Reforming in-home aged care update – 7 December 2022

[Opening visual of slide with text saying 'Australian Government, Department of Health and Aged Care (with logo)', 'Reforming in-home aged care webinar', 'Dr Nick Hartland, First Assistant Secretary - Home and Residential Division', '7 December, 2022', with visual of Dr Nick Hartland and an Auslan interpreter connecting via videocall and visible on the right-hand side of the screen]

[The visuals during this webinar are of the moderator, panellists and Auslan interpreter connecting via videocall and visible on the right-hand side of the screen, with reference to the content of PowerPoint presentations being played on the main part of the screen, with all participants visible during Q&A]

Nick Hartland:

All right. Well good afternoon everybody. Welcome to our reforming in-home and aged care webinar. I'm Nick Hartland, the First Assistant Secretary of the Home and Residential Division of the Aged Care Group in the Department of Health and it's great to see or to hear from a lot of people that have taken the interest to attend the webinar today.

Before we begin I'd just like to acknowledge the Traditional Owners and Custodians of the lands on which we meet wherever that might be across Australia and pay my respects to Elders past, present and emerging. And I'd like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander peoples who are here with us today.

Today we're going to be providing updates to you on what we've heard from the recent submission process for the new in-home care program out of a discussion paper that the Minister released quite recently. We'll talk a bit about CHSP extension and changes until July 2024, changes to the Home Care Packages program and what they mean for providers and consumers. We'll provide an update on the new Aged Care Act and an update on the new model for regulating aged care.

So to help us all through that 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 and Support Branch, Julia Atkinson, the Acting Assistant Secretary of the Home Care and Assessments Branch, Mel Metz, the Assistant Secretary of the Legislative Reform Branch, and Caroline Turnour, the Acting Assistant Secretary of the Harmonisation and Regulatory Strategy Branch.

If you've joined us before you'll be familiar that we also welcome Auslan presenters who will be joining us today to assist. Live captions will also be available. So we've got a link that was provided, an event reminder emailed to you for that, for live captions, and there's some information on our website about how to watch the webinar.

Very importantly we look forward to this interaction at each webinar. You'll have the opportunity to ask us questions throughout the webinar and we'll deal with them at the end. So we've been doing that through the Q&A function. So to ask the panel questions submit a question through the Q&A tab on the lower right-hand corner of your screen, type in your question and hit enter. It'll send to us, then we'll sort through them. Look obviously we won't be able to answer any questions - all questions excuse me. So we'll do our best to get through as many as possible but there will be some that we obviously don't get to.

If we don't get to your question during the webinar we'll be using them to create frequently-asked questions on the in-home reform areas of the department's website so you'll be able to get some information from that. And look as I said before we really look forward to and appreciate those questions so please do use that function to communicate to us.

So noting that time's short and without further ado Nick Morgan will now provide an update about the in-home aged care and the recent discussion paper. Over to you Nick.

Nick Morgan:

Thanks. Thank you Nick.

So my session today is going to focus on what was proposed in the recent discussion paper on reforms to in-home aged care and an initial summary of the feedback we received through the submissions.

The department released the discussion paper on the 18th of October this year which outlined a proposal for a new in-home aged care program to replace the existing programs, the Commonwealth Home Support Program, Home Care Packages Program and Short-Term Restorative Care.

Members of the public including older Australians, their family members and carers, health professionals, service providers and peak bodies were invited to share their feedback on the discussion paper via an online form or over the phone or to upload a submission. And the submissions closed on the 25th of November so about a week-and-a-half ago. So we've been trawling through those feedback.

But before we get to the feedback on the model I'm going to run through quickly what the model is that was proposed in the discussion paper. And apologies to those of you who've joined the Q&A sessions with me over the last month, you will have seen this before but I will still just talk people through so we're all on the same page.

So under the new model as is the case today there would still be independent assessment. It might happen in your home or in a hospital by an assessment workforce. And at the conclusion of the assessment the assessor and the client would together jointly set an initial support plan that would outline services but also would have a quarterly budget attached to it. And that's something that's a bit different to what we were talking about back in January this year where people would just receive a support plan with services, now there's a budget as well.

So the support plan would be set up into two parts, short term or episodic support to support independence and ongoing supports at home. So if we start with the short-term category. That includes goods, equipment and assistive technology, as well as home modifications. And we're looking at a separate scheme for that that would include purchase of equipment. But also we've been talking to states and territories about the proposition of working with them on using their equipment loan schemes which involve loaning equipment and refurbishing it to make the money go further and to have that kind of support for people post accessing the equipment.

Also included there short-term Allied Health services for more intensive support, a bit like what we have today in the Short-Term Restorative Care Program, and then specialised support services. So that's the sorts of things like dementia advisory support, vision advisory services, continence advisory services. Those sorts of things that are funded today through the Commonwealth Home Support Program would be continued to be funded as kind of episodic support for people when they need them.

In terms of the ongoing supports at home, under the model that's proposed in the discussion paper an older person would be able to have one provider or they may be able to choose or if they choose to do so would be able to have multiple providers. As I mentioned there would be a budget. The intention is it's a quarterly budget so people can adjust services within that quarterly budget.

So at the point of assessment you might get a list of services listed and the units of service, so so many hours of this and so many hours of that, in a support plan that fits within the budget but consumers will be able to adjust the services within that budget as they wanted to with a couple of important caveats. What's proposed is that there be caps on cleaning and gardening services so a person can't just essentially load all of their services into cleaning and gardening.

Also in the support plan for people who have more complex needs they would be separately funded to have a care partner to provide that sort of clinical oversight and check in with the client over time.

There'd be also the ability to access extra services for temporary needs when needed. Client contributions we're still working through what that will look like. The Government's still looking at that. So the paper doesn't have a lot of detail in that area but we know that the client contributions under the Commonwealth Home Support Program and Home Care Packages Program are done quite differently and they will need to come together in the new program. So we expect there to be client contributions set according to capacity to pay but we'll need to come out with more detail later on how that would work.

And then from a client's perspective regular reports and services on their services and budget would be available to them.

So that's sort of focusing from the clients what the system might look like. If we go to if you like from a provider's perspective then in terms of the short-term supports, the aids and equipment and home modification scheme like I said that'd be separately funded. It's funding set aside for that so that people can access it when needed upfront. They don't have to save their Home Care Package budgets to be able to afford to access that equipment. I mentioned we're looking at a loan scheme.

We'd also expect to be looking at some national procurements. So we've been talking to other government departments that have these goods and equipment schemes and there may be ways to have more combined procurements to get a good price on some of the more consumable type products.

In terms of the specialised support services I mentioned the expectation is they will continue to be grant-funded if you like separately, a bit like they are today through the CHSP. That's because it's very episodic and needs to be a standing service really and you can't really attach funds to people you don't know when they'll need them.

Allied Health and restorative care. How we reframe the Short-Term Restorative Care sort of elements of the program is still being worked through from a funding perspective. We think there's pretty good opportunity to put more of a focus on that intensive Allied Health supports upfront to step down on to kind of maintenance programs that might be lower cost. So we're still working through with the Allied Health profession on how we set that up and fund it.

So if we move on to the ongoing support. We're looking at a mixed funding model here. It includes activity-based funding. So that's where there'll be a service list of services, each service would have a kind of price attached and as providers deliver services they can then invoice for those services at the prices on the price list if you like for a government subsidy.

In addition to that though we're now looking at supplementary grants for some service types. So transport, cottage and centre-based respite, meals and a social support group would all as part of their ongoing funding model, as well as that activity-based funding they would access some kind of supplementary grant.

And then as we proposed in the original design back in January we would still have grants for providers who operate in thin or niche markets. That might be people operating in remote areas where there are higher travel costs and that sort of thing. Or it might be a provider operating in an urban setting but with a particular group. So like for people who are at risk of homelessness or something like that where there's a need but there's higher costs associated with delivering to that client group.

I mentioned that from a client perspective when they had short-term needs for some extra help that they'd be able to access that help. And that's through a funding pool that providers will have access to and be able to bill against. And the proposition is that that funding pool be set at 25% of the size of their client budgets. So have clients on their books worth $100,000 worth of services, then they will have a funding pool valued at $25,000 in which they can bill against that pool to support clients who need it and it would be up to providers to be allocating that funding to those who need it on a short-term basis.

We're also talking about monthly or more frequent payments with automatic data capture. And again back in January when we had a discussion paper we were talking a lot about a point-of-delivery payment platform in order to make payments and capture that data. Since then we've done a lot of consultation with service providers about that approach and what we've found is not a lot of interest. Or providers are essentially telling us that the outcomes we're trying to achieve, which is the ability to make payments based on the actual service delivered to the client, how many hours of that service paid at a different price and invoicing on that basis can be done from within existing systems. And so now at the moment what we're doing is working at looking at how existing systems can be enhanced to enable that upload and invoicing on a monthly or more frequent basis for providers.

If you just go back sorry. There's a last point on that side. It notes that we are consulting on an alternative approach for First Nations people in Australia. We've had some strong feedback from Aboriginal and Torres Strait Islander providers that there's a need for a more flexible model and we're kind of about to go out and do some consultations around that.

Right. If we move to the next one.

So the discussion paper had five areas of focus that we sought feedback on.

The first was how to support self-management across multiple providers. Two was how to ensure care partners are available to support people when they're needed and at times of change. The third was how to ensure funding arrangements provide value for money without adversely impacting the ability of providers to deliver services. Four how to implement flexibility to meet the changing needs of older Australians over time. And five how to create incentives for providers to innovate and invest in service delivery improvements.

So let's move on.

I'm going to turn to the feedback on the model now essentially against those five areas.

So look thank you to everyone who contributed their feedback and input. We received my notes say 511 submissions but I think we got a few late ones too. So it's probably more like up to 520 or 528 I think I can see a little note on the slide says. But 511 at 2 December, which is what the analytics are based on, from older Australians receiving aged care services, their family members and carers, health professionals, service providers and peak bodies. We also heard from others such as researchers and older Australians who anticipate to receive aged care services in the future, and local governments and advocates.

So I'll provide a feedback of the summary that we've received against the five focus areas, highlighting the views of older Australians, carers and families and service providers. And I should preface the slides by noting that across most areas the majority of responses reflected kind of uncertainty about different aspects of the reforms. And that's perhaps understandable given the discussion paper was at quite a high level and I expect a lot of that is to do with people wanting more detail. So bear that in mind as we go.

All right. So let's start with self-management.

So we've reviewed the submissions to get a sense of the sentiment towards people who self-manage being able to directly book multiple organisations to deliver their services and then those organisations invoice the government without the need for a lead provider as you would have today in a Home Care Packages Program. As I just indicated the majority of respondents didn't provide a clear position but for those who did they were generally in favour of the concept and that included service providers. Carers were probably the most divided. And I should note that where I've labelled these graphs carers that's carers and family members that I've grouped together in those responses.

So one of the questions we posed in the discussion paper is whether people using multiple providers should be responsible for keeping within their budget. Again most submissions didn't tackle the question but of those who did it was really the providers who had the strongest view. A quarter of providers did not want consumers to be keeping track of the budget. And I think what that means is that a number of them indicated that they've experienced issues in the NDIS with clients essentially running out of funds in their budgets before the invoice has been paid leaving the provider to foot the bill. So providers coming in with some concerns there I think.

In terms of the sort of qualitative feedback we received on self-management, issues raised by older Australians who self-manage today include a strong desire to retain the ability to purchase services and be reimbursed and particularly in rural and remote areas. And that's something that's not really reflected in the current model so we need to do some more thinking there.

Also they're worried that if workers and providers have to be registered in the new system that some of the local workers again particularly in rural areas won't want to register and will be left with service gaps. So again something we're looking at now.

And while some tell me they like the idea of accessing multiple providers directly with no middlemen there are others who say they'd be prepared to pay for a lead provider type arrangement to keep track of the budget and help when needed.

And there remains some uncertainty about the concept of the quarterly budget. In some of the discussions I've been having with consumers there's been some anxiety about that meaning every three months you have to be reviewed again and get a new budget. Just to be clear that's not the intention. The intention is that you get a budget, it's sort of an annual budget but it's just paid in quarterly - you know it's allocated in quarterly amounts. And at the end of each quarter if you haven't spent all of your budget, let's say you had a $2,000 budget and you only spend $1,500 the next quarter your budget is still going to only be $2,000, you don't get 2,500. In other words it's sort of use it or lose it in the quarter but you don't get reassessed on everything each quarter.

All right. From a provider perspective like as I mentioned earlier people over-booking services and there being no money left in the budget when the provider invoices for their services is a key concern and that's something we're again putting further thought into. And there's also you know keen to get clarity about accountability for client outcomes where someone has multiple providers and what does the regulatory framework around that look like.

All right. So let's move on to care partners or care management. So yet again majority of responses not a clear view but those who did were largely positive about the care partner concept across older Australians, carers and families and providers. So positive in general.

The next slide.

The discussion paper asked about whether the care partners should monitor outcomes. You know what we see there is those again who answered fairly strongly in favour of yes that's kind of the key role there.

If we go to the next one that's about where should the care partner sit. That's should they be independent or not independent, should they sit within a service provider who's delivering services. Those who did favour the care manager being independent, those who answered the question tended to favour the care manager being independent of a client service. Older Australians and carers were particularly strong in this view but interestingly providers who answered were also in this camp which did surprise me a little bit. I thought providers might push to have care partners sitting within the organisation but again the majority of people really didn't have a strong position in their submissions on this.

So in terms of the qualitative feedback older Australians and carers and families are clear that they don't want people making decisions for them as care managers. They want help to be available when they need it, not just on a schedule. They don't want expensive fees for care management services that are invisible to them, as in the service is invisible to them and what are the fees for. And per the previous slides some consumers are really adamant the care partners should be independent. I think COTA may have also expressed that view in their submission.

From a provider perspective there's a real concern about accountability of the care partner particularly where the client has multiple providers. Providers want a more precise definition of what care management should cover which could include onboarding clients, care planning and clinical oversight, implementing care plans, monitoring and evaluating client goals and service delivery and so on. But it's also what's in and what's out is important.

They want more clarity on how episodic support will be funded. One option we're thinking about for example is an extension of that flexible funding pool concept I talked about earlier. In other words there could perhaps be an additional funding pool to build care management services against but we're still working that through.

There is a question about the clinical qualifications needed for care partners. At this stage we're considering how to support the team-based approaches that we are told operate today that could involve a mix of clinical and non-clinical staff with clinical oversight. We kind of again need to get to some further clarity on that particularly for the service providers.

And finally there's still a question around how care management would operate for lower-level clients and single-service providers.

All right. On to the funding model.

This chart shows what we saw in terms of just overall sentiment towards the proposed funding model and for those who expressed a view it was really pretty mixed. Carers were fairly positive. Clients were fairly evenly divided. Providers were more negative about the model although there was still a fair proportion of positive providers as well.

In terms of the feedback we are getting on the funding model older Australians have said that they like the idea of the budget but have concerns about it being quarterly. And as I mentioned there had been some confusion around needing to get a review or assessment each quarter which isn't being proposed.

Most Home Care Package clients are happy to hear that prices would be set by government rather than providers. Although several self-managing clients have indicated that price ranges or price caps would be better than just set prices to allow them to shop around for better prices if someone offers something at a lower price than the government price.

There's also general support for a model that opens up the market to new providers rather than locking in only the grant-funded CHSP providers in a region particularly in areas where there's a shortage of services available today.

From a provider perspective understandably very wary about the model until they see more detail I guess. And so what we're seeing is some pessimism about prices being set too low. And in terms of prices I should say the Independent Health and Aged Care Pricing Authority will be providing advice to government in 2023 on initial prices for the program based on the cost of delivery for providers and they would include administration and travel and other costs in those prices. Some providers are arguing for alternative funding models such as either retaining grants or moving to a sort of fixed and variable funding model under a case-mix type approach.

But that said providers have generally acknowledged that the discussion paper has sought to address concerns they raised earlier in the year about fee-for-service type funding through the addition of the supplementary grants and more detail on the flexible funding pool.

Some providers, particularly those used to grant funding have sort of flagged that the model looks too complex. And many of the grant-funded providers suggest that it's also a bit too transactional and competitive and that's something that's come through strongly from local government.

There's also very strong desire from providers for more details to come more quickly I suppose and for implementation to be staggered so that they have time to make business decisions and changes to their systems.

All right. The fourth topic of our five topics is around flexibility for changing needs.

So this might just be our first chart where the majority did express an opinion, and the opinion was overwhelmingly positive across all groups. So people supported the idea of the flexible funding pool and the ability to change services within a budget.

If we go to the next one.

So we also asked about the size of the flexible funding pool. The discussion paper proposed 25% of a provider's total client budgets form the pool. I mean I guess very few people really had an opinion on this one. Providers who did answer were divided between 25% being about right or suggesting it should be a bit higher.

So the next one.

Yeah. So in terms of the qualitative feedback, people liked the concept of flexibility but some concern about providers determining how the flexible pool is spent coming through from consumers or older Australians.

There's support for the budget concept and support for a separate scheme for goods, equipment and home modifications as needed so that people don't have to save for those services. And providers are supportive of the flexible fund but they're really keen to ensure that there are guidelines on how it can be used so they don't have to get into disputes between their clients about why one person got something extra through the pool and another person didn't. They want some clarity around how that pool can be used.

All right. The last area that we asked for feedback on was innovation.

Look I haven't split this chart into the different groups but the responses were a little bit scattered. We proposed innovation grants which got some support. A small number also suggested relaxing regulation but most made suggestions I guess in the other category. So a couple of those if we click should pop up on the slide.

Thanks.

So some of the suggestions included greater focus on technology, letting providers - something that came through from some providers was around letting providers increase prices to deliver higher quality with more quality measures for consumers to know if the extra cost is worth it like star rating systems and the like.

Some took the opportunity to say that the whole concept of activity-based payments will stifle innovation. Collaboration with universities was proposed. And there was some support for the concepts around how you could better share innovative practice through communities of practice and the like.

So there has been some interest from consumers in some of the concepts that were flagged in the discussion paper including the idea of pooling funds in a congregate setting. What I mean by that is for people who for example live in a retirement village are they able if there's multiple people there who all have in-home aged care budgets could they pool those budgets with their provider to try and get the money to go further. That was flagged in the paper and got a bit of support. Similarly the home share arrangements that were flagged as something that could be explored where for example boarders stay with people rent free in exchange for sharing chores like cleaning, shopping and gardening, there's been a bit of interest in that sort of thing.

As I said on the previous slide service providers have expressed some concern about a model which sets prices and pays for services on activity-based processes.

All right. So that's the five areas we asked for feedback but of course people didn't limit themselves to giving us feedback just on those five things. So this slide talks about what's some of the feedback that was on things that were missing from the paper.

So firstly older Australians and carers are keen for more information on the assessment arrangements. In fact everyone's been keen for more information around assessment. We're planning a large-scale trial in April next year with the existing assessment organisations which should give us data on around 20,000 assessments that we'll be able to then use to verify the new assessment approach and the classification arrangements that are proposed. That's the next big thing that we're looking to do on assessments before getting to the next version of what we're proposing.

Carers have raised some concern about access to respite. And we are planning a couple of workshops I think even before Christmas that Carers Australia is organising for us with a focus on spouses who are carers as well as children who are informal carers. So we'll be trying to get a better understanding of the issues in that space through those workshops to progress.

Different diversity groups have raised issues about a lack of information on things like translation services. And we're going to have to set up some further workshops early in the new year to make sure we've picked up those issues and we're clear about what's included.

The discussion paper didn't have too much detail on the goods, equipment and assistive technology and home modifications scheme, that's a bit of a mouthful. We're looking to try and release another paper with our thinking on that shortly.

Service providers are watching the clock I guess is the best way to put it. The government did extend the start date for the program but time is still ticking and they're looking for details as soon as possible, including on ICT and transition arrangements as well as regulatory changes.

Providers are also very focused on workforce constraints and workforce shortages, especially in rural and remote areas are already constraining services so that's a focus. Obviously the Fair Work Commission wage case should have a positive impact. And there are a range of other initiatives underway including through training places and support to attract new workers into the sector and so on.

All right. I think I'm coming to the end. I hope I haven't gone too far over. No one seems to have nudged me yet.

So in terms of next steps we will be continuing the consultations right through to February before government makes some decisions probably in the context of the normal May Budget next year. And then that'll give us around a year, a bit over a year to once we've got some decisions move across into transition and implementation ahead of that July 2024 start date.

So thank you. Thanks for listening today. Please contact us if you have any further questions or queries. And look out for further consultation and sessions that we'll be running right through over through to February this year - next year. Thank you.

Nick Hartland:

Great Nick. Thanks very much. And we've seen quite a few questions come in as Nick's been talking and we'll have a chance to deal with some of them towards the end of the - at the end of these presentations.

So now I'd like to introduce Russell Herald who will be providing an update today on the Commonwealth Home Support Program.

Russell Herald:

Yes. Thanks Nick.

So a quick update on CHSP for everyone. The first thing. So obviously with the extension of Support at Home to 1 July 2024 CHSP has been or will be extended by another 12 months. That was outlined in the most recent Commonwealth Budget. Detail of the extension is expected to be provided to everyone in front of Christmas. We're just finalising a few bits and pieces at the moment. But I just wanted to outline that the broad intent of the extension will be basically status quo, a rollover of the system as it is with a few minor adjustments here or there.

So what that means is we retain the nationally consistent unit prices that we implemented from 1 July 2022 but there will be an indexation increase on the unit prices in line with ordinary processes. I can't detail what that is today but that will come out shortly. There will be continued monthly payments in arrears and monthly reporting. That so far has been going really well with 97% compliance or uptake of those arrangements which is really good. And we'll have a continuation of the 100% flexibility provisions in the way in which providers can use that funding.

I guess onto the next slide.

The one element around the extension which is quite uncertain at the moment is how we respond to the Fair Work Commission interim decision around the 15% increase of wages for direct care workers under the Schedule E and Nurses Awards. So we did send out a survey to do a couple of weeks ago and thank you to everyone who responded to that. We're just going through the detail at the moment. But what we'll be doing, once a decision has been made by the Fair Work Commission around when it takes effect and how, we will provide further advice about what that means to funding under CHSP.

So the message I wanted to provide here is when we come out in the next few weeks around the funding indexation for the next financial year it is not yet inclusive of the Fair Work Commission process and further advice will come through.

Apart from that we have been asking CHSP providers to update their My Aged Care client records as soon as possible. What we are doing there is trying to make sure everyone is on the system so that we can be as prepared as much as possible for the transition to Support at Home.

We will be providing shortly a fact sheet and an update to the CHSP manual in line with everything here with the extension. And as I said before that will be in front of Christmas. So please look out for that and get on top of the changes that will come into effect on 1 July.

Okay. Next slide.

The other minor elements that will be included as part of the CHSP extension are we will be clarifying the definition of what a specialised support service is. This follows a range of consultations with existing SSS providers and the new definition will come into effect on 1 July 2023. I think most if not all providers will have seen this by now.

I will respond to one comment that was in the questions. It is clarifying how CALD and Indigenous services are in scope for specialised support services. So look out for that if you are a SSS provider.

Sector support and development. With that service type in CHSP we now have a community of practice that's been stood up. And we will be working with those providers on an ongoing basis to help facilitate connections into CHSP providers on the transition to Support at Home to help relay information and also to get feedback from providers through SSD providers into the department so we can help improve the - or help the information flow in the change management process. So that is another thing to look out for if you are a CHSP provider.

Finally on this one, the care finder program will start on the 1st of January 2023. So that is when we'll formally see the navigation elements of assistance with care and housing split out from CHSP into the care finder program, with hoarding and squalor to remain under CHSP and it will eventually move into Support at Home. And more information will be provided around that as part of the process for finalising Support at Home.

Next bit. And I'm not sure if many people saw the announcement on this but recently we did expand the provision of goods, equipment and assistive technology in CHSP to address a couple of policy issues around Home Care Packages and the effect of having monthly budget allocations in Home Care Packages. So what that means now is if a Home Care Package client has exhausted their monthly budget and has an urgent need for goods and equipment they're now able to access up to 2,500 worth of GEAT from our national assistive technology provider geat2GO.

So that is a way of just managing until we get the design of the new assistive technology program in the Support at Home broader program. It also applies to clients who are eligible for Home Care Packages but are currently waiting to be assigned so we can push out any technology that we need to as soon as possible.

Finally I just want to make a point around the standing grant opportunity that exists on GrantConnect. We do occasionally get information saying that we don't have enough funding to deliver demand for services.

We do have the ability for providers on an ongoing basis to come to us and put in a bid for additional funding to expand service delivery. It's that second sub-dot point there. So if you are a provider and you do have the workforce and do have the capacity to help meet demand, please feel free to put in a funding request. We do have a budget allocation that we can distribute there and that's our standard response when people come to us for that information. Applications are open until the 30th of April.

Okay. And next - well I think this is the final slide for me.

And I'm hoping everyone in CHSP is aware but effective the 1st of December the Serious Incident Response Scheme has been extended over the top of CHSP. So obviously what that means is that the Aged Care Quality and Safeguards Commission has the ability to pick up and investigate issues consistent with Home Care Packages in resi where this already applies and CHSP providers will be required to have a system in place to capture and report serious incidents. So that includes unreasonable use of force, neglect, psychological or emotional abuse, unlawful sexual contact or inappropriate sexual contact, unexplained absence, unexpected death, inappropriate use of restrictive practices and stealing or financial coercion by a staff member. And CHSP providers are reminded that a high priority reportable incident is reportable within 24 hours or 30 days for a priority 2. So if you are a CHSP provider and not across that information at the moment please ensure that you move on that as soon as possible.

And I think that's it from me.

Nick Hartland:

Thanks very much Russell. As I said please keep your questions coming. I'm just flicking through them at the moment.

And now I'd like to introduce Julia Atkinson who will be providing an update on Home Care Packages.

Julia Atkinson:

Hi everyone. Thanks so much for joining us today. I'm Julia Atkinson, the Acting Assistant Secretary of the Home Care and Assessments Branch, and I'm here today to share with you some information about the recently announced caps to administration and management charges in the Home Care Packages program and these caps will come into effect very soon.

Capping how much your package can be charged for administration and management was a key election commitment and this was based on the Royal Commission's findings. The government is now progressing a number of measures to reduce excessive charges and make provider pricing more transparent.

So let me tell you a little bit about the changes that we're making from 1 January 2023.

Firstly care management will be capped at 20% of the package level and package management will be capped at 15% of the package level. Providers will not be able to charge more than 20% for care management or 15% for package management from 1 January onwards. Providers cannot charge for package management in a calendar month where there are no services being delivered other than care management. And there is an exception for this in the first month of care as there are some - we acknowledge there's onboarding to be done.

Providers will no longer be allowed to charge exit amounts when a care recipient moves providers or leaves the program.

And lastly third-party service charges such as subcontracting and brokerage charges must not be charged separately. Providers will need to incorporate these charges and costs into their care management, package management or direct services charges as appropriate.

I want to point out that these caps that I've just stated now are the maximum amount that a provider can charge and most providers do and will continue to charge less than these caps. These caps are not what we consider to be a fair and reasonable price in most circumstances. However there may be some circumstances in which they're appropriate.

And so if you are currently getting charged less than that cap don't worry, it's not about to go up. Your provider can't charge those amounts without having that conversation with you and your agreement and it would be inappropriate for them to do so as a result of this measure.

So setting those caps and the levels of them. It's a balancing act getting those numbers right and our aim is to target high charges and really excessive charges and make sure that you have more funds for direct care and services. At the same time we absolutely must ensure that providers continue to have enough funding to deliver quality and safe care and the services we all expect.

So the next steps on those numbers. The government will continue to monitor the situation and consider the need for any further action on administration and management charges over the 2023 calendar year. And that monitoring will focus on providers who perhaps raise prices unreasonably, those who charge over the caps or charge separately for third-party or exit amounts. We will be looking very closely at that.

So I next want to speak briefly about what we mean by care management and package management and provide some clear definitions. I want to be really clear that I'll be speaking about the Home Care Packages Program as it exists today and from 1 January 2023. And I note that Nick Morgan spoke earlier about how care management could transform into a care partnership model under Support at Home. So please take this advice as relevant if you're a Home Care Package's client from 1 January 2023 until the commencement of Support at Home.

So in the Home Care Packages Program as you may be aware care management is a mandatory support service and this reflects the complexity of care typically required by a HCP recipient. All providers have responsibilities under the legislation to all of their care recipients including those who are self-managing.

So we have updated our communications and definitions on care management under the Act to make these responsibilities as clear as possible and our definition is as follows. Providers must regularly assess the needs, goals and preferences of care recipients. They must review their home care agreements and care plans. They must ensure that their care and services align with other supports. They must partner with care recipients and their family or carers about their care and the choices they make about their care. They must ensure that their care and services are culturally safe and they must identify and address risks to their safety, health and wellbeing.

So we've made an update to this definition largely to give you and your family some guidance on what you should expect from providers. We want to emphasise the essential role that care management can and should play in the tailored delivery of your package and we want to recognise you and your family's role as active partners in your care.

Everybody has different needs and goals. Services need to be flexibly delivered and may be more or less intensive as your preferences change.

So package management. Package management is a service that supports the delivery of the Home Care Package and these services can include activities such as establishing and managing home care budgets, coordinating services such as scheduling and getting rosters in place and making sure that things are organised, preparing invoices and monthly statements and conducting quality improvement, compliance and assurance activities.

Package management does not include business overheads or costs or general administration and communication or marketing costs. Those costs should be built into the direct care costs that are paid in the direct care billing.

So what do providers need to do when they're charging for care and package management? Providers must set reasonable and justifiable prices for care and services. To do this they must ensure that prices are value for money and reflect the resources it takes to provide the care or service. They must make sure that their prices are clear, understandable and transparent and that they are in the best interests of their care recipients. They must make sure their pricing is in line with the program requirements and legislation and that it's directly related to coordinating allowable care or services or purchasing goods to meet the care recipient's assessed needs and goals.

They should not price care or package management as an hourly charge or hourly price on top of a base care or package management charge. You should see one charge for care management and one charge for package management, not a base charge and then an hourly charge.

So providers should also not set a separate price for extra care management or package management. So you should not see additional charges for a care plan review and development or extra invoice processing. This should all be captured in your already agreed price.

From 1 January 2023 even if you request or agree to it providers cannot charge more than the maximum amount for care and package management, they cannot charge for a third-party service separately and they cannot charge an exit amount. Providers must publish a distinct price for each service type in a dollar figure so that you can better understand and compare prices. They can also publish a different amount for self-managing care recipients.

So what do these changes mean for you? I want to quickly take you through an example of what this might mean for someone where their provider needs to make some adjustments.

So our example is on the screen. We have Mary who is on a package level 1 and her package costs include $75 a fortnight for care management which would be currently above the cap from 1 January and $40 per fortnight for package management which would be below the cap. We find that Mary is also charged a separate sub-contracting amount for gardening services and that that gardening is charged at $57 per hour plus $7 subcontracting. And so under this example her provider's going to need to make some changes to get in line with the legislation. They need to reduce their care management to below the cap, they must adjust their prices where necessary and they must make sure that their pricing is all inclusive of subcontracting costs.

So next slide please.

So what happens next? The client and the provider much reach agreement. So before 1 January 2023 Mary's provider must sit down and talk to Mary about these changes and propose some new prices in line with the new legislation.

So the prices they propose are a $5 reduction per fortnight for care management to bring it in line with the cap, a $5 increase per fortnight for package management which remains below the cap. They also propose that gardening will be charged from now on at $60 per fortnight all inclusive. And the provider meets with Mary to discuss and explain these new prices and they explain that they're moving scheduling services from care management to package management as this is an administrative task so they can collect the cost of doing that task under package management and that's okay. They will cover invoice processing costs for Green's Mowing in her existing package management charge and they will combine the service price for Green's Mowing and the reasonable business cost to make one price.

Mary is welcome to ask questions and negotiate this price and she in this example agrees to the price changes as they make sense to her and they seem reasonable. So once they've reached agreement, Mary and her provider, the provider will update Mary's documentation and include these new prices in her home care agreement and monthly statement. Mary will need to review this and sign it and the provider will need to discuss, agree and document the changes with their care recipient, so with Mary to ensure that she understands what's in that document. The provider will need to update the My Aged Care website so that their pricing schedule is now in line with what they're currently doing and in addition they'll need to update their own organisation's website for consistency.

So that's an example where we've got a provider who's slightly above the cap and what they would do reasonably within the legislation to get into the cap.

So the next slide please.

And somebody give me a nudge if I'm starting to run out of time. I'm not sure if I am.

So the key benefits to this measure I think are pretty clear. We are really aiming to reduce excessive charges for both care management and package management so that we can get more funding targeted at direct care. We don't want to see excessive and outrageous charges for administrative charges that we can't justify what's happening with that funding.

The measure's also going to help us with the transparency of provider pricing. So getting rid of exit charges and separate prices for using third-party providers will mean less hidden charges. Care recipients and their families will better understand what's being charged and why. You'll be able to compare prices more effectively using the finding a provider tool on My Aged Care. And the greater transparency also provides a fairer playing field for providers because we know that the clients can now better compare apples with apples.

This is also going to help care recipients know what to expect from their providers and knowledge is power. We are making it as clear as possible what services you must receive as part of care management, so what your provider must give you for that charge. And we are making it clear that all care recipients under the Home Care Packages Program will receive some care management but that this needs to be worked through with you, that you are a partner and that that activity will be agreed how that will be done.

We've also developed guidance to support providers to do the right thing and comply with the legislation and departmental policies. Providers need to work in partnership with you and to ensure that your package budget is used appropriately and transparently. Care recipients should be actively involved in deciding how their package funds are sent and providers should support this.

We have additional guidance online to support providers to understand these reforms and their general obligations when it comes to pricing services. We will closely monitor prices published by providers to ensure they are complying with the legislation, that they are not moving their prices to the caps and that they are not being unreasonable in shifting costs. Another aspect of this work is about improving pricing data. And less hidden charges will mean that we can get a better understanding of what providers are charging and what the costs of services are and that'll inform our reforms moving forward.

Okay. Next slide please.

So what can you do if it seems like something's not right?

What if your provider comes to you and proposes changes to your home care agreement that don't sound right to you and that you don't agree with? I would reiterate providers must make clear what their reasons are if they are proposing to lift prices. For example if they are integrating a subcontracting charge into a service fee and so direct care charges go up but overall the cost hasn't gone up, that's a pretty easy story for them to tell. They need to make that really clear and communicate that with you.

So they are obligated to have that conversation and they're obligated to seek mutual agreement before updating your home care agreement or charging new prices. If you don't agree to the changes they propose providers may try to negotiate the price with you to reach agreement and that's okay.

You may seek independent advice such as consumer advocates, family members or legal advice should you choose to. And you may choose to change providers if you're unhappy with what your provider is offering you. The My Aged Care website provides a range of tools to support this choice.

Prices can only change if you agree and you do not have to. Meaning providers must continue to provide care under their current agreement, that is an obligation.

So that's all from me. Thank you for listening today. I hope you found this a useful presentation. And if you have any questions or concerns you're welcome to contact the department via the website or through my team. Thanks everybody. Have a great day.

Nick Hartland:

Thanks very much Julia. Thank you for that. Okay Mel Metz over to you for an update on legislative reform.

Mel Metz:

Thanks very much Nick.

For those of you who don't know my team has responsibility for the aged care legislative reform program and that includes amendments to current legislation as well as delivering the new Aged Care Act. And today I'm going to provide you with an update on development of the new Act and also a summary of what we're proposing under the new Act for the appointment of supporters and representatives of people seeking or receiving aged care services and they're often referred to as nominees.

So we've made quite significant progress in the second half of 2022, progressing a number of time-critical amendments to the aged care legislative framework. Most recently on the 27th of October the Aged Care Amendment (Implementing Care Reform) Act passed the Parliament and that Act received Royal Assent on the 9th of November 2022.

It contains three measures to implement the government's election commitments. And they are to require a registered nurse onsite and on duty 24 hours a day, seven days a week in residential aged care, cap administration charges and banning exit fees in home care and improving transparency and accountability of aged care providers.

So in addition work has been progressing on the subordinate legislation that supports all of the interim amendments that occurred this year. And we've had 13 instruments that are now complete, 12 have commenced and one is due to commence early next year and we've got a further three legislative instruments that are currently in development.

The passage of those interim reforms means that we can now focus on developing the new Aged Care Act as recommended by the Royal Commission. And we're working with the Office of Parliamentary Counsel on the bill for the new Act, with drafting instructions for the primary legislation and all of the related subordinate legislation being prepared. And this is happening alongside all of the regular consultation that's happening with internal and external stakeholders.

So feedback from older Australians, their families and carers and the sector is being sought at the same time that the new Act is being developed and prior to broader public consultation on an exposure draft next year.

The Council of Elders, the National Aged Care Advisory Council and the National Aboriginal and Torres Strait Islander Aging and Aged Care Council are also being consulted with recent discussions focusing on how rights will be presented in the new Act and the proposed access and eligibility arrangements.

So I thought today would be a good opportunity to talk through in some greater depth the proposed arrangements for nominees and supported decision making under the new Act. Under the new Aged Care Act we plan to establish clear nominee arrangements and I'm going to provide you with an overview of the proposed approach. But first I'll just caveat that by noting that at this stage substitute decision making for restrictive practices is outside the scope of the proposed nominee arrangements. That aspect is currently subject to ongoing work with state and territory governments. And while we don't expect any of that will be inconsistent with the proposed nominee arrangements it will likely need to be more targeted and have extra requirements to interact with state and territory laws.

So what is it that I mean when I say nominee? A nominee is a person who's nominated to represent or support another person due to some form of inability, need for help or want of help. There are a number of established nominee arrangements under existing Australian government schemes including the NDIS and Social Security. Those arrangements vary but they generally involve an administrative process where a person or body is appointed to act on another person's behalf.

Most existing models also have different types of nominees who perform different functions and have different levels of power to act on a person's behalf. And we've looked at several of the existing schemes to develop our model and we propose to adopt some aspects of these existing arrangements under the NDIS and the National Redress Scheme.

So you might be wondering what's wrong with the current arrangements and why there needs to be a change. So currently aged care law includes inconsistent references to representatives or equivalent, with varying definitions and differing approaches taken across different aspects of the aged care system. The current legislative framework doesn't include an administrative process for the appointment of representatives and the definitions are very broad which means that multiple people could equally be considered a representative at a point in time. And separate to the legislative arrangements My Aged Care also has a process that allows for the appointment of representatives.

These types of inconsistencies have been known to lead to confusion, family disputes and decision shopping. So one of the aims of the new arrangements will be to introduce a consistent approach for all aspects of aged care. And the new arrangements will also integrate supported decision making which is not explicitly considered under the current arrangements.

So this slide provides - sorry if you could just go back to the previous slide sorry.

This slide provides an overview of the proposed types of nominees. So consistent with the arrangements under several other schemes we're proposing to have two types of nominees for aged care. We've taken guidance from the recommendations of the Australian Law Reform Commission which were supported by the Royal Commission to call the two types of nominees 'supporters' and 'representatives'.

Supporters will have similar functions to a regular representative under the current My Aged Care arrangements and assistance nominees under the National Redress Scheme. Supporters will only be appointed on request of the person receiving aged care and they're meant to support that person to navigate the aged care system and help them to make informed decisions on their own. So therefore that person wouldn't have the power to make decisions on behalf of the person receiving aged care.

Representatives will have similar functions to authorised representatives under the current My Aged Care arrangements and are similar to legal nominees under the National Redress Scheme or where a person is both a co-respondent and a plan nominee under the NDIS. Representatives would be authorised in general to take any action or make any decision that a person receiving aged care would be able to although they would only be able to exercise those powers as a last resort. And representatives might be appointed where a person receiving aged care doesn't always have the capacity to make decisions on their own or where they don't want to make those decisions. A person can also appoint a representative in the event that they have a decline in their capacity later.

And it's really important to clarify here that a person receiving aged care does not forfeit their own decision making ability when a representative is appointed. The representative would just be an alternative decision maker if and when that's required.

Next slide please.

So we also propose that the new nominee arrangements will integrate a supported decision making model. The Royal Commission noted that a diagnosis of dementia or cognitive impairment does not mean a person is incapable of making decisions and instead the person requires support to help them understand the information, make decisions and communicate those decisions. So nominees will have a series of duties which include making the best endeavours to maintain the capacity of the person to make their own decisions. And it's the intention that a nominee will often support a person receiving aged care to make their own decisions. And in some more difficult circumstances others such as advocates may provide that support too.

To ensure that people receiving aged care are provided every opportunity to maintain their autonomy, make decisions and take actions on their own, representatives will have a specific duty to refrain from doing an act or making a decision on a person's behalf unless it's not possible for the person to do so or to be supported to do the act or make the decision themselves, or where it's possible for the person to do the act or make the decision they instead want their representative to do it for them.

Next slide please.

Sorry.

In the limited circumstances where a representative needs to make a decision or take action on behalf of a person receiving aged care they'll also have a duty to do so in accordance with the decision making principles as recommended by the Australian Law Reform Commission and supported by the Royal Commission. So where a person's either not able to make the decision or be supported or where they want the representative to make the decision for them they'll need to work through these principles in order.

So first they'll need to ensure that the decision or action is undertaken in a way that gives effect to the wishes and preferences of the person. And in circumstances where the current wishes and preferences of the person cannot be determined the representative would need to give effect to what the person would likely want. This will be done based on all of the available information which would include the representative consulting others such as family and other persons with close continuing relationships with the person receiving aged care. And lastly if it's not possible to determine what the person would likely want, the representative would act in a manner to best uphold the person's human rights and therefore act in a way that would be least restrictive to those rights.

The proposed aged care nominee arrangements will operate in parallel with state and territory arrangements rather than relying on them. However where a person is appointed as a representative regard will be given to whether there's a person who has authority already to make relevant decisions under state and territory laws.

So in most circumstances if there's a person with this authority they're likely to be the most appropriate person to be appointed as the representatives. But nevertheless if there are circumstances where it might be appropriate to appoint someone else that can be done. For example a person might have nominated one of their children as their enduring power of attorney but they want to have their other child as their nominee for the purposes of aged care. And the proposed arrangements will ensure that consumer choice can be supported through the arrangements.

And I just want to reiterate that the representative's powers would be limited to decisions or actions that may be taken under the new Act. With the complexity of interactions with state and territory arrangements we want to ensure that the nominee process under the new Act doesn't cause any unintended consequences for older Australians. And we consider that this approach will ensure greater choice for older Australians if they want to have someone different as their nominee for aged care purposes. And the proposed approach will reduce complexity and allow for one person to fulfil that nominee role if that's what's preferred.

Next slide please.

So this last slide brings together all of the elements that we've covered in this discussion and summarises the nominee arrangements proposed under the new Act. I'm aware that there's a lot happening on this slide but we thought it would be useful to provide it by way of summary as part of the webinar.

The existing Act does not include an administrative process for the appointment of representatives. And under the new Act we'll be seeking to introduce a new framework for appointing nominees and therefore clarifying the existing arrangements.

The Royal Commission said that people in receipt of aged care often lack the opportunities and support that they need to make meaningful choices about their lives. And this new framework intends to make it easier for people to make decisions about the aged care that they receive.

And that's all. Hop onto the next slide thanks.

So I hope that's provided you with some clarity on the proposed arrangements. I'm grateful for any feedback that you have on this through the chat function and I'm very happy to answer your questions about the proposed arrangements at the end. Thank you.

Nick Hartland:

Thanks very much.

Thanks very much Mel. Now we'll go to Caroline Turnour who will be providing an update today on the new model for regulating aged care.

Sorry Caroline. You appear to be on mute.

Caroline Turnour:

Sorry about that.

Good afternoon and thank you Nick.

Regulation, the new regulatory model, definitely last but not least. So I'm Caroline Turnour, I'm the Acting Assistant Secretary for the Regulation Strategy and Harmonisation area of the department and my team is working hard on the details of the regulatory model. So thank you for joining us today and thank you and we're very pleased that you're keen to find out more about our work and how this relates to the reforms that are happening.

So a quick recap. A high-level design so far and the main changes we are proposing, and then we'll touch on feedback we received to date and share what we've been working on.

 So the new regulatory model for aged care is required to support the new Aged Care Act and the new in-home care reforms. The agreed model will commence on 1 July 2024 with the new Aged Care Act. We provided a high-level outline of the new model in the consultation paper released in September this year.

Key changes from the current arrangements include that the new model will be person-centred. The current approach is provider-centred. The new model will be rights based and designed to protect older Australians' autonomy and dignity. It will be risk proportionate instead of a one-size-fits-all approach. This means the regulation will be proportionate to the risk associated with delivering that service. It will promote continuous improvement and build sector capability.

Registration will be introduced as a single entry point for all providers wishing to deliver Commonwealth subsidised aged care services. Non-corporations such as sole providers and partnerships will be allowed to enter the sector. Under the current approved-provider arrangements only state and territory governments and corporations can be approved providers. This will support greater choice for older Australians and hopefully improve sector sustainability. Assessment of providers against the Aged Care Quality Standards will be graded to incentivise excellence and innovation. This will replace the current pass and fail assessment against standards.

So what we've heard. I'd like to thank those who provided feedback on the regulatory model outlined in the September consultation paper. We received 40 submissions and 108 completed questionnaires. The feedback was broadly supportive of the proposed model but called for greater detail on how proportionate regulation will work in practice and how registration will work. We also heard that there was a preference for referring to the sector rather than the market and a desire for older Australians to be active participants in care decisions and assessing and managing risk.

Therefore we need to find a balance between managing risks without being overly prescriptive and reducing consumer choice and dignity. We also need to avoid duplication with other accreditation and regulatory requirements, for example AHPRA. We also need for there to be alignment and mutual recognition across the programs, for example worker screening arrangements between the different programs that are currently provided subsidised by the Commonwealth. And we also need for complaints and handling processes to be robust and independent and involve professionals, carers and family. We need for the regulation to foster a collaborative culture and build capacity for collaboration across and as well as being appropriate for the enforcement powers. So the model also needs to integrate with other aged care reforms.

So registration categories and provider obligations. Registration categories will be developed with group services with familiar characteristics and similar risks. This slide gives examples of two possible categories. These are just possible categories. A provider will be able to apply for registration into one or more registration categories based on the services that they are looking to provide. Registration into a category will enable a provider to deliver all the services within that category. And providers will need to nominate the services within each category that they are primarily delivering.

Registration requirements including the application and assessment process will be proportionate to each registration category.

So we're talking about obligations. Obligations on providers to manage risk will be attached to registration categories. Based on these categories provider entry requirements, obligations and regulatory oversight will be graduated, that means it’s specific and are proportionate to the risks being addressed. There will be core obligations that all providers need to meet, for example a code of conduct for aged care. Then there'll be category-specific obligations to address characteristics and risks that are common to the services in that category. And thirdly there'll be specific obligations that the regulator can apply to specific providers or registration categories to address other risks.

So developing the detail. We are working on developing the evidence to support the design of registration categories. This includes developing the evidence for establishing the right groupings of services into categories and the category boundaries. We're also ensuring obligations are proportionate and effectively manage the risk associated with the services. And we're looking to make sure that there is flexibility to accommodate future services.

We're working through the detailed considerations such as how to manage a situation where providers wish to provide services across several categories with different obligations, how to assess providers with multiple sites. For example a new residential care provider with multiple locations, would all sites need to be assessed before the commencement of the services or initial sample with the remaining services tested after they have opened? More details on these issues will be included in the next round of public consultations expected to be released early next year.

So thank you for your participation and we're looking forward to receiving your feedback and questions. On the slide we have our email address and please feel free to send us your feedback. Thank you.

Back to you Nick.

Nick Hartland:

Excellent. Thank you. So thank you to everybody who's been putting in questions. We have just over 230 questions. But we've got a bit of time to get through them but I don't think we'll get to all 230. So Nick I think the first question's for you.

Q:          Has the Support at Home Program name been changed to In-Home Aged Care Program?

Nick Morgan:

Yeah. Thanks for the question.

No. Not formally. The discussion paper referred to the in-home aged care reforms more as a general term rather than as a name. I think as the government makes its final decisions on what it's wanting to do with the program we'll formalise the name. So no the name hasn't been jettisoned. It's causing me as much confusion as it is you. But we've just been talking in a more generic language I guess.

Nick Hartland:

Thanks Nick. I thought I'd get rid of that issue first up. Excellent. Thanks for the question.

So this might be either you, Russell or Nick. Wendy's asking:

Q:          I'd like more detail on ACH funding please as hoarding and squalor cleans can't be activity-based reporting and Wendy noted that they sometimes cost around $10,000.

Nick Morgan:

So Nick I might jump in again just quickly.

That's a good point. And part of the ACH or the Assistance with Care and Housing services will be I think part of the care finders role where it's more supporting people and linking services. The hoarding and squalor services will be within Support at Home.

It's something that's come up though as well with the home maintenance providers that I've been talking to is the if you like episodic nature sometimes of those sorts of services or in some cases it's the seasonal nature of getting work done in the home maintenance space. Hoarding and squalor is probably one that has some of those similar sort of lumpiness to it. I think it's on my list to be doing more work over the next couple of months to work through you know how we make sure we accommodate that.

So I don't have a great answer for you other than it is on the list of things that we need to work through in the coming months along with some of the other home maintenance type services that are also lumpy.

Nick Hartland:

Yeah. Thanks Nick. Mona asks:

Q:          Will these slides be available on the website after the webinar?

I probably should have dealt with that one first. Yes they will Mona.

All right. So Caroline this might be one for you but it might also be Nick. Max was asking:

Q:          Can you please explain what is being done to synchronise the various government programs to standardise the service offerings and allow a provider to easily cover aged care, home support, DVA, NDIS and state-based programs?

Caroline Turnour:

Thanks Nick. That's a great question. And one of my other responsibilities is to work with those other government programs to try and harmonise as much as possible all the regulatory requirements and it's certainly a top priority of the current government. They've got a commitment to the care economy and to making it as efficient and as productive as possible and of course regulation is a big part of that.

So we're working with those in the NDIS and DSS and Veterans Affairs to look at making sure wherever possible the regulation is aligned. Work that's already been done has identified that nearly 60% of aged care providers are also providing services in the other sectors and so obviously we want to make that harmonisation happen as part of this new regulatory model. So thank you for that question.

Nick Morgan:

Nick I might just quickly jump on the back of Caroline's answer to say also when we're looking at prices for the new Support at Home or In-home Aged Care Program we're asking the Independent Health and Aged Care Pricing Authority to also look at prices across programs as well to try and remove any sort of perverse incentives to work in one sector rather than the other on the back of pricing.

Nick Hartland:

Great. Thanks Nick.

All right. I think this next one's for Mel. And it's from John who says - actually Mel Metz:

Q:          As well as rights, will responsibilities be covered in the new legislation? Do we not want consistency of approach by providers?

Mel Metz:

Yeah. A good question and I can see Caroline's nodding because it's also a bit of a question for her. So absolutely we'll be covering responsibilities for providers in the new Act. And the good thing about the new Act is that it gives us an opportunity to really streamline and make clear what those responsibilities are. So in the current legislative framework we have over 300 different provider responsibilities. And so it'll be an opportunity for us to really clarify what they are, both for providers and for people receiving care, so that they know what they can expect of providers.

Nick Hartland:

Okay. Caroline anything to add?

No.

Caroline Turnour:

No. I think that that's one of the reasons why we're taking our time at the moment to try and make sure that we get the registration categories right. And as I said we'll be going out at the beginning of next year with those categories and more detail associated with the obligations hopefully that are associated with them. And so what we're trying to do is make sure that we don't have those 300 obligations but we have obligations and requirements that actually suit and are proportionate to the risks associated with delivering those services. So we definitely will have those responsibilities outlined in the Act and in the regulation.

Nick Hartland:

Yeah.

Thanks very much.

Julia I think this might be for you. Wendy was asking:

Q:          Some clients manage their own Home Care Package and get us to pay their bills. Why can't we charge a handling fee? And she notes that she has two people who do this service and wonders how she can fund that.

Julia Atkinson:

So sorry Nick. Why can't we charge a handling fee or why -

Nick Hartland:

Yeah.

Julia Atkinson:

For somebody who's self-managing?

Nick Hartland:

Mm.

Julia Atkinson:

So I suppose - well my question back to the provider would be what's the handling involve and how is that different from the day-to-day running of your business? If somebody's self-managing their package then they are doing the handling by definition.

Package management can be charged for other things including if somebody is self-managing. It's up to the provider to look at the market and decide if they're offering a self-managed package fee and that's not lower than what they're offering for clients who they are managing and are they actually offering any benefit there.

Care management is slightly different and it can cover some of the costs around maintaining the quality of the service and responding to audit and assurance requirements and that is something that package providers who have self-managed clients still need to do. Does that kind of answer the question Nick?

Nick Hartland:

Well I think so. I think that's all right. Wendy might want to follow up if there are some more issues in the chat.

All right. Nick I think this might be for you. Renee was asking:

Q:          Can you explain how the care partner will fit in with the new care finder program being rolled out from 2023?

Nick Morgan:

So the intention of the care finders is I think helping people to access aged care at the start of the journey and helping to get them into care and working with them through to that point. I think at a particular point there's likely to be if you like a handover once someone's in care to a care partner. I think under the new arrangements there may well be an opportunity for those organisations that are delivering care finder services to maybe also be able to provide care partner supports. So there may be an opportunity used to link the two more closely than that. But I think in the current model it's the care finder at the start of the process leading into a bit of overlap ... and the care partner from when you start services being able to support you from then on.

Nick Hartland:

Thanks Nick.

So Christine and Wendy were asking about the nominee arrangements Mel. And Christine wanted just to confirm:

Q:          When these new nominee arrangements will come into place?

And Wendy was commenting that:

Q:          Some residents of aged care will only communicate - providers will only communicate with one sibling and she wanted to know whether this would mean that the provider would have to discuss the consumer's preference for her to communicate with?

Mel Metz:

Thanks for those questions. So there's a good reason why I didn't say the date that the nominee arrangements will be commencing because they'll commence with the new Act. And so our current plan for the new Act is that we'll have an exposure draft next year and we will take that public and do a consultation process on the new legislation. It'll be introduced in the second half of next year and commencement of the legislation is really contingent on how quickly that legislation can get through Parliament. So I can't give an exact date but I can say that it will align with the new Act.

And the second question around residential aged care facilities only communicating with one sibling. Yes it does mean that the facilities will have to discuss care arrangements as per the consumer or the older person's preference. So that's the approach that we're proposing. So the representative or the supporter under aged care law, under the Commonwealth law will be the person who is communicated with about care management and that type of thing. So as opposed to enduring power of attorney arrangements which are much broader than aged care this will just be an arrangement for within the aged care system.

Nick Hartland:

Excellent. Thanks Mel.

So Russell this might be for you. Teresa was asking:

Q:          What is meant by specialised support services and would this include CALD-specific support for language and cultural matters?

Russell Herald:

Yes. And that was the question I was responding to earlier. The definition is being tightened or clarified at the moment to come into effect on 1 July 2023 and will specifically call out services to support CALD through the aged care system. But fundamentally specialised support services is directed at particular specialised types of conditions. For instance the main four streams are those with continence needs, or incontinence sorry, hearing loss, vision loss and dementia advisory services. So it's essentially there to provide specialised and tailored support and advice and services to those with those specialised conditions.

Nick Hartland:

All right. Thanks Russell.

Karen was asking:

Q:          Will ACATs be extended past June 2023?

And yes Karen we are working with our state and territory colleagues to extend ACATs and RAS assessment services for a period to make sure that we've got assessment services in place and before the new system rolls in.

Nick, Becky was asking whether:

Q:          In an activity-based funding model would funding still be based around MMM categories in recognition of the increased costs of service delivery in rural and remote locations?

Nick Morgan:

Sorry. Based around what categories Nick?

Nick Hartland:

MMM.

Nick Morgan:

Yeah. Well under the activity-based model as I said before the Independent Health and Aged Care Pricing Authority will be looking at coming up with a set of prices that incorporate all of the ... back office costs, the admin, the travel and so on. We've asked them to consider whether there should be loadings by different MMM regions or not and they'll be considering that. So there may be a price in one area and higher prices in another area. But in addition to that the intention is to have the thin market grants there as a way to support those providers who are operating in regions where they do have high travel and it's more expensive.

At the moment the way we're thinking about those grants being provided is less every single provider who operates in an MMM7 or whatever region gets a grant. It's more a process of applying and just explaining why there are reasons why your costs exceed what you could get through the fee-for-service arrangements which would pick up those areas. But it also keeps it more open so that someone who's operating in an area that's not in one of those particular MMM regions but still has higher costs for some other particular reason is also able to apply for those grants. And the other thing I'd say about that is the intention is these grants will be part of the ongoing funding model for those providers. So we're looking at whether we can make them longer term, three-year or five-year grants or something so that providers have a bit of certainty around those grants as well.

Nick Hartland:

Thanks.

Now I'm just looking through the questions to try and focus on ones from older Australians and people who are receiving services. There are quite a lot of questions coming through from providers which is fine but we do want to make sure that we deal with consumers' questions. And unfortunately it's sometimes hard to tell where the question comes from so excuse me if I get it wrong.

So Lily was asking:

Q:          Many of our seniors provided feedback that they were unwilling to register with MAC and have an in-home assessment with a RAS assessor and they complain that MAC is too intrusive and collects too much information of their private information, especially for clients who only have one type of service such as transport which is a lot of sacrifice for a limited service.

So a number of people might want to have a comment on this, maybe Nick, then Mel but happy if others have a view.

Nick Morgan:

Yeah. Look I think at the moment the intention is that people would need to be assessed in the new program for access into aged care services. And where there are people who are unwilling to be assessed there is scope for - we talked a little earlier about the care finders being out in the community. There is an intention that they would be able to support people through that process and participate in the assessment with them. I've had a similar thing raised in the context of First Nations people. The work there, there are trusted Indigenous facilitators who are also being established and we're also looking at establishing as part of the new assessment workforce Indigenous-specific assessment organisations. But at the moment an assessment is a critical step in getting approved for aged care services.

Nick Hartland:

Thanks. And continuing on - did anyone else have anything to add? Sorry. I just didn't want to -

Mel Metz:

I'm happy to add a bit further Nick.

Nick Hartland:

Thanks Mel. Yeah.

Mel Metz:

So just on the issue of MAC being intrusive and collecting a lot of private information I think that it's really important to find the right balance between the information that government needs in order to be able to deliver the right services to people and collecting too much information about people. And in order to provide services there is a certain amount of information that is required.

Having said that our intention under the new Act is not to create such a burdensome process that there's pages and reams of documents that people need to provide to access services. So we're really not looking to embed complexity in the legislation at all, and to streamline those entry processes into aged care where we can. So if there's feedback from people around difficulty getting into the system or information that they think is being collected that shouldn't be we're really interested to hear that. We're working through what the information collection use and disclosure provisions will look like under the new legislation so yeah really interested to hear a bit more about that.

Nick Hartland:

Great. Thanks Mel.

All right. Kathleen was asking - was commenting I think. So I'll just read out her question.

Q:          How will the new in-home residential aged care be funded to better support older Australians who have a history of institutional care as children? And she noted that the evidence regarding negative effects of re-institutionalisation is compelling.

Nick do you want to have a - provide some information about that?

Nick Morgan:

Yeah. Look I think it's an area that has come up. It's come up again when we've been working with First Nations providers around making sure that we have an assessment process in particular that is sensitive to that. And where there are opportunities to collect information once and not have people telling their story multiple times and reliving trauma that we look for ways to do that as well. So we're looking at where there are - you know getting that Indigenous space where people have filled out the Indigenous health checks, whether there's ways of capturing that data more seamlessly.

I think the other thing that we're exploring at the moment that may be relevant to this is we're certainly keen for the new program to help people to stay at home independently as long as they can rather than having to enter into residential aged care. And we've got a study that we're commissioning at the moment to look at how to safely and what it would cost to provide higher levels of care in the home. So that's about to get underway. That's the idea that as people age and their needs get higher there'd be more funding available in the home. That's something the government will need to look at the study and then make some decisions around but that sort of thing that can help people stay at home independently for longer.

And I also think the separate goods, equipment and assistive technology scheme that we're looking at will offer higher levels of aids and equipment for people than is available now, certainly without having to save a lot of your Home Care Package. So there are some - just in the general sense of keeping people in their homes and out of residential, institutionalised sort of arrangements we're also looking at that.

Nick Hartland:

Thanks Nick.

My screen’s just moving around on me. So Helen was asking:

Q:          Has any thought been given as to how the transition of clients for 1 July 2024 will be managed?

It might be you again Nick.

Nick Morgan:

Yeah. We are starting to work through and look at that now. You know broadly speaking the intention is for a client on the last day of the existing programs to have no difference in their services being provided on the first day of the new programs. So the intention is to map existing services. Work with service providers to make sure we've got a picture of the services being delivered to existing clients and map that into the arrangements for the new program. So the services are listed and the budget's listed and people can see what they're getting.

In a Home Care Package sense our expectation that the Minister said, no existing clients will lose services under the new arrangements. So we're certainly - you know there's no intention for anyone to - there's not an intention for people to all be reassessed and for people to then have to move between programs. The intention is that you would be mapped into the new program, services remain the same, provided they continue to deliver services under the new program your provider or providers remain the same.

The one change would be around the unspent funds. Under the Home Care Packages program today, where people don't spend their funds they can accumulate those unspent funds. Whereas there's no accumulation of unspent funds under the new program.

So just in doing the mapping work there are a number of clients who are not registered in My Aged Care at the moment. So for the service providers on the line, particularly CHSP service providers I guess, there's a process about to get underway to capture those clients who are not registered in My Aged Care. We picked up I think quite a few through COVID where there were emergency provisions extended but we need to know who they are so that we can map those services across. So in the next few months we'll be chasing you for those details.

Nick Hartland:

Thanks very much Nick.

So Russell this might be for you. Josephine's asking:

Q:          Can you please confirm if current CHSP funding will continue at the same amount? And she notes possibly an increase due to the wage increases. She has heard some sources were saying that the 2023 funding will be based on outputs at the end of June 2023 and she'd appreciate the clarification of that.

Russell Herald:

Yeah.

So that's an easy one. In the vast majority of circumstances the funding will be rolled over based on the outputs that are in the contract at the moment with a funding indexation. There will be a very small number of providers where there may be a compliance reduction in the value of the contract if performance against outputs is exceedingly low. And so you would have to be delivering not much and having a lot of underspends in order to be in that category. So assuming that as an organisation you're getting reasonably close to or in the ballpark of the outputs I wouldn't expect there to be anything other than a rollover. But if you have any concerns if you reach out to your funding agreement manager then we can clarify whether or not you are potentially in that category but we're only talking about a handful of providers.

Nick Hartland:

Okay. Thanks Russell.

Mel, Priscilla was asking:

Q:          Would the nominee be covered by an advance care directive or power of attorney?

Mel Metz:

Yeah. So the interaction between those different state-based instruments which have different names in each jurisdiction and the Commonwealth proposed nominee arrangements I often describe it as effectively the Commonwealth arrangements overlay those state and territory based arrangements. So at the Commonwealth level for the purpose of aged care we will have clarity around who the representative of a person is. And it may be the same as a person under an enduring power of attorney or an advance care directive or it may be a different person appointed according to a person's wishes. So I hope that sort of clarifies how the arrangements work.

The real difficulty that we have with representative arrangements is that they are different in each jurisdiction and it does become very confusing. Which is why at the Commonwealth level we tend to have nominee arrangements for particular schemes so we have clarity for each Commonwealth scheme who the representative of a person is. So you'll see that in Social Security and the NDIS, the National Redress Scheme and I'm sure there are other Commonwealth schemes where we have separate arrangements to state and territory. Separate but connected in that the state and territory arrangements are taken into account but the Commonwealth arrangements overrule for the purpose of a particular Commonwealth scheme.

Nick Hartland:

Yeah. Thanks Mel.

Just continuing on some questions about nominees Amie was asking:

Q:          How will we know as providers who the supporter or representative is? Will there be any automation to advise that this has changed or been deleted?

Mel Metz:

So that's a good question. Providers need to know who the representative is for people. So I'd hope that they currently have records. How we connect what we know or what we record through My Aged Care to providers is an implementation issue. So our intention is that providers will be provided with that information and they'll be updated where there's a change. We intend to rely on My Aged Care and it's an operational matter that we'll have to work through once we settle on the final model for nominees.

Nick Hartland:

Thanks Mel.

Julia, Mel - a different Mel - was asking or was commenting that:

Q:          Fifteen working days' notice to review pricing schedules, meet with and negotiate with all clients and implement Home Care Packages is unrealistic and she wanted to know if the Commonwealth is offering support to providers to achieve this tight timeframe?

Julia Atkinson:

Thanks Nick. I should just maybe provide a clarifying response to that. Providers do not have to meet with and negotiate with every single one of their clients as a result of this measure. And in fact providers if they are going to drop their prices because they need to to get under the caps, they should inform their care recipients but they don't need to negotiate that, they just need to do it.

For the case of those that do need to do that - and it should be a minority - it isn't 15 days. So I'd point out that the Minister in her election campaign announced this is a commitment that admin fees would be capped and the details of this measure have been gradually communicated over the months since. There was a very clear and specific advice released by the department earlier in November around exactly what those figures would be. So providers have been given the time to action this and we do expect that it should be a minority of cases like the one I outlined in my slides where they would actually need to sit down and negotiate shifting a charge from one place to another where that is a reasonable thing to do. But if it is not a reasonable thing to do then they should not do it. And the client can refuse that change.

Nick Hartland:

Thanks Julia.

So Nick I think back to you.

Q:          Has any consideration been given to starting care partnering services earlier than 2024 as a new separately-funded service so that when Support at Home rolls out there's a skilled workforce to be able to help with the transition?

Nick Morgan:

The straight answer's probably no but it's a kind of interesting -

Nick Hartland:

Not a bad idea but no -

Nick Morgan:

Not yet. Yeah. It's an interesting bit of feedback. I mean just to be clear that the discussion paper was put out as a discussion paper and we are still working through a lot of the feedback that we received. We've at a high level replayed back today some of the general sentiment and some of the individual things we've been hearing. So there is opportunities for us to be working through a number of areas and that's kind of one I've made a note of that as something to think about as we go yeah.

Nick Hartland:

Yeah. Okay. Thanks.

There's a couple of repeated questions. I'm just struggling to find them. So Nick, Pam's asking a question about surpluses in the Home Care Packages budget. So I'll read it out. We may not have a definitive answer at this stage. So Pam's question was:

Q:          If I have a surplus in the Home Care Package budget at the end of the current program and it carries over to the new home program which needs to be exhausted before tapping into the goods and equipment amount - so her question is how long will the surplus be available for?

Nick Morgan:

Yeah. I understand. I think I understand the question. I mean these decisions will have to be made by government kind of in going - at the moment our expectation is that those surpluses that are on the books remain for those existing clients who have them as additional flexibility for them to provide additional services from. As I think that the question sort of implied that it would need to be - we would expect if that's the case that people would need to use up those surpluses before they access - before a provider dips into their 25% flexibility pool to support the person.

The aids and equipment question's an interesting one. We will have a separate scheme for aids and equipment. I know at the moment people do use that surplus. I haven't really thought about that interaction but at the moment we're thinking of the aids and equipment scheme as separate to the ongoing support and budgets. So you know I wouldn't have thought it was used for aids and equipment but we'll have to look at what happens with the unspent funds. And in terms of the time that it's available I don't know. We at the moment have not put a kind of particular timeframe on that sort of thing, as in it would just stay there.

Nick Hartland:

Thanks Nick.

Mel, Janine was asking:

Q:          Will the registration process for existing providers occur prior to July 2024 and whether there was a chance late in 2023 to enable registrations to be processed prior to the 1st of July 2024?

Caroline Turnour:

Mel do you want me to do that one?

Nick Hartland:

Sorry.

Mel Metz:

I do. That's why I didn't say anything.

Nick Hartland:

My bad yeah.

Caroline Turnour:

That's all right Nick.

So it's a very good question. And look we're working on getting the regulation framework in place as quickly as we possibly can. And we will also be doing a consultation on the transition arrangements with the sector to make sure that the things that need to be in place to ensure the new Act comes into effect on 1 July 2024 happen. But unfortunately for all of us there are a lot of dependencies. So of course we need to make sure that the new Act is passed by Parliament and we also have all the details we need for the new in-home care program. So once those are all done and we will have as much information as we can for that through our consultation process about the registration categories and the obligations associated with them and so on, as much information out there as possible, and we will try to make sure that in terms of the transition it's as seamless as possible.

If need be we're looking at ways that we can make sure that there is continuity of care for all Australians. So we all I think are recognising the tight timelines and the many dependencies. So one of the mechanisms we're considering to make sure it all happens is applying a deeming arrangement for existing providers. So as we heard earlier definitely try and get your registration in for all of those programs. So that if that's what's needed we will definitely be working with the sector to make sure that that transition happens and that all the things are in place and time. But in terms of an actual date or timelines we've obviously got a lot of things that we're still working out. So I hope that helps.

Nick Hartland:

Thanks very much Caroline.

Nick, Milgo asked:

Q:          If a client would like to have a major home mod or buy a piece of equipment such as a bed how would they be able to get those without being able to accumulate their funds?

Nick Morgan:

Yeah. So the intention is that there's a separate scheme that's separately funded. So that the funds for your ongoing services and where you need access to equipment it comes out of a separate scheme. You would be referred. There would be a - for something that's an expensive piece of equipment like that it's likely there would be an occupational therapist or someone would need to set that up for you.

As I said we'll have a loan scheme for certain items. So I suspect things like some of the wheelchairs and so on would be part of the loan scheme and will be able to be provided fairly quickly through the loan scheme. Some more bespoke equipment might need to be measured up and purchased separate to that. But the intention is to have a properly funded goods and equipment scheme and home modification scheme that enables that to happen when needed rather than saving up.

Nick Hartland:

Thanks Nick.

Nick I think goes to you. Doris was asking:

Q:          What about CHSP clients that are above the CHP level hours of service?

Nick Morgan:

Yeah. So in the new program again they will be mapped across to the new program. Everyone will be in one program in the new world and they will be mapped across at their existing levels of service and their services will remain as they are today under the new program. Some of the things that today we see is people who have high levels of service within CHSP are not wanting to move across to a Home Care Packages Program potentially because they're worried about means-tested fees might be higher, although in some cases it's not the case it's the opposite but there's those sorts of anomalies between the two programs. And so as we move to a single program there will be - and I gave you no detail on it but we'll need to have a single set of consumer contribution arrangements and so on. So you know in one sense no change for you in a different program but it's recognised the level of services that you need in the new program.

Nick Hartland:

All right. So we're getting near to the end so we might leave it at that. We got in the end about 328 questions and unsurprisingly unfortunately didn't get to answer all of them. But thank you very much for them and we will kind of do a Q&A on them.

So I just think I'll close the seminar at this point. The PowerPoint will be on the webinar, will be on our website and you can find information on that. And as I said we will have a Q&A document on the webinar that deals with in summary the questions that we weren't able to get to. And just as I said thank you very much for participating today and we'll be in touch again with further webinars and information as we proceed through these reforms. Thank you very much.

[Closing visual slide text saying 'Thank you', 'For more information, please contact the Department of Health and Aged Care', 'Email us: SAH.implementation@health.gov.au', 'Go to the Ageing and Aged Care Engagement Hub: www.agedcareengagement.health.gov.au', 'Visit the My Aged Care website www.myagedcare.gov.au or call 1800 200 422', '7 December, 2022']

[End of Transcript]