Support at Home program questions and answers session – Older people, families and carers

[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Support at Home Program’, ‘Questions and answers session for older people, their families and carers’, ‘26 September 2024’, ‘Presenters:’, ‘Nick Morgan, Assistant Secretary, Support at Home Reform Branch’, ‘Lezah Rushton, Assistant Secretary, Assessment and Home Care Transition Branch’, ‘Susan Trainor, Assistant Secretary, Funding Operations and Analysis Branch’, ‘agedcareengagement.health.gov.au’]

[The visuals during this webinar are of each speaker presenting in turn via video]

Nick Morgan:

Hi everyone. Welcome to today’s question and answer session on Support at Home. My name’s Nick Morgan. I look after the Support at Home Reform Branch here in the Department of Health and Aged Care. 

I’d like to start today by acknowledging the traditional custodians of the lands on which we meet and by paying my respects to Elders past, present and emerging.

I’m joined by my colleagues today, Lezah Rushton who’s the Assistant Secretary for the Assessment and Home Care Transition Branch. So Lezah is responsible for all of our transition activities including some of the communication activities that will be coming up. And also Susan Trainor who’s the Assistant Secretary for the Funding Operations and Analysis Branch and Susan is the expert on participant contributions today.

Today’s session is an opportunity for older people and their families and carers to ask questions about the Support at Home Program that is scheduled to commence in July 2025. So the way this session will run is that you can ask questions in Slido and vote on the questions that you want answered the most and we’ll do our best to answer as many of those questions as we can. The session is going to be recorded and published and we’ll also be updating the published FAQs based on any questions asked today.

All right. So let’s get started. I can see we have the first question posted.

Q:        Will there be an exceptional pathway to seek greater than 52 hours of cleaning or 18 hours of gardening? If so who can initiate this request and who decides? Is it a reassessment?

Look at this stage the cleaning and gardening arrangements are capped. It’s something that since we’ve announced those caps I’ve already received a lot of feedback on around particularly that idea of an exceptional pathway. There is not an exceptional pathway as part of the design right now but it’s something that as part of the initial feedback we’ll take on board to have a look at as part of our implementation. But the short answer is at this stage no.

So the next question.

Q:        Where are the legislated provisions for hardship? It is confusing but is it a form of secondary person-centred subsidy? What will the hardship amounts be and will it be both resi and Support at Home?

Susan can I throw that one to you?

Susan Trainor:

You can throw that one to me although I don’t think I have some of the specifics here. I can talk in general terms about hardship provisions but not so much what sort of subsidy classification it might be. In both residential aged care and the Support at Home Program there will be hardship provisions for people who genuinely cannot afford to make the required contributions for their aged care costs. The details of those for Support at Home are something that I think are still in the process of being finalised as part of rules. In residential aged care they will look very similar to what we have in place right now. So in residential care they’ll be based around as a person’s assets decline that they would move from being someone who pays for their care to accessing hardship provisions. And likewise in support at home if a person’s facing genuine financial hardship it means they can’t make the contributions, that the sliding scale that we’ve talked about at other webinars suggests what they are required to pay, there would be a process for them to be able to apply for hardship support.

Nick Morgan:

Thanks Susan. The next question is:

Q:        Will everyone currently on a Home Care Package migrate to Support at Home on the 1st of July or will they stay on their current package until they choose to move to a Support at Home package?

The answer is a sort of combination of both I suppose. Let me try and be clear about it. If you’re on a Home Care Package as at the 30th of June 2025 or in fact if you’ve been assessed as eligible for one and you’re on the national prioritisation system waiting for a package you’ll move across into Support at Home at that package level. So if you’re on a Level 4 package the amount you will have under Support at Home over a 12 month period will equate to the same as under a Level 4 Home Care Package. But there will be some changes to the arrangements under Support at Home. The Support at Home model will be introduced meaning that your budget will be divided into four effectively and you’ll have four quarterly budgets and the amount you can carry forward from one budget to the next will be limited to $1,000 or 10% of that quarterly budget between quarters so that we don’t get the unspent funds accumulating.

The unspent funds that someone already has under a Home Care Package, that will move across with them into Support at Home and that balance will still be available to spend in addition to your Support at Home package which will be the equivalent of your Home Care Package amount. So that’s the short answer.

On the consumer contributions there will be some slightly different grandfathering arrangements there. I might again throw to Susan to just describe how they will work for people who are on a Home Care Package.

Susan Trainor:

Yeah. So in terms of grandfathering arrangements for current Home Care Package recipients or people who on 12th of September were either on the national priority system or approved for a package but hadn’t yet got themselves onto the national priority system, their contribution arrangements will move to the Support at Home system but they will move to the Support at Home system that’s based around pension status and whether you hold a Commonwealth seniors health card at lower transitional rates. And those lower transitional rates will mean that everybody who is currently paying an income tested care fee in Support at Home will continue to make a contribution but it will be no greater in total than the amount that they’re making as a contribution under the Home Care Package as they have at the date of transition. So we’ve worked really carefully to model and set numbers that mean that that no worse off principle applies and those participants will stay on those transitional rates for however long they stay in Support at Home. 

Even if they are reassessed and move up package levels we don’t then move people across to the ongoing Support at Home rates. They remain in that grandfathered transitional contribution system. And then of course those on a Home Care Package who are not currently paying an income tested care fee will continue to not pay fees for Support at Home for however long they stay in the program.

Nick Morgan:

Thanks Susan. Just to try and be super clear on this because I know a lot of people online will be in Home Care Packages today. We talk about moving from the four Home Care Package levels to the eight ongoing levels under Support at Home. And I’ve said you won’t move onto one of those eight levels. You just stay on the same level as your Home Care Package. If you’re reassessed in future and you get reassessed onto a higher level you’ll move then into the higher level that you’ve been assessed into under the new eight classes.

All right. The next question is:

Q:        How are meals going to be paid for by clients? Is there still an expectation for the clients to pay for ingredients as Support at Home charges clients a percent as prescribed?

Yes is the short answer to that. I think the rate for meals will exclude ingredients and then there will be a percentage applied based on where you sit on your contributions.

Q:        Equipment and home modification purchases. Is it available as a one time thing only or can funding be used annually?

It’s a one – sorry. Let me try and be clear on this one too. When you’re approved for assistive technology or home modifications at the point of assessment you’ll get an approval that lasts for one year. And so if you’re getting equipment and you need a couple of pieces of equipment through the year within the funding tier that you’ve been approved you can do that. At the end of the year that expires and you would need to be assessed again for assistive technology and home modifications if your circumstances change and you then need more equipment or a different home modification. So it’s not once only as in once only ever. It’s for a period of 12 months but then you need to be reassessed if you need it again.

The only thing I’d point to there is we are also looking at having a loan scheme as part of the assistive technology and home modifications scheme. And so the loan scheme, we’re working with states and territories on using their existing equipment loan scheme so that a wheelchair or other pieces of equipment could be provided to someone on loan where there’s maintenance and follow up. And I think part of that loan scheme will be the ability to swap out equipment when needs change a little more easily as part of the loans. So that’s the one area where it might look a little bit different. Okay.

Q:        Can you provide a list of what digital devices can be funded, ie smartphones, tablets, computers, wearable technology etcetera?

There is going to be a very detailed item list that sits underneath the assistive technology and home modification scheme. That list is still being finalised. We’ve had Monash University doing a lot of work and consultation on developing that list for us. It’s still being finalised and should be available over the coming weeks I hope and possibly days. But separately the services list that lists all of the individual services, we’re expecting to get that published at 2:00pm today. The assistive technology list is separate. So it does go into a fair bit of detail and I don’t really have it here to provide today but that will be published.

Q:        For Support at Home what is the reasoning behind dividing services between independence and everyday living? Do you think that a 75 year old man on a Zimmer frame can still do his own meals, shopping etcetera? The current system will force him to choose between having regular meals or a wash.

So I might actually ask Susan to respond to that one.

Susan Trainor:

Yeah. Sure. Look in terms of the reasoning behind dividing services between independence and everyday living, that was a recommendation of the Aged Care Taskforce, that we have the services split across three categories. And the real focus in that was thinking about what is a thing that relates to a person’s frailty or cognitive decline and sort of the clinical supports for that, the focus in Government funding in that space first, which is part of the reason there’s a zero dollar co-contribution on all those clinical services. Between independence and everyday living I think what the Taskforce really sort of saw as the distinction there is that independence is things that help a person to stay independent in their own home and in the community for longer and avoid the need for them to go to hospital, avoid the need for them to enter residential aged care. 

Generally speaking everyday living items are things that the Government would not pay for for any other individual at any other stage of their lives. And so that’s the rationale for why there’s a higher expectation on the participant in terms of how much of a share of the contribution they make, was it’s that element of there may be things in the other two categories where the Government would fund other people at different stages of their lives but lots of the things in that are very much things that people have either done for themselves or paid for someone else to do for them throughout their lives. And so that’s the rationale for the division there and why there’s a higher co-contribution for everyday living than independence.

Nick Morgan:

Thanks Susan. The next question is:

Q:        If a person wishes to leave their residential aged care facility and return home to use the Home Care Package again are the terms and conditions still grandfathered?

That’s a good question and I don’t know that that’s come up in my discussions. Susan is that one that you’ve thought through?

Susan Trainor:

It’s something we’ve given – I’m not sure about the idea of a person leaving residential aged care and returning to use a Home Care Package, purely because I’m not sure what the mechanism is in terms of whether that person is considered to be in a Home Care Package or on the national priority system or assessed as eligible for a package at the moment. That’s the only question mark in my mind. I know we have said if a person leaves residential aged care and re-enters it, if they’re in care on the date of commencement, that we would be treating that person as under the grandparented rates permanently even if they exit and re-enter. And we thought the same about a person who was eligible based on that 12 September date, if they then exit and re-enter we’ll treat them as grandparented for Home Care. But that is a very specific scenario in terms of leaving resi to re-enter Home Care and I’m just not sure I can give a definitive answer on that scenario. 

Nick Morgan:

Okay. We’ll have to take that one on notice and look to answer it in the FAQs.

Okay. This is another one for you Susan I think.

Q:        How will the 5% to 50% or 17.5% to 80% individual contribution rate be determined?

Susan Trainor:

Sure. So this is for the – just to be clear for everybody this is the co-contribution rates for people who are part aged pension recipients or people who are not part pensioners but hold a Commonwealth seniors health card which at the moment means they have income of below about $95,000. I know this is a very popular question, what does it actually translate to in terms of a contribution for an individual person, and we are working to get a calculator or a table or something that gives people a bit of a ready reckoner ready to go and to publish as quickly as we can but it is quite complex. 

But effectively what will happen is for a part pensioner when they enter Support at Home Services Australia will use the information that’s been provided for their means assessment for their aged pension and look at their income and assets through that to determine where they fit on that sliding scale. And it’s a little bit more complicated because the age pension looks at your income or your assets whereas we’ll be looking at both. But as a general rule a person who’s receiving a part pension that is close to a full pension can expect to be closer to the bottom end of those scales than a person who’s receiving only a few dollars of age pension a fortnight. 

And then for Commonwealth seniors health card holders because they haven’t had as fulsome a means assessment because the Commonwealth seniors health card is only based on your income, they will go through a means assessment process with Services Australia when they first begin to access services under Support at Home and it will similarly look at both the income and assets to determine where in that grouping that they fit. As a general rule again the lower their aggregate outcome the closer they are to that 5%. A person who’s only just eligible for a Commonwealth seniors health card is likely to be very close if not at that 80% mark. So it is complicated. We have more details coming about what that would translate to with hopefully some worked examples for a person with certain circumstances where they would fit on that scale.

Nick Morgan:

Thanks Susan. The next question is:

Q:        Will there be any considerations for regional and remote areas where there are many limitations to supports?

There are under Support at Home arrangements that we’re looking at for regional and remote areas. So one aspect of the program is that service providers in those areas where they have higher costs of delivery than other parts of the country will have an opportunity to access some grant funding to top up the revenue for the business to be able to operate in those areas. So that’s one thing we’re doing. We’re waiting for the Independent Health and Aged Care Pricing Authority to provide us with some advice around prices for services, and so looking at being able to have higher prices if it’s higher costs in those areas with a supplement to support people to be able to pay for those higher prices.

And the other thing, it’s more of an over time thing under Support at Home, but we’re going to have a lot better data and information about what services are being delivered in future. As service providers invoice now for the services that have actually been delivered we will be able to see if there are parts of the country where there are systemic shortages of particular different types of services and be able to investigate that and target specific areas for some of the sort of workforce measures and things that we’re doing So I think all of those arrangements are going to help with service provision in those areas. And then down the track, no earlier than July 2027, but when the intention is that at the point in time that the Commonwealth Home Support Program comes into Support at Home that that would also enable us to open the market to smaller, independent, single service type cleaning providers or gardening providers or others to register as a Support at Home provider and deliver services more easily. So that’s something that’s a bit more down the track in the future but I think those other things will help in the meantime.

Q:        With reference to the grandfathering aspect of the client fees will current CHSP clients have their fees grandfathered when they eventually transition to Support at Home after 2027?

That’s something that the Government has not considered yet and that will be one of the questions that needs to be looked at as the final arrangements and timing for the Commonwealth Home Support Program coming into Support at Home is worked through. So there isn’t really an answer for that one yet.

Q:        Can you explain meals funding a little bit more? Can more companies like Lite n’ Easy still be available or will there be more control about what we can get?

So there won’t be those more controlled – it’s not changing the ability for your service provider to source meals for you through organisations such as Lite n’ Easy or if you are self-managing with the agreement of your provider to be able to access meals through a third party and have those invoices paid. So no intention there to make changes to your current arrangements.

And for existing clients the contribution rates will be set at a rate that means you’re not paying any more than you are today. So for new clients those new participant contribution arrangements that Susan’s been talking about will apply to meals as I think we’ve already discussed.

Q:        Will my provider be able to charge me additional care management from my funds or are they only allowed to have the 10%?

So for care management the intention is that 10% of all clients’ budgets goes into a pool that sits with the provider and that the provider can deliver support to people as needed. And if a person needs additional support at particular times then the provider can provide that to the person and if someone needs less then they can receive less. So the 10% is not tied to the individual and a provider is not limited to only providing a person with a level of care management that equates to that 10%. They can provide more than that at times when people need more and less when people need less. 

So I think the intention is to try and have a pooled fund for providers to be able to meet the needs of their clients without having to draw down further on a client’s budget. In practice if a participant wants to use their budget for additional care management that their provider wouldn’t otherwise have provided I think that’s something that is not excluded from happening but it’s not the intention of the program for care management to be funded out of the rest of your budget. That 10% is going into a pool which should cover the needs of all clients.

Q:        My worker comes out for two hours and helps me shower for about 30 minutes, cleans for about an hour and then some social time, and maybe takes me to the newsagent to pay a bill. This is both independence and everyday living. How will the amount be calculated?

Yeah. Look this will be one of the areas as we’re finalising our implementation arrangements and providing guidance to service providers and advice to people about the specifics of the program that we’ll have to be very clear about. Lezah and I met with some service providers and consumer peaks the day before yesterday and this was an issue that came up to try and get some clarity around how the time is divided up and therefore how the contributions are calculated and how the invoicing from providers is done at a practical level. So I understand the question. In theory the way it works is there’s some calculation done on around about this much on this service type and this much on that service type and this much on this service type and that equates to this much of a fee for that two hour period, and a provider invoices for the different services that have been delivered. We just need to make sure that’s practical and we don’t want care workers walking around like lawyers billing every six minutes to work things out. We want to make it sort of a practical implementation arrangement and that’s something we’re going to be doing more work on over the next month or two.

Q:        How will vulnerable customers be managed when they cannot afford any co-contribution? Who wears the cost of providing them services, eg showering, daily meal prep?

So I think that’s around hardship provisions so I might throw again to Susan on that. 

Susan Trainor:

Yeah. So the details of what hardship provisions will look like and who would be eligible for them are still being worked through as part of developing rules under the program. But there will be settings that allow for a person who genuinely cannot afford any co-contribution to be able to receive those services without that coming at a cost to the provider or a cost of their ability to get services. But the details of who meets those requirements we’re still working through and what they look like will be things that we need to sort in the coming weeks.

Nick Morgan:

Thanks Susan. So the next question says:

Q:        I want to self-manage a Home Care Package for mum. Providers take 15% in fees from packages under this type of arrangement. In the new system they take 10% for case management. How will they make up the 5%? Can they ask me to pay them admin as they will not organise any services for my mum?

So the 10% is for care management and that’s checking in on people, helping to ensure that the care plan which specifies the services and so on is agreed, and when things go wrong helping to make changes and deal with issues. So that care management 10% is still being paid. The package management fees, at the moment providers can levy care management and package management and for people who self-manage they tend to have lower package management fees. Package management fees – there won’t be package management fees under Support at Home as Claire has said. And so that’s because under Support at Home there will be price caps that are set for the individual prices for each different service that providers are charging for and those price caps will have an administration component built into them so that as you’re paying a price for an hour of personal care all of those hours add up with a component that’s built in that covers the travel costs and the admin costs and the back office costs and the scheduling costs and so on. So that’s why the Independent Health and Aged Care Pricing Authority is putting so much work into data collection to determine how to allocate all of those administrative costs.

Now if you’re self-managing and you’re finding your own care workers who don’t work for the organisation what we’re saying is that the provider may be able to put a premium on top of the invoices that are being submitted for them to be able to cover off the costs of the admin work they do have to do such as submitting invoices and checking that third party care workers meet obligations and so on. So that would just add a small amount to the price that you’re being charged by the independent care worker.

Q:        I don’t pay an income tested fee and my provider doesn’t charge daily care fees. Under Support at Home will I have to contribute?

Susan again.

Susan Trainor:

Sure. So if you’re part of the 86% of people who are receiving a Home Care Package right now and don’t pay an income tested care fee based on your means assessment you will continue to not pay fees under the Support at Home Program under the grandparenting arrangements. So when we talk about those transitional arrangements and those transitional co-contribution rates we’re only talking about the 14% of people who based on a means assessment when they entered the Home Care Package Program were assessed as needing to pay that income tested care fee. So the short answer is no. The slightly longer answer is that we are aware of a number of people who perhaps their means assessment indicate that they should be paying an income tested care fee but their provider is waiving that. That’s a scenario that we’re still examining a little bit further and trying to figure out what happens in that situation. But when we talk about 86% of current participants will pay no fees and 14% will they’re in that 14%. So we are talking about a small number of cases. But people who have been assessed as not needing to pay an income tested care fee will not pay for Support at Home. And that’s regardless of how long they stay in the program.

Nick Morgan:

Thanks Susan. I’ve got a good clarifying question here where the question is:

Q:        Nick and Susan seem to have contradicted each other. Susan says that if a Home Care Package participant is reassessed you will not have to pay any more than you were before but Nick’s saying that if you are reassessed for higher needs you’ll move to the Support at Home level. Which is it?

So if you are reassessed in Support at Home the level of your package, the budget that you’re on, the money that you receive, will go onto the Support at Home package level if you like. So you might be a Level 2 Home Care Package recipient. You get reassessed. Instead of going onto a Level 4 Home Care Package you go onto a Level 6 Support at Home budget. But in terms of the contributions that you pay – and Susan might just quickly jump in here – they will be set at whatever you were paying previously. Isn’t that right Susan?

Susan Trainor:

Yeah. So I think there’s a really important point around not pay any more. We’re not talking about in terms of dollars there. What we’re talking about is if you’re one of the people who did pay an income tested care fee and then moved to those transitional rates you won’t move off those transitional rates into the higher ongoing Support at Home rate. So I’ve just had a quick look at what the transitional rates look like and an example there. A self-funded retiree receiving something that’s in that independence classification in the ongoing rates would pay 50%, in the transitional rate they’ll pay up to 25%. You’ll move onto a Support at Home package and the sort of equivalent to what you would have stepped up into in Home Care is, but you’ll continue to pay at that 25% rate. So the total amount you pay might go up but that’s because of the amount of services you’re receiving not because the proportion of the amount you need to pay is changing.

Nick Morgan:

Yeah. Look I think we’ll sort of endeavour to really spell this out in clear detail in writing for people. I suspect that we’ve had a crack at answering that for you but I suspect there might still be some confusion there. We will really try and put forward some really clear communications with some examples to illustrate what we’ve just tried to talk through.

Q:        What are the criteria for entry into the highest levels of Support at Home?

So unfortunately I can’t give you a clear answer to that. I don’t have it all spelled out in front of me. Under the new assessment tool it uses a range of different verified assessment instruments to collect information from people and goes through into sort of a formula that puts you into a classification. And then assessors will also have an ability to override the classification that the tool recommends and put someone into a classification if there are other reasons that they see that it needs to happen. So ultimately it can be an assessor’s determination on the back of the assessment. In terms of what other different characteristics that the formula uses to put you into different classifications that’s something that we’ll need to provide more information on going forward. But I don’t have a very clear cut answer for you today I’m afraid.

Q:        You say that the Government is asking us to co-pay for supports that are everyday services that would not normally be expected to be paid for by the Government, but the Government have been paying for our domestic assistance, cleaning and gardening for many, many years.

Susan if you wanted to comment on that one.

Susan Trainor:

Yeah. Look I think I would largely take it as a comment but I’m presuming the person who’s made this comment is someone who is a current Home Care Package recipient. And understand that for Home Care Package recipients that is a different situation and we’ve talked I think a few times about a Home Care Package recipient who’s not paying an income tested care fee will continue to not pay fees in Support at Home. But if we generally look through the whole of someone’s life it’s very rare that the Government would pay for domestic assistance, cleaning or gardening for people generally through their lives and that’s the rationale for why there’s that higher co‑contribution rate for those services. Noting that even under Support at Home even for the fully self-funded retiree the Government will be still making a 20% contribution towards those services for that person right through to over 80% for a full rate pensioner.

Nick Morgan:

Thanks Susan.

Q:        Can someone outline what is seen by appropriate training for the home support workers? Can we have a clear outline of what support workers can do? If we have a cleaning agency and they are not allowed to move furniture in order to vacuum is an example there.

I might throw to Lezah here on any thoughts about the sort of training and program manual that will be coming.

Lezah Rushton:

Yeah. Thanks Nick. So we are working with provider organisations through co-workshops and also consumer organisations and the sector around the operational detail for a number of elements of the program. So certainly in terms of training and training for support workers that is a current focus that we’re working through. We will provide guidance material that we’ve developed in consultation with those working groups with both providers but also with client representation to work through that detail. Noting I guess under Support at Home model it is a single provider model so where providers are contracting other service providers to provide those services they will need to manage what those arrangements look like consistent with the guidance material and training material that the Department will be providing.

Nick Morgan:

Thanks Lezah.

Q:        Some people need more care management than others. Why isn’t the Government assessor saying how much you need rather than leave clients to fight with providers to get the amount the provider decides they do or don’t need?

Look it is a good question but the challenge that we’ve had in trying to work out a way to sort of determine care management is you’re right, some people may need more than others. It’s not always clear who. But secondly it’s just lumpy. Some people need a lot at a certain point in time and then not very much later. And another person later needs more and not very much today. And so trying to assign for each individual this is how much care management you have in your budget if you like and you can spend that on care management means that there will be times when it’s just not enough and there will be times when it’s sort of too much. And that’s why we’ve moved to calculating at a rate of 10% which will go up with each classification. So someone on the lowest classification, that equates to somewhere in the order of an hour a month. Someone on the highest classification, that equates to somewhere in the order of six hours a month. But that all goes into a pot for the provider to draw on as people need it.

The other thing I don’t think I’ve mentioned yet is that for people who are First Nations people, people who’ve been supported by Care Finders, someone who’s homeless or at risk of homelessness and Veterans who are on a Veterans supplement, for those people the Government will also pay an extra amount into that provider’s care management fund and that amount will be the equivalent of around an extra hour a month in respect of each of those people again going into that fund so a provider can support people as needed within the fund. I take the point around you may feel you’re not getting enough support and then it becomes a negotiation with your provider but that’s where we’ve landed given the difficulty in estimating how much someone needs regularly throughout the year.

Q:        Can the existing clients who have Home Care Package unspent funds – can these funds be used to extend maximum cleaning hours or gardening hours or are they still capped no matter how much funds they have?

 At this stage the cleaning hours and gardening hours are capped regardless of how much funds you have. Those funds can be used on services but the caps are in place.

As I said probably one of the areas we’ve had most feedback on.

Q:        My client has $50,000 in unspent funds. Wrongly assessed as a Level 4 package in this person’s opinion. And is not using as she’s very independent. Will the three month budget and $1,000 rollover apply to her? Will the Government then use these unspent funds for others waiting for a Home Care Package?

So the short answer is no. Your client will continue to hold those unspent funds but they won’t be able to continue to accrue beyond that $1,000 or 10% of the quarterly budget accruing each quarter. So if the person doesn’t need them they will remain still with an account in that person’s name until that person exits the program.

Q:        How will the new system allow for carer holidays if you can’t save up more than $1,000 between quarters so you can pay for more intensive care once a year? Carer burnout is real.

Look so I think what the question is asking is if a carer is away and during that period you need some intensive support how do you manage that. And I guess it’s going to depend a bit on how long the carer is away for as to what $1,000 or 10% of your package value can cover. That’s potentially depending on the nature of the service types. And we don’t have the final prices and so on yet. But somewhere in the order of eight to ten hours over a period and that may be for many people sufficient, or I’m not sure what it would equate to in terms of meals. But at the moment that’s the decision that’s been taken around the amount that people can carry over between quarters noting as per the last question that those people who are existing Home Care Package recipients who have unspent funds will also have those unspent funds available.

And I think from our perspective in the Department as these arrangements are implemented we will certainly be monitoring the program and observing the extent to which people are utilising their funds, are utilising the carry over provisions, but also the extent to which existing Home Care Package clients who do have those unspent funds will have a much better perspective on the patterns of use of those funds than we have today, due to like I said before invoicing arrangements which will allow us to see what services are being delivered to who when. So this is a new program. We will be monitoring how the program is running and where there are potential changes that might need to be put in place over time.

Susan Trainor:

Nick I was just going to add to that really quickly of course that if this is talking about carers as in a loved one, a live in carer scenario, there are of course options like residential respite care where a loved one can temporarily enter residential care to allow the carer to have a bit of a longer break if that sum that’s been saved up between quarters isn’t sufficient.

Nick Morgan:

Yeah. Good point. Thanks Susan.

Q:        The NDIS provides access to cleaning and gardening services in a way that is unrestricted by time constraints and co-contributions. Why is there a distinction between the two systems?

So as we’ve developed the Support at Home Program we’ve been talking to the NDIA and Department of Social Services. The program design has evolved over a period of time to where it is now with the restrictions in place with Government taking into account some of those questions. I suppose that’s a bit of a fudge answer and I don’t have a great response as to why you may have provisions that look like one way in one program and different in another program. But this is where the Government’s landed in terms of the Support at Home Program.

I don’t know Susan on the contributions in terms of the Taskforce work or anything whether there’s anything further you can point to on differences there.

Susan Trainor:

Look in terms of NDIS versus Support at Home not directly. I think it’s a thing that they were mindful of. But one of the real things when considering the idea of co-contributions around these sorts of services very much the scale of growth that’s going to be needed in Support at Home over the coming years was on their minds when thinking about this. We’re looking at in ten years from now having 1.4 million Australians in the Support at Home Program. And so some of the constraints around that really did factor in the Taskforce’s minds. How do we make sure there’s enough available for everyone who needs care in the home to be able to access some support? So that’s including the current numbers in Home Care Packages and the current numbers in Commonwealth Home Support Program as well as a forecast 300,000 people increase in the number of people receiving care at any point in time. And so there was some considerations about the need to make sure everybody in that group can get a little bit and this was one of those areas where they felt there was a need to say we have to enable it so that everyone can share a little bit of the total amount of service available.

Nick Morgan:

Thanks Susan.

Q:        Will allied health recommendation continue to be required for goods and equipment or will the suppliers incorporate that in the ATHM funding?

The ATHM, so that’s the assistive technology and home modifications funding, so things like equipment and handrails and things. The item list across that program will specify prescribing requirements for lower risk, generally lower cost items. There won’t be a need to have an allied health person do prescribing. For other items you might need an OT or other allied health professional. So the funding for the scheme, the assistive technology and home modification scheme, people will receive a funding tier and that funding tier will pay for both the prescribing and the equipment and the fitting and so on. And so the other thing I’d just point to on prescribing is we’re trying to not be too prescriptive about where you find that OT or where you get your prescription as long as it’s from a qualified prescriber in line with what the list says so that someone who has a prescription from a medical specialist doesn’t then have to go back around and get a less qualified person to come and assess them for a particular type of wheelchair or something like that. It’s feedback we’ve received. So we’re not trying to be too prescriptive about where the prescription comes from but there will be items that require prescription with the cost covered in the funding tier.

Q:        Some people need more care management than others.

I think I’ve done this one.

Yep. Next one.

Q:        Do you have a number on how many Home Care Packages will be released before Support at Home starts?

I should. I’m really sorry. I haven’t got it in my head ready to talk to here. I’m just not sure if it’s finalised or what that exact number is. But we’ll just have to take that one on notice. I apologise. Unless anyone else on the call, either of my colleagues have that clarity.

No. Okay. Sorry. I’m the Support at Home guy and my colleagues down the corridor are managing the current package releases and I just don’t have that to hand.

Q:        With client contributions coming into place for personal care, domestic assistance, gardening, a full pensioner will be forced to do things on their own causing significant risk to their safety, specifically with mobility issues leading to increased falls risk, hospitalisation, burden to the medical system. 

Well I mean we think that the funding – well I might pass to Susan actually to talk about the contribution rates being set to try and avoid those sorts of unintended consequences.

Susan Trainor:

Yeah. Sure. So I think as we’ve talked about previously the co-contribution rates are progressive based on a person’s means. In the case of a full pensioner and as with all participants in Support at Home they’ll pay nothing towards things in their clinical care list. Things in the personal care space, a full rate pensioner will pay a 5% co-contribution towards. So for a service that has a unit price of $100 they will be asked to pay $5. And for the domestic assistance and gardening items what we’re asking from a full pensioner here is 17.5% of the total cost of the service. So for a service that costs $100 we’re asking them to contribute $17.50. I think we have some worked examples on our website that are based on a Level 5 Support at Home package that show that even a person who’s at a Level 5 package where they’re receiving a quite significant amount of service will still be paying only a moderate amount of their pension in co-contributions. We’re certainly not asking pensioners to hand over all of their money or anything like that. These are tiered based on what a person with a full rate pension is considered to be capable of contributing towards. 

And so we understand that for some people they may choose to use their package based on what the contributions are and what that does in terms of whether they do things on their own or get assistance from someone like a neighbour or a family member. But I think in terms of the risk to safety and things we’ll have to treat that largely as a comment. We sort of have designed these based on a progressive co-contribution rate that’s expected to mean no one is asked to contribute more than they’re capable of and we will as we’ve mentioned earlier have hardship provisions where there really are circumstances where a person cannot make that contribution.

Nick Morgan:

Thanks Susan.

Q:        How would that 10% pooled care funding fees sitting with the provider work if I want to change providers halfway through a year or quarter?

So the way we intend the pool to work is at the start of each quarter a provider’s pool gets updated for the participants that they have on their books. So that happens every quarter. And then there will be ons and offs during the quarter. Some people leave. Some people will join. But those adjustments will just happen once a quarter. And so if you move from one provider to another they will have a pool of care management funding that they can use to support you and when the quarter ticks over there will be some adjustments if they’ve lost some clients and gained some clients, recalculation to update their care management fund. The care management fund doesn’t have the same sort of – you can only carry over a proportion of funding for care management. Again because care management is sort of a bit unpredictable and lumpy, that fund just sits with the provider. If they haven’t used a lot in a particular quarter that’s available for the next quarter, for clients in the next quarter. But there will be quarterly adjustments to take account of the ons and offs I suppose in terms of their client base.

All right. We’re getting close to time I think.

Q:        In recent webinar Q&A advised that a person on a palliative pathway beyond 16 weeks will go back to their package or category. Does that mean that the extra services during the end of life phase will not be provided because they are still living beyond the 16 weeks even though actively dying?

So the level of services may drop off after that 16 week period. The end of life pathway has been designed to support people who have been diagnosed with 12 weeks or less to live. We understand that people may live beyond that point. It’s a 16 week period to utilise that funding and then that’s right, moving onto the existing package level or the level that you were assessed at at the last point of assessment after the 16 week period, which particularly if that becomes an extended period.

Q:        If a provider runs out of care management funding what will happen? I need care management. How can I ensure my 10% will last if other clients are possibly dipping into mine etcetera?

So again the care management funding goes and sits with the provider. So it becomes the one package for all of the participants – the one fund that covers all of the participants on their books. And they will need to ensure that that funding is used in a way that means that they don’t run out of the fund. As I said earlier I don’t think we would preclude any individual client using their budget to access additional care management if they needed, if there was such a situation arising, and also people would be able to use any unspent funds they might have if they’re an existing Home Care Package client. And as I’ve said a couple of times these are the sorts of things we’ll also be monitoring as the program is implemented in case there are any of those sort of unintended issues arise and we do need to make adjustments.

I think we’re getting to the last question. There’s one minute to go. So I’ve got another - - -

Q:         If paying 10% of care management costs from my Support at Home package will it be reasonable to expect a care partner to have to take place face to face interview on a quarterly basis?

Cheryl I think as I’ve said earlier if the 10% was used on an individual client basis it equates to roughly an hour per month of care management at the lowest level in Support at Home and roughly six hours per month at the highest level of Support at Home, noting that all goes into a pot. And so there will be an expectation of face to face engagement with clients around the review of how things are going and how the care plan is working for that person. And I think our sort of program manual will be providing sort of additional guidance on what our expectations are for people in different classifications around sort of what would be a minimum expectation that a person would access. And I don’t know Lezah whether there’s anything you wanted to add to that before we wrap up.

Lezah Rushton:

I think you probably covered it there Nick. This is all detail that we will be prescribing within the guidance material provided to providers and portions of that guidance material will be available to obviously recipients so that they are aware of what their entitlements are under the various elements of the program.

Nick Morgan:

Okay. All right. Look I think we’re at time. The next question was really sort of a case study of a person and what’s their services going to cost and I think that in terms of finishing up Susan has indicated that we’re looking to have a little bit of a ready reckoner of some sort, whether it’s a calculator tool or tables that people will be able to start to do some of those calculations themselves around what contributions might look like in future noting that there will be these sort of grandfathering arrangements for existing clients.

But with that I’d like to conclude. I think we’re at time. I’d like to conclude the session. Thank you all for joining. Thank you for your questions. We’ll look through all of the questions we couldn’t get to and we’ll continue to update the website. So look out on our website for frequently asked questions and other material such as a handbook which will set out a lot of the Support at Home Program in one place that will be published shortly along with the service list details which I believe will be published today at 2:00pm. Thank you.

[Closing visual of slide with text saying ‘Thank you’, ‘For more information, you can contact:’, ‘Email: SAH.implementation@health.gov.au’, ‘Website: health.gov.au/our-work/support-at-home’, ‘Visit our website’, with image of QR code, ‘agedcareengagement.health.gov.au’]

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