Australia's home care system is "shambolic" according to the lead author of a major new report by the Grattan Institute.
Despite the vast majority of Australians wanting to be cared for at home in their old age, home care is hard to get, confusing, and expensive.
"More money and better design could give Australians more dignity and better care in their old age," says Grattan Institute Health and Aged Care Program Director Stephen Duckett, adding that the aged care system is failing many older Australians.
The report Unfinished business: Practical policies for better care at home says, "The Federal Government has made significant and welcome commitments to address many of the shortcomings identified by the Royal Commission.
"A new care-at-home program is being introduced from mid-2023. The number of Home Care Packages is being increased by nearly 50 per cent, care finders are being employed to help people find services, and small regional offices are being established. But despite committing more than $2.44 billion of additional funding each year to home care places, the Government's response leaves unfinished business."
The Institute would like to see the Government take the system to the people, by establishing dozens of regional offices across Australia to develop local, personalised services for people who need aged care and want it delivered to their home.
According to the report, Australia's home care system is inefficient and Home Care Packages deliver relatively low levels of low complexity care at high cost.
Gaming the system
"Administration costs and the hourly rates for services are high. The four-level classification scheme for Home Care Packages is only loosely related to the actual costs of providing care. This allows providers to pad out their costs and game the system.
Despite committing more than $2.44 billion of additional funding each year to home care places, the Government's response leaves unfinished business.
"Average hourly rates for personal care, cleaning, and gardening are nearly $60, and $100 for nursing, with overheads on top. Administrative and management costs are about a quarter of the total allocated for a package ($13,000 a year for a Level 4 package), regardless of the level of service delivered.
"Providers have discretion about whether they charge recipients a basic daily fee as a co-payment. As a result, it is difficult for care recipients to compare the value-for-money provided by individual providers. There are also big differences in the costs of care between high-cost and low-cost providers."
The report says, the extra money the Government is providing will be spent in a poorly regulated and hard-to-navigate system where consumers get a poor deal.
"Despite the Federal Government's proposed reforms, stewardship of the home care market will not be sufficiently strengthened to protect older people's interests. Only small regional offices with limited scope and authority are proposed.
"The introduction of face-to-face support and 500 care finders to assist at-risk older people is an important improvement to My Aged Care. But their role is too limited. They have no capacity to negotiate, monitor, and manage service agreements with providers on behalf of consumers."
Administration costs and the hourly rates for services are high. The four-level classification scheme for Home Care Packages is only loosely related to the actual costs of providing care. This allows providers to pad out their costs and game the system.
The Government also has no plan to boost the number, pay, and conditions of home care staff who have insecure work with high levels of casualisation, poor working conditions, and are underpaid for what they do.
The report expalins, "There are workforce shortages, and high levels of dissatisfaction among workers. Vacancy rates are above 10 per cent for most staffing categories, and staff turnover, at between a quarter and a third each year, is high.
"Home and community care has been devalued as 'women's work'. Unpaid additional work time, split shifts, and highly variable hours are commonly expected from workers as part of the 'caring' role traditionally associated with women," says the report.
It estimates about 46 per cent more staff - or about 58,000 carers - will be needed just to meet the planned increase in home care places and bettter pay and conditions will be needed to attract and retain home care workers.
The report is highly critical of the online and telephone My Aged Care service which it says is "transactional, impersonal, and insufficiently informative. The website is difficult to use.
"There is no systematic, personalised pathway to information, assessment, and home care services. The Government's proposals do not adequately address these problems."
A better home care system would cost the taxpayer more, says the report.
At least $400m more needed
The costs of creating more places could be partly offset by reduced administrative costs and reduced demand for residential care. But the improved regulation and navigation support needed would cost at least $400 million a year more than the Government is promising to spend."
The report's recommendations are: Improve stewartship of the home care market, Clear the waiting list for home care, and expand and develop the home care workforce.
"The Government has done a lot in response to the 2021 final report of the Royal Commission, but our report shows that it needs to do a lot more," says Dr Duckett.