through the chat and the Slido and if you’ve got questions of course as well. So I’m going to cover the proposed definition of high quality care for the new Act and also proposed arrangements for protecting whistle-blowers.

So first of all high quality care. We intend to define high quality care in the new Act in line with the recommendation about that that was made by the Royal Commission. The draft definition which appears on the slide is also included in the consultation paper on the new regulatory model that has recently been published. And the aim is to make the concept of high quality care central to the new regulatory model. The focus of strong enforcement measures will then be on addressing risks or actual harm to older people and more minor issues will be able to be addressed with other regulatory tools like education and engagement.

The draft definition of high quality care would be the delivery of aged care services to a person in a manner that prioritises delivery of services with compassion and respect for the individuality, self-determination and dignity of a person accessing care and their quality of life, responding to the person’s expressed personal needs, aspirations and their preferences regarding the manner by which services are delivered to them, facilitating regular clinical reviews to ensure that the services delivered continue to reflect individual needs and supporting a person to enhance their physical and cognitive capacities and mental health.

We welcome further feedback on the definition taking into account that the aim is for this to apply across all Commonwealth funded aged care services that will be delivered under the new Act. The definition is really important so consistent with the Royal Commission’s vision to aim higher and not just focus on minimum standards our aim is for the new Act to deliver the foundations of an aged care system where there’s no place for substandard or low quality care, all registered providers deliver the care required under the new framework and as the system matures high quality care becomes the norm.

So the aim is to encourage registered providers to do more than just the minimum and it’s also intended to provide a focus for the compliance and enforcement work of the Aged Care Quality and Safety Commission. We want the new aged care system to be constructed to promote and grow high quality care throughout the sector.

So we do know that a definition of high quality care on its own is not going to lift the overall standard of aged care services and ensure that the needs of older people are at the forefront of care delivery. No single measure or legislative reform is going to achieve that outcome. Instead we need an Act that provides for an integrated suite of measures and ongoing effective governance and stewardship of the new aged care system. So the new system needs to be constructed and managed to ensure that registered providers are funded, supported and incentivised to grow their services and it also needs to balance the diverse needs of older people and the challenges facing the sector particularly in remote and regional Australia.

The Aged Care Quality and Safety Commission also needs to be able to use the most appropriate tools available so that risks to older people can be addressed immediately. And some of the key features of the new Act that will help ensure the concept of high quality care remain central are the proposed new Statement of Rights which we will be consulting on as well, the new National Provider Registration Scheme as well as revised obligations on all registered providers, a new regulatory model which you’ll hear about today as well that includes enhanced enforcement powers to take strong action where there’s substandard care but also allows for regulation before situations deteriorate and older people are harmed. And importantly also revised complaints processes.

So the second topic that I’m going to talk to you about is whistle-blower protections under the new Act. And we heard from the Royal Commission that it’s really important to protect people who disclose information about incidents or unacceptable conduct in aged care. I’m going to talk you through our proposed approach to protecting whistle-blowers and I’m very happy to hear your views about our proposal because it’s still sort of early in the design phase.

So the current arrangements are that the Aged Care Act only protects people who disclose information about defined reportable incidents under the Serious Incident Response Scheme. The proposed new approach will acknowledge the Royal Commission’s concerns about the limited protections in the current Aged Care Act and aged care workers and people receiving care and their families and carers might be reluctant to raise concerns.

So we propose broadening the current protections and aligning the new Aged Care Act with other frameworks such as the NDIS and the Corporations Act which was particularly mentioned by the Royal Commission. And under the proposed scheme a disclosure can be made by a broad range of people which would include employees of providers, people who spend time in aged care facilities like contractors or volunteers, recipients of care and people who are close to them such as carers, family members and advocates. And those people will be able to make disclosures to appropriate officials which will include staff of the Aged Care Quality and Safety Commission or the Department, workers of aged care providers and volunteers at aged care facilities and police officers and anyone else who we authorise to receive that information. So we’ll have scope to broaden that in the future.

The person who makes the disclosure will have to have reasonable grounds to suspect that an aged care provider, worker, volunteer or contractor has or may have contravened aged care legislation. And finally the disclosure must also be made in good faith. The proposed approach intends to ensure that people are empowered to disclose information if they think there might be a breach of legislation without fear of repercussions. And this is really important for protecting the safety of older people and we hope it will lead to earlier identification of concerns before they reach the point of becoming a reportable incident. And we’re proposing to make it an obligation for providers to have internal whistle-blower policies and we’ve heard from a number of providers in different forums that many providers already have policies around whistle-blowing in place.

So when a person makes a disclosure they’ll be protected from a range of consequences which could be civil consequences, criminal, administrative liability or contractual and other remedies. So what that means is if a person makes a qualifying disclosure their employer would be unable to fire them or to sue them for a breach of contract or confidentiality. And we’re also proposing to maintain the protection against victimisation which means that it would be a civil offence to engage in any conduct that causes detriment or threatens to cause detriment to someone who’s made a disclosure or to anyone else, a third party because of the disclosure that’s been made.

We’re also proposing to maintain the existing obligation of providers to ensure that disclosers including staff members and other individuals are not victimised and that their identities should be kept confidential. And that includes where a family member has made a disclosure to a staff member. In that case it would be the responsibility of the care provider to ensure the staff member keeps the discloser’s identity confidential.

It would be an offence to disclose a whistle-blower’s identity or any information that might lead to their identification. In order to allow for that disclosure information to be dealt with and investigated properly it will be necessary to include some exceptions. And what we’re proposing as exceptions is information provided to the Commission or the Department or anybody with a legislated function around investigation of information provided by a discloser, one of the provider’s key personnel, a legal practitioner for the purpose of obtaining legal advice, where that disclosure is necessary to lessen or prevent a serious threat to the safety, health or wellbeing of an aged care consumer, or with the express or implied consent of the discloser.

So thank you very much for your time today. I am happy to respond to any questions that you might have around the material presented today, also around the new Act generally. If you have any questions I’m happy to take those at the end. If you’d like to send us any feedback you can send it to the Legislative Reform team and the email address is up on the slide. So thank you very much. I will now hand over to Caroline Turnour who will be providing an update today on a new model for regulating aged care.

[Visual of slide with text saying ‘Thank you’, ‘For more information, you can contact:’, ‘Email: agedcarelegislativereforms@health.gov.au’, ‘Website: Aged care legislative reform’, ‘Visit the website’, with image of QR code, ‘agedcareengagement.health.gov.au’, ’18 May 2023’]

Caroline Turnour:                                               

[Visual of slide with text saying ‘A new model for regulating aged care’, ‘Caroline Turnour’, ‘Assistant Secretary’, ‘Harmonisation and Regulatory Strategy Branch’]

Thank you very much Mel. My name is Caroline Turnour and I’m the Assistant Secretary of the Harmonisation and Regulatory Strategy Branch. It’s my job to lead the Department’s work in designing a regulatory model for the aged care sector that builds trust and confidence in Australia’s aged care system. The new model goes hand in hand with the new Aged Care Act and responds to 18 Royal Commission recommendations covering important regulatory matters such as provider registration obligations, monitoring and enforcement, complaints and whistle‑blower protections.

Today I will outline the proposed model’s main elements and I also encourage you to read our consultation paper, A New Model for Regulating Aged Care Consultation Paper No 2 – details of the proposed new model. You can find it on our Aged Care Engagement Hub and we ask that you please provide us with your feedback by the 23rd of June 2023.

So what’s regulation? Regulation is in very basic terms the rules of engagement. It sets out what is expected of those, the rules, and the consequences for following or not following, ie meeting them or not meeting them, the rewards and penalties. Regulation influences how we behave and brings order to our social interactions. It reduces uncertainty and makes life more predictable. It’s essential for a harmonious, efficient and trusting society. Regulation is a powerful tool for driving change in behaviours and attitudes and protects health and safety, supports a well functioning society and efficient economy. When it works well we don’t even notice it. The way we regulate really does matter.

So we’re designing a regulatory model to deliver high quality care and this means we need a regulatory model that will support the sector move to an optimistic view of aged care where the Government’s commitment to high quality care is embraced and older people feel safe and empowered when receiving aged care services. This means we want to create a culture where providers feel secure in working with the regulator to improve quality and innovate. This type of regulation is called relational regulation. We want providers delivering high quality care not because we’re making them but because that’s what we all agree older people deserve. We’re talking about a cultural shift, a change in outlook and behaviour. The new model has been designed to shift the culture by transforming the way the system interacts and it places more emphasis on working together with providers in a positive and proactive way rather than through a system of punitive actions. It requires us all to build stronger working relationships, deeper trust and embrace more transparency.

But don’t think that because we want to promote trust and lived commitment to high quality care that we are in any way naïve. We know that we need to back up these good intentions with a powerful regulator and the new model will do this. We are striving for a fundamental change in outlook and behaviour across the sector.

We will achieve this from multiple mechanisms that we call regulatory safeguards, functions and tools as shown on the slide. The new model safeguards include supporting providers to do the right thing so older people receive high quality care, introducing universal registration so that only providers who are suitable, capable, viable and have propriety can enter and remain in the sector, and setting out clear obligations on providers based on the services they deliver and establishing mechanisms and powers to hold providers to account for the quality of services they provide. I will talk about some of the key changes in the following slides. For more details please read our Consultation Paper No 2.

In the new model we propose allocating providers to six registration categories. There is flexibility built in with providers able to register into one or more categories and deliver a subset or all of the service types within each category. This slide shows the six registration categories that we’re proposing. The grouping is based on common characteristics, service risk and the provider obligations to address the risks. There will be a public register with key information about registered providers such as who they are, their location, the types of services they are registered to deliver and registration conditions and sanctions that apply to them. This information will provide transparency and help older people make informed choices about their care.

So this slide shows the proposed obligation architecture. You can read more about it in Consultation Paper No 2. The obligations seek to manage risk and vary depending on the category. This is intended to replace the current one size fits all approach to regulation. There will be obligations and conditions that apply to all providers such as a Statement of Rights and Code of Conduct for aged care, obligations for specific categories, for example providers in categories four to six will be audited against the strengthened quality standards, and obligations specific to providers to manage provider specific risks. This approach will strengthen the protections of older people and improve transparency of expectations as the obligations will be easier to understand and navigate. All providers will be monitored to ensure that they comply with their obligations and conditions of registration.

So the new model is about raising the quality of aged care and building trust and confidence in the sector. It’s time for a new Act and a new regulatory model and we are committed to a seamless transition process that ensures continuity of care for older people and minimises impact on providers. We are proposing a single go live date for the new model and that it commences when the new Act commences. The current regulatory framework will cease when the new model commences. This way we won’t need to operate two legislative schemes in parallel. The new regulatory model will apply regardless of how the services are funded. Existing providers of Commonwealth subsidised aged care programs including grant funded providers under the current scheme will automatically be granted an initial registration provided when the new model goes live. As part of this process we’ll be asking providers to submit specific information to ensure that they are deemed into the appropriate registration category or categories. Both the regulator and the Department will work closely with providers to support their smooth transition as we move towards a commencement date. This will include making sure you receive the information you need to plan ahead and offering opportunities to ask questions ahead of time.

As mentioned earlier we encourage you to read the Consultation Paper No 2 and share your feedback on the model we’ve discussed today by the 23rd of June. We’re also hosting workshops next month and invite you to register to participate. You can find the paper and all the details about the regulatory model consultation on the Aged Care Engagement Hub website. The web address is agedcareengagement.health.gov.au. Your feedback will inform refinement of the new model and inform the drafting of the new Act. So thank you for listening and please reach out if you would like more information. Our contact details are on the Engagement Hub. I’ll now pass back to Nick.

[Visual of slide with text saying ‘How to provide feedback’, ‘Visit the Aged Care Engagement Hub to provide feedback by 23 June 2023’, ‘Options include:’, ‘a quick 15-minute survey’, ‘a detailed survey to answer questions in the paper’, ‘email a written submission to agedcareregmodel@health.gov.au’, ‘mail a written submission to the department’, ‘Register for workshops’, ‘Take this survey’, with image of QR code, ‘Register for workshops’, with image of QR code’, ‘agedcareengagement.health.gov.au’, ‘18 May 2023’]

Joshua Maldon:                                                  

[Visual of slide with text saying ‘Aged Care Quality Standards Review update’, ‘Joshua Maldon’, ‘Assistant Secretary’, ‘Choice and Transparency Branch’]

Thanks Caroline. It’s Josh Maldon here and I’ll jump in for the next piece on quality standards. What a brilliant relevant segue from the regulatory model. So again thanks for taking the time to have me here to talk to you about what’s happening in this space. I want to bring you up to speed with what we’re doing at the urgent review and what next steps look like.

So I want to thank everyone who’s already had the opportunity to engage with us because I know you’ve spent a lot of time in feeding into the design of what they look like at the moment. And again want to thank you for your involvement and contribution in shaping what this looks like at the moment.

So just in terms of some relevant context just to reorientate you, so one of the things the Royal Commission recommended was an urgent review of the quality standards with a focus on governance, diversity, dementia, food and nutrition and clinical care. And the aim of the review is to provide more detail around the actions required and objective measurement to better define those expectations. At the same time Government also gave responsibility for setting the clinical components of the quality standards to the Australian Commission on Safety and Quality in Health Care.

So as a first step what we did was an independent review with KPMG which included research into national and international standards in consultation with a range of key aged care stakeholders including older Australians, providers and peak bodies. In total we spoke to around 1,300 participants with 300 participating in 35 virtual focus groups and a number of people putting in surveys. Between December 2021 and October ’22 we held targeted consultations with a range of experts to codesign the strengthened quality standards and we had 15 targeted sessions with expert groups across the focus areas.

What we then did was test the strengthened quality standards with a consumer reference group and a sector reference group as well as the National Aged Care Advisory Council and the Council of Elders. We then had a public consultation process on a draft set during the 17th of October to the 25th of November. Again we had 18 focus groups with over 900 people. We received 873 online and hard copy survey responses as well as 119 written submissions.

So through that process we were really happy with coverage because we got a range of older Australians, friends, family, experts and providers and peak bodies and we got some really good feedback. So in terms of the overarching feedback it was largely positive with stakeholders agreeing it broadly met their expectations. So stakeholders supported the overarching structure of the strengthened quality standards noting that we have brought that into alignment with the disability system. They noted that the standards themselves provided greater clarity and were easier to understand than the existing standards and agreed that these responded to those focus areas which were raised by the Royal Commission.

Stakeholders also noted that the strengthened quality standards were rights-based, person‑centred and recognised the importance of culturally safe, trauma aware and healing informed care and that they put a greater emphasis on choice, autonomy and dignity of risk for older people and therefore met the expectations of older Australians. We also heard about areas that we could further strengthen. So stakeholders broadly saw the greater focus on the role of carers and families and we need to involve those who are important to the older person in decision making and to provide collaborative support. Heard about reablement, independence and quality of life including supporting older people to maintain function and live well, particularly supporting to live at home for as long as they wish.

We heard about the role of multidisciplinary care teams with many stakeholders highlighting the importance of allied health professionals and the part they play in a person’s care, and also around promoting mental health and wellbeing and as part of that taking a holistic approach to a person’s spiritual, cultural, emotional and psychosocial needs.

So a key theme was related to how the standards apply to different settings particularly home care services. So under the new regulatory model which Caroline’s just talked about the quality standards will apply to different services in a proportionate risk-based way. So this means that some or none of the quality standards would apply to providers delivering different services in different categories.

Stakeholders provided a range of views on how the quality standards outcomes and actions should apply in the in-home context and it’s centred around clinical care and particularly small providers, sole traders and episodic care. We heard views about how the strengthened standards may also apply in the context of infection prevention and control, medication management and palliative care. And people also raised the need to ensure that the requirements in the standards align with the new in-home care aged care program that Nick Morgan was talking about earlier. And in addition we had a number of suggestions and comments on how to support implementation and ready the sector to transition, so what we need to do in the context to developing well targeted, useful guidance, tools and resources.

There was also another key area of interest which was food and nutrition and many of you would know that we’ve developed a dedicated food and nutrition standard which applies to residential care and while that received positive feedback we did receive a number of questions about how this also needs to be monitored in home care.

So in response to that feedback we took further steps to enhance the strengthened quality standards. So we did make moves to address those key gaps and we also refined language and added a glossary of terms to improve clarity. So in order to determine how to best apply the quality standards under the new regulatory model being developed a pilot is currently underway by the Aged Care Quality and Safety Commission and that will test the application of the strengthened standards. So that’s been in play since April this year to see how those standards actually work in practice. And the pilot involves a sample of 40 providers. We’ve got diverse service types, sizes, locations and also people receiving care. And so as part of that we hope to learn more about how the standards work for home care settings and for small providers, sole traders as well as clinical care. So that will help us to understand if further changes are needed and it will also inform guidance tools and resources to better support the sector and also assist people to understand how the standards work in home care.

The pilot is also testing a redesigned audit methodology for assessing provider performance against the strengthened standards and in relation to food and nutrition we currently here in the Department are undertaking further work to explore options for how we can make sure that this is monitored in home care. So it could include meal delivery requirements. Some of these providers are not currently proposed to have the quality standards apply in that regulatory model and we’ll have further consultation with experts and representative groups in this space. And again we’ll also continue to work really closely with Nick Morgan and others to ensure that the development of the new In-Home Aged Care Program has good alignment with the quality standards.

In terms of next steps we’ve provided advice to Government on the outcomes out of the consultation. That included a revised set of strengthened standards which has incorporated the consultation feedback. And pending Government approval we intend to publish that consultation summary report soon and also the updated draft strengthened quality standards and we’ll do that on Aged Care Engagement Hub shortly. As well as managing the pilot the Aged Care Quality and Safety Commission obviously is responsible for developing guidance and other materials to support the sector to transition and again that’s being done in close collaboration with the Australian Commission on the Safety and Quality in Health Care in the context of the clinical care standard. We’ll draft the quality standards into legislation and subject to Government decisions we hope to see that come in play with the new Aged Care Act which will be from 1 July 2024.

So with that I think it’s time to start the Q&A session. So I’ll just check Nick if you’re ready there for a handover.

Nick Morgan:                                                       

I’ll take that as a handover to this Nick. I think we may have just lost Nick Hartland for a moment. There are some questions that have come through on Slido and I might just take a couple that have been posted around my presentation in the first instance and then perhaps the other speakers can sort of review the Slido questions and I’ll throw to you. There’s one question around care management and can I provide more information on care partners. The arrangements around care management and the care partners, the intention is that people who have higher levels of need – so if you think about say in today’s world someone on a Level 3 or Level 4 home care package – those people would have access to a care partner. That’s the language that’s come out of our sort of consultations. A care partner who is someone who would check in with them regularly to see how they’re going from a clinical perspective and from a program and services perspective, help them make any adjustments to their services over time. They would also be checking in wherever there are any sort of red flags raised by care workers and so on.

For people who are on the lower levels what we want to have is more the availability to access care management when needed as opposed to having that sort of regular check in. And we’re looking at different sort of funding arrangements to support that. And then the other thing I’d say is we’ve had some very strong feedback from some consumers wanting to have an independent care manager or care partner who can support them. Under the proposed Support at Home arrangements a care partner could either sit with your services provider or be independent and it would be the choice of the older person as to whether they wanted someone independent and find someone to do that role.

That’s a bit more on care management. I’d also point out that we have a paper that we put together summarising the outcomes of our consultation on care management which is available on the Department’s website.

Before I throw to someone else there was another question around – I think there’s one that was quite high in the voting from what I could tell from service providers saying it would be great to have the Department talking more to consumers or older people around the role of service providers in terms of their clinical support they provide and that sort of care management role. And so I do think there will be an opportunity as we are sort of rolling out the new program both in terms of how we describe the program in our documentation for people whether that’s on the website and so on, to outline that care partner role and the importance of checking in clinically on how people are going and making adjustments over time. But I also think there’s potentially a good opportunity to use the new assessment workforce to be delivering some of those messages at the point of assessment. So I think that’s a good point that’s been raised and one that we’ll kind of think about.

I know Russell Herald there was a question about CHSP funding so I might pass to you to talk about what might be on the horizon in that regard.

Russell Herald:                                                   

Yep. So I mean it’s fairly obvious from the comments that everyone’s noticed that with Support at Home pushing out that there’s questions around investment in CHSP to alleviate some of the demand side pressures out there. I would note that additional funding is available for all existing providers at the moment. They can apply for up to $250,000 per annum to increase supply but in terms of bringing in new providers and increasing demand and investing in that area yes we are looking at doing that. There is a natural lead time in all of those processes so it’s probably not until 1 July 2024. But we are looking at what we can do in the next financial year to address some of those issues with the tools that we have at our disposal. So the answer is yes we are looking into it and more information I hope will flow in the next couple of months.

The other questions that have come through is around the Fair Work Commission stuff. So just a bit of extra clarity there. The grant that is applied for for 23-24 will be rolled into the base ongoing. So it will be a permanent increase to the value of the grant. So you’ll have an agreement which is for 23-24 and then you’ll get a separate grant for Fair Work Commission and then they’ll merge together to become your new contract for 24-25 with indexation.

On the indexation point the 15% boost is on top of indexation and that is across the board on all the programs affected. So there is a general indexation increase and then there’s a Fair Work Commission increase on top of that. So you’ll see higher than trend numbers coming through there. So for instance with CHSP overarchingly we’re looking at about a 10% increase in funding to CHSP providers year on year and that’s a combination of both of those two things. And every other program has their own equivalents.

Finally there was a question about accountability. How will we know that the money will go to wages? First and foremost the award wage is not optional. It’s required legislatively. But secondly the CHSP grant will require an acquittal that the funding was spent on wages. So that’s a really important element of the framework there.

Finally there was questions about whether or not providers will receive additional funding if they’re already paying above the award. Now for CHSP the funding that is provided at the moment will be matching the legislative requirements of the workforce that you currently have. So for instance if you are currently paying more than 15% above the award and they are on that award then no additional funding will flow because the wages are already above the new legislative requirement. And if you’re in the middle, so between zero and 15% you’ll receive some based on where you sit on that spectrum.

So I think that was most of the CHSP questions there.

Julia Atkinson:                                                    

Russell that might be a good segue for me to jump in and talk about the same issue in Home Care Packages just so that we’re kind of covering the same ground. So the question of how will we be sure that the funding will be passed on to workers, so it will be different in Home Care Packages as it’s not a grant. It will be through the increase to the subsidy amount and then for the providers to access that additional funding they’ll need to talk to their care recipients about what the impact of the wage increase is on prices.

So as Russell mentioned again the minimum wage award is a legal requirement and all of those accountability frameworks remain in place. In Home Care Packages as we don’t have the same grant reporting framework what we do have instead is the quarterly financial statements and Quarterly Financial Reports which Home Care Package providers are engaging in. And that includes data about what providers are paying their workers. And so we expect that those reports which are public will make it quite evident which providers are offering the best deal to their workers. And so that is kind of a clarity and transparency mechanism where we will be able to see where those subsidy increases have been passed on, noting that the subsidy increases will be the same amount for every package which we can’t determine which providers are paying the award wage. So if that funding is made available for the wage increase the expectation is that it goes towards the wage increase and if we are seeing that those wages aren’t going up in the financial statements but the prices are in the pricing data then we might have some questions about that.

Nick Morgan:                                                       

Thanks Julia. I notice Nick Hartland is back. I’m not sure Nick if you’ve had a chance to look at the questions. I’m happy to jump in and take another one.

Dr Nick Hartland:                                                

Well why don’t you take one. There were a couple I did want to – thank you very much Nick for standing in. Sorry everyone. Yeah. Take one Nick and there’s a couple that I want to get Caroline and Mel to have a look at.

Nick Morgan:                                                       

I might jump on to one because I just noticed it’s sort of voting quite high. That’s around concern about the assessment model effectively. They reference sort of AI and that kind of thing. So a bit of a concern that the assessment model will – I think the language was spit out generic outcomes for people who may be at high risk. And so I just wanted to clarify that at the end of the assessment while the assessment tool will determine a classification based on the assessment and the answers to the questions and the observations of the assessor, within that there is flexibility for the assessor and the older person to determine exactly what services they will access within that classification or that budget really and that’s also flexible for people to adjust over time. And we are also looking at ways in which we can support people as their needs change to make adjustments quickly and easily without too much rigmarole in between when they may need to be reassessed for additional support.

So just wanted to make that point and also to say there are a lot of areas where obviously assessor judgment and so on will be really important. And linked to that there was a question – sorry. I’m sneaking in another one. But there was a question around the concern with the classification linking system linking physical and cognitive, and I guess my point on that one is we would agree that’s something we need to explore further. That was one of the pieces of work identified which was looking at where someone may have low physical needs and has landed in a low class but they do have dementia or other cognitive issues. We need to work through whether that’s appropriate and I guess our ingoing assumption is we may need to put those people into a higher classification. So that is something we are looking at. Thanks Nick.

Dr Nick Hartland:                                                

Okay. Great. So Caroline there are a couple of questions about the work on regulation. One was about how would a HCP provider apply for the new registration models and another about whether standard one, consumer dignity and choice should apply across registration categories one to three in the new model. Is that something we can give a view on?

Caroline Turnour:                                               

Yep. Thanks Nick. So how to apply. As I said we want to have a smooth transition to the new regulatory model so if you’re currently providing services when you’re the same name and entity we will work with the Commission to find the information out and to deem you into different categories. So it will be a very smooth transition. If you want to change the services that you’re providing or register if you’re not currently providing services then that will be a process that we will be establishing with the Quality and Safety Commission and we’re currently designing the ICT programs to make that happen. But in terms of current providers and current entities it will be a smooth transition. We’ll get information from you and we’ll put you in the different categories and then they’ll just click over when the new Act comes into existence.

In terms of the obligations required for the different categories the point we’re trying to do with the categories from one to six is we want it to be nuanced so that depending on the types of services that you’re delivering there will be different obligations. And this is really to get away from the sort of one size fits all approach. We want to make sure that our regulator has the capacity to focus on what really matters. And everybody in the system will need to register. Everyone will need to demonstrate that they’re the right type of provider to deliver the services that they’re saying they’re going to provide. And then the amount of I guess oversight and obligations will depend on the level of risk associated with those services.

So in designing that we have looked at the categories from one to three and everyone will need to register in those categories. And the Code of Conduct will apply. And so the issues that I think were raised in the question around older people and their concerns about whether they will be person-centred, whether they’ll have their rights recognised, absolutely because the Code of Conduct will pick up all workers in that respect and all workers will have to be the types of people that we want delivering aged care services.

The other thing to remember in those lower categories is that we will also be monitoring all providers so that if there are issues we want to pick them up quickly and we want to address them. But in that respect this is a consultation process. We’re trying to make sure we get the right nuance around the level of regulation and depending on the different services. So if you’ve got particular issues around the services that are provided in those lower categories and whether there needs to be specific obligations associated with them then we definitely would like to hear from you.

Dr Nick Hartland:                                                

Great. Thanks very much Caroline. Mel I think we’ve got a question for you about the new Aged Care Act. And it’s about will the Aged Care Act be amended to include people with a disability in the section addressing people with special needs?

Mel Metz:                                                              

Yeah. So I think the first really important thing to note is that we’re not amending the current Aged Care Act. We’re developing a completely new piece of legislation from scratch. And an important point around that is that we’re going to be shifting the constitutional basis of this legislation and we will be relying on external affairs and looking to some of the international conventions including the international convention on the rights of people with disability. So it will be a very different looking piece of legislation and the needs of people with disability and the rights of people with disability will be central to this legislation as well.

We will have – in the principles we’re likely to have special needs groups sort of outlined. We won’t be using the terminology special needs groups but the current list will be included somewhere in the legislation and nothing preventing people with disability being added to that group. So yeah really good piece of feedback there. Thank you.

Dr Nick Hartland:                                                

Great. Julia have you had a chance to talk about how the tender will work, and there was one about whether ACAT services would be expanded to take over all assessments.

Julia Atkinson:                                                    

Can I be very cheeky Nick and pass that back to my colleague Nick Morgan who’s still overseeing the work?

Nick Morgan:                                                       

I was waiting to see how you’d go Julia. So yeah look that is currently me and as I said in my presentation that work will be progressed by Julia from next week onwards effectively. Yeah. Look perhaps I wasn’t as clear as I could have been in the presentation. The limited tender – so the new workforce will include all of the existing ACAT workforce and it will include the existing RAS and AN-ACC workforce, and all organisations whether you’re in the RAS and AN-ACC side or the ACAT side will be able to deliver assessments for people to assess for all different aged care services. And so the limited tender is for the RAS and AN-ACC providers who are non‑Government providers only around that proportion of the overall total assessments, across all assessments, like today’s RAS and ACAT assessments. And we’ll be working directly through negotiations and discussions with the ACATs on changing the composition of their assessments so they’re not just doing what today we would call a comprehensive assessment but doing a mix of the sort of home support and comprehensive assessments. So in other words we get to a point where all assessment organisations are assessing across all different aged care service types. I hope that’s a bit clearer. I think that was a bit clunky too. But that’s the intention.

Dr Nick Hartland:                                                

Great. All right. We’ll have another go Julia. There’s a question about has the Department considered the logistical planning that’s required to get consent from each care recipient to get a price increase? They noted that for a large provider that could mean over 4,000 phone calls and the impact that has on client times. Can you talk a bit about our plans in relation to that?

Julia Atkinson:                                                    

Yeah sure. Thanks Nick. So I did speak a little bit earlier about some of the communications the Department will be doing and the Government will be doing to support care recipients to understand what’s coming. We acknowledge that yes our providers do need to contact care recipients and get agreement to any price rises. We just kind of emphasise this is not new. It’s not a new requirement. Providers have had to do this for some time and it’s something that a lot of providers do annually as the indexation increases come through. A big benefit at the timing – it just kind of happened this way – of the Fair Work wage increase is it’s coming through on the end of financial year, so the same timing as the usual indexation increases.

So yes we have thought about that. Yes it is a job that providers have to do. We’re providing some additional support around that messaging for the reasoning around that particular additional funding and additional costs but we agree it’s a job that providers will have to do and that they should work with their care recipients on that as usual.

Dr Nick Hartland:                                                

All right. So Nick there are a couple of questions about grandfathering for both Home Care Packages and CHSP. Have you had a chance to talk a bit about how we think that might work?

Nick Morgan:                                                       

Yeah. Thanks Nick. So firstly recognising the new program will start now in July 2025 there is a little bit more time to work through exactly the details of that. Our assumption however has always been that if you’re on a – let’s say you’re on a Home Care Package whatever level it might be that under the new program your budget, your quarterly budget under the new program would be – effectively if it was a $52,000/$53,000 Level 4 package, one quarter of that each quarter. So in other words you retain the same budget. Everyone’s grandfathered at their existing budgets into the new program and then they’re reassessed under the new tool. And if you’re on a Level 1 you might go to up through the new structure rather than the existing structure.

For someone in the CHSP receiving services our thinking at the moment is that you would again receive exactly the same level of services in the new program as you are the day before the new program, same providers, assuming they continue in the new program, and your budget would equate to that level of services that you have been in receipt of to date and when you get assessed you’ll be assessed into a classification that goes up. So we wouldn’t expect anyone to be going down. Only up from what they’re receiving today. The one change I’ve talked about previously is that this idea of a quarterly budget means you can’t really save between quarters. So we don’t have unspent funds like we do in the Home Care Packages Program today. Today if you don’t use all of your package it accumulates and accumulates and accumulates to the point where we have billions of dollars in unspent funds that are being held against people and not being used. So under the new program you’ll need to use your budget within a quarter and then it resets for the next quarter and then it resets for the next quarter. So that’s the one big change for people who are existing clients.

Dr Nick Hartland:                                                

Okay. Good. Caroline I think I’ve got one for you. Is there scope to shift personal care out of category four? And the question noted the level of governance outweighs the community benefit of delivery. And that’s just moved from my screen so I can’t complete it. But anyway, and it doesn’t require any conversation if I can remember it.

Caroline Turnour:                                               

It’s a very good question. It’s a really good question and it’s certainly a question that is being debated amongst the team here in Health and with other service providers. But it goes to I guess the heart of the previous question too around what are the obligations in categories one to three and how will we make sure that older people receive the high quality care that is consistent with the Act that Mel’s been talking about in terms of older person’s rights.

But I guess the question in terms of personal care and category four is around the level of risk. So all the categories are based on an assessment of risk and sites and characteristics. It’s been put in category four because we want to make it clear that there are risks associated with personal care workers in terms of the intimacy of the services they’re delivering, they’re out of sight, there’s potential for significant harm to occur in those settings. But other people are saying no it’s more appropriate in terms of the services being delivered if it’s in category three. So it’s a debate. This is a consultation period and I would really encourage you if you have strong views on which category you think that service belongs in based on the risks and the service types to let us know through the consultation process and the feedback process.

So at the moment we’ve put it in four because we want to err on the side of caution. But if there is other views we really want to hear from them.

Dr Nick Hartland:                                                

Yep. Thanks very much. Julia there’s a question I think from one of our consumer partners. Why do providers charge so much for essential services? For example my provider charges about $70 per hour for domestic assistance and they’re planning to increase this shortly.

Julia Atkinson:                                                    

Thanks Nick. So yeah I mean that’s a good question. I guess the starting point is probably to say that providers are operating in a market where they can set prices but only if somebody agrees to it. So if you’re finding that your provider is charging an amount that seems more than other providers in the area you can find another provider who offers a better rate. That’s one option available to you.

And I guess probably to step back I can imagine the answer would be well the other providers are charging that as well. And so I suppose one thing to acknowledge in aged care is that it is regulated and there are some costs to providers involved with regulation. I won’t comment on that particular price. I’m not sure if that’s right for the area or the region or the situation of the provider. But it’s not just a case of the provider basically sending a bill. They also have responsibilities around managing care. So they have care management responsibilities and they have the responsibility to make sure that the care is delivered aligned with the Aged Care Quality Standards. So there are activities that they must do as aged care approved providers with a Home Care Package and those activities do take some effort. So that can explain some of the differential between perhaps what a price is in a Home Care Package versus what you might see in the open market.

But as I said you are free to take your package to another provider if there is one available. Another option people have is some providers will offer self-management arrangements and that can be a situation where the provider will facilitate subcontracting. Sometimes there are opportunities to get a better deal through those arrangements but the provider always remains responsible for the quality of that care. So they will still be doing a level of oversight but you may be more involved in the organisation of your care which could lead to a better price on your package management for example. So that kind of is some of the reasons why you might see some of those prices and some of the things you could do if you think that your provider is not offering a good deal.

Dr Nick Hartland:                                                

Russell there’s a question about grant application processes and the person noted that grant applications are time consuming and complex especially for small organisations that do not have the capacity or staff to assist with this process. And they’re asking about whether there will be an easier application process and a faster turnaround.

Russell Herald:                                                   

Yep. So the work at the moment that the team are doing is trying to make the process as simple as possible in terms of what you fill in and the supporting documentation for two reasons. One to make it easier for providers but also two, easier for us to assess and get the funding out the door. So we will be producing a lot of guidance material and support to help providers through the application process but we do recognise that smaller providers will find it harder to do all of the admin work and so we will look at supporting providers through that where necessary. The fundamentals are if you are having issues let us know and we’ll do what we can.

Dr Nick Hartland:                                                

Thanks. Nick there’s a question that presumably comes out of your talk about the equipment program. Why is the Commonwealth setting up for a new equipment purchase in one program when all the states and territories already have schemes in place? Why not just provide funding for the existing programs instead of creating a costly double up?

Nick Morgan:                                                       

Yeah we’re not. So that’s me not being clear. We are engaging with states and territories about delivering a loan scheme through their programs not creating a separate new one. And I should just say someone asked when we talk about loan schemes what do we mean by loan? It is loaning out equipment to people that then gets returned and refurbished and loaned out again. And we had some pretty strong feedback from consumers that they thought that was sensible given the amount of equipment that sort of ends up in the back cupboard or on eBay when we’re not sure where it’s been and it could be dangerously being resold and that sort of thing. So we are keen to explore that idea of a loan scheme with the states and territories utilising their schemes.

Dr Nick Hartland:                                                

There’s one I might handle which is about how will the newly announced Aged Care Taskforce interact with the initiatives outlined today? So yes the Minister’s announced an Aged Care Taskforce. It will have a focus on a range of things. I mean it will include looking at whether the consumer contribution arrangements in aged care are right. I mean that in the Support at Home area and the Home Care reform area generally – I mean it’s well known that we need to look at that issue because we have two very different arrangements in place across the two programs. And so having something that makes more sense to consumers and can be administered cleanly by providers is really important to getting to home care reform. So that will be one aspect of what it does. It will check on where we are with the service list for home care, the types of services that are provided, whether there needs to be changes to that.

And the Minister is very interested also in making sure that the future funding arrangements encourage more innovation in the sector or additional innovation in the sector to try and be more mutual about it. So it will check in on that. Now they haven’t been appointed yet. They may have some other issues that they want to raise. But it will segue with the extension which is timed to integrate if they’ve got any changes to what we’re proposing into it. It won’t affect the integrated streamlined assessment services but it may affect some of the details about what we’re proposing and give another point of view. So it will report in plenty of time to work that into the new system.

All right. I think we’ve got one for Josh that’s just cropped up. Sorry. I am going across the – we are getting your questions in. Let me just explain myself a bit. And I’m trying to go to both the ones that a lot of people care about because you’re voting on them but also to move the topics around so that you get a kind of overview of what the whole system is rather than just one issue. So that’s sort of an explanation. And we’ll keep going for as long as we’ve got time.

Josh will there be a star ratings system for home care?

Joshua Maldon:                                                  

Thanks Nick. So there’s no decisions by Government for a star ratings system on home care but what I would say is the general policy direction is that we are establishing or building an end to end aged care system. But I think as a first step what we would need to do is establish more datasets that we can draw from in the system. So certainly looking at things like quality indicators, surveys for older Australians to feed us in the data from consumer experience and those sorts of things. They would be logical steps that we would look to put in place first in the context of a new Home Care Program. Thanks Nick.

Dr Nick Hartland:                                                

Russell, but Nick might also want to comment on this and this is again from one of our consumer partners. We are approved for CHSP but there were zero services available in our area. That meant that we were without any assistance for over a year until we were granted a Home Care Package. How will this be addressed?

Russell Herald:                                                   

I’ll start with the short term and Nick can come in with the long term Support at Home elements. I think everyone’s aware that the CHSP model has some issues in terms of being able to respond to demand areas in certain locations, just as a function of what has been a closed market and a grant system. Part one is fundamentally about looking at where those service gaps exist and targeting the funding that we do have available through open grant rounds. And as I mentioned before we are looking at what opportunities we have in that space. But ultimately depending on where that area is – it’s not clear – this is where some of the work around thin markets can go just to ensure that there are services available where there are limited provider pools or what not in the future. So I might hand over to Nick for anything more in that space.

Nick Morgan:                                                       

Yeah. Thanks Rusty. The intention under the Support at Home Program is to open up the market a little bit more so that new providers can enter provided they meet the registration and regulatory requirements. And in some cases that may be sole traders for example entering the market. And there’s a separate question on here from someone who – I think it was Dot maybe who uses one of the online platforms and wants to sort of check whether they would still be available under the reforms. So certainly from the Support at Home Program perspective we still envisage that those platforms are part of the service offer. And so those people who are operating on those platforms may need to be registered but they may be able to be registered as sole traders. And I don’t know in that context whether Caroline might want to jump in as well.

Dr Nick Hartland:                                                

Caroline?

Caroline Turnour:                                               

Thank you. Absolutely. So in terms of the platforms as Nick mentioned anyone providing a service will need to be registered. And so there are a lot of different platforms that are operating at the moment. Our primary concern is with the people delivering the services, that we can have trust and confidence in the quality of the services that they’re delivering. But we’re asking a question about platforms because we recognise that we need to have regulatory line of sight and also it’s a new and innovative area and we need to be able to move with the times but we also need to make sure that our services that we’re delivering are able to meet the requirements of our high standard of care. So it’s a new space. Our objective in terms of regulatory strategy is the delivery of that service. How the person and the service connect is what platforms are doing and we need to know what their role is in that space. So we are looking and seeing what is the regulatory need for platforms so it’s a question we’re looking at at the moment. And if you’ve got particular views again we’re very interested in them.

Dr Nick Hartland:                                                

Great. Mel there’s a question on the timing of the new Aged Care Act. When will the new Aged Care Act be finalised, and the questioner notes that providers will need time ahead of 1 July 2025 to ensure compliance.

Mel Metz:                                                              

Yes. I think one of the things people who’ve been listening for this whole webinar will have noticed is that we’ve got a number of measures starting on 1st of July 2024 and Support at Home has been delayed to 1st of July 2025 which means that we’re going to have to have a different approach to the new Act. And so what we’ll be looking to enact by the 1st of July 2024 is the Statement of Rights, the new regulatory framework, the common eligibility requirements and the single assessment process, so the single entry point into the aged care system for people. And the new Act is looking to have a holistic picture of Commonwealth funded aged care services and it will be structured in such a way that we can incorporate the new Home Care Program from 2025.

So effectively we’re targeting the 1st of July 2024 for some aspects and 1st of July 2025 for others. And looking to have a draft Bill ready by the end of this year so that we can take that out publicly and really talk to people about it, get your feedback before we get to the point of introducing that legislation to Parliament.

Dr Nick Hartland:                                                

Look I might also have a crack at one because I think it relates to the Taskforce even if that wasn’t what the questioner had in mind. So the question is it’s very hard to collect income tested care fees from clients. They note that profit margins are getting thin and clients seem not to understand how presumably Home Care Packages work with the income tested care fee. And they would appreciate support from the Government to collect the income tested care fee. Look I think the income tested care fee does – we can see some issues about transparency with the income tested care fee because of the way in which it’s calculated. It is a legislative requirement but we do understand some of the communication difficulties with it. So I think one of the issues that we will put in front of the Taskforce is what is the clearest and most transparent way for providers to consumers for any contributions to be calculated and collected. So I think that’s a really important area of the way the system works, that people understand what the Government’s paying and what they need to pay for their services.

So that will certainly be raised. Whether there are different ways of doing it though of course is another question because it’s quite a complex thing to legislate around. But the assurance is that we are aware of that issue and it will be looked at.

All right. I think again this is one for – I think this is for Nick. So the question is that CHSP was designed and providers resourced to deliver basic entry level care for eligible customers with low care needs and Support at Home includes customers with much higher care needs. Are there any provisions to upskill the current CHSP providers to meet the needs of this new expanded client group?

Nick Morgan:                                                       

Yeah. It’s a good question. I think that will be over time something that may start changing more over time and we can work through. I think the new program as you say will include still those sort of entry level clients coming through the door and we would expect on day one the majority of clients that today’s CHSP providers are supporting will continue to be the same clients they have now and new clients coming through who are similar sort of looking clients. But there will be opportunities for CHSP providers to extend their services and to offer services to people who have more complex needs. And I think the regulatory framework will help us to be able to do that in a sort of structured way to be clear about what the requirements are of providers for different sort of types of services or different categories of services as people maybe move through the spectrum of complexity rather than entirely focused on the client. So if you’re mowing the lawn of a complex client it may still be that mowing the lawn is a fairly simple thing to do but there may be some extra things you need to worry about. But that will be different to someone providing personal care to a simple client versus a more complex client.

So again the regulatory framework will be important. And I suppose again I don’t know if Caroline you want to touch on that as well?

Caroline Turnour:                                               

That’s right. I think the great thing about the new Act and new regulatory framework will be that the services that you’re providing will be the services that you’ll need to meet the obligations for. So as Nick was saying the obligations of mowing or personal care will be I guess calibrated depending on what the risks are associated with delivering those services.

In terms of moving up and delivering clinical services that will depend on your expertise. So I think there was a question there about will non-providers be able to deliver services. There will be no such thing as a non-provider. Everyone will be registered and they’ll be registered to deliver the services that we have made sure that they’re capable of providing. So if you’re capable of providing a service in category one of a particular type then you will be registered into that category to provide that service. If you want to register to deliver different types of service you’ll have to demonstrate that you have the capability and you’re the right type of person to be delivering those services.

So obviously if you want to deliver into a different category then you need to be able to upskill those services to deliver in that category. So that’s what the regulatory strategy and the model is designed to do, if that answers the question.

Dr Nick Hartland:                                                

Thank you guys. Well we’ve just clicked past four o’clock so we will close it there. Let me just say that yes we will share the slides. And we’ve got up on the screen some information about how to – please take part in our voluntary survey. Excuse me. I should have ended with that. We’re always interested in feedback even if it can be kind of confronting. But that’s all cool. We will share the slides and we will share some Q&A documents and also there’s going to be still a lot of times for you to get in contact with us and give us your views about home care reform. So thank you for attending today and you’ll see us and hear from us soon.