Report on respite services welcomed
Not for profit aged care provider Benetas has welcomed the recent release of the Aged Care Financing Authority (ACFA) report on respite services saying the review is an essential piece of work to address issues with the service.
Benetas CEO Sandra Hills OAM said the review is the first undertaken in a number of years and many recommendations in the report are sure to make a positive impact to the provision of the services in respite.
“We welcome the important recognition of respite as a vital component of the aged care system and also the necessity to ensure consistency with other reforms taking place in the sector,” she said.
“We also welcome the recognition that consumers who are able to make a contribution to the cost of respite care should do so, with appropriate support from Government provided where they are not able to contribute.
“In addition, we welcome any improvements to the assessment processes and the recognition of carers with a recommendation to support carers in line with the original intent of respite.”
However Ms Hills said that while the issue of fee integration across different forms of respite has been addressed, the impact of the integration of the Commonwealth Home Support Program (CHSP) and Home Care Packages (HCP) program on access to respite services is absent from the report.
“Furthermore the issue of un-affordability of respite under HCPs has not been addressed,” she said.
“The report also recognises the difficulties with navigation and finding services as a key issue however there is not a recommendation to address this concern.”
The report is heavily focused on residential respite service and Ms Hills said that future reviews would be well placed to look more deeply into community based services.
Report key issues
Key issues raised in consultations in preparing the report included:
- Issues in relation to access including difficulties with the assessment process (difficulties in finding services and navigating My Aged Care); the importance of giving consideration to carer needs as well as care recipient needs; and the problems faced by people with special needs (including CALD communities and dementia and bariatric care).
- Funding – concerns that funding, particularly of residential respite care, does not meet the cost of care and accommodation; proportionally high administration costs associated with short-term respite care compared with permanent residents; and the nature and administrative processes for respite care which can expose providers to greater financial risk than for permanent residential care.
- Fees – concerns that fees for residential respite care are a barrier to access, and that there is a disparity in fees for different types of respite care in CHSP, home care and residential care.
- Administrative processes – concerns over the administrative process for managing residential respite, including the rules for minimum and maximum place allocations, the 70 per cent respite incentive supplement and the 63 day limit per year on an individual’s respite care use.
- Availability – general concerns over the availability of respite care in CHSP (including concerns over the availability and funding of ‘cottage respite’) and residential care, with issues over different business models and approaches to offering respite by different providers affecting availability of residential respite care and the use of respite as a ‘try before you buy’ approach before permanent admission into residential care
The recommendations in the report are summarised below and are outlined in full in Chapter 3. They include:
1) Recognising respite care as a vital component of aged care services and, that the Government should implement policies to facilitate a sufficient supply of the different types of respite services to meet care recipient and carer needs and preferences.
2) Ensuring the needs of carers, as well as care recipients, are recognised when assessing access to respite care.
3) Establishing funding arrangements that are neutral between respite residents and permanent residents, and not act as a disincentive to respite care.
4) Ensuring access to, and suitability of, care for special needs groups, including people with dementia, needing bariatric care, and from CALD communities.
5) Recognising that consumers should make an appropriate contribution towards the cost of their respite care and accommodation where they can afford to do so, with appropriate support from the Government where consumers are not able to contribute.
6) Ensuring consistency with other potential reforms, including that consumer fees for respite care be considered in conjunction with wider changes to consumer care fees, such as better integration of fees more broadly in the residential, home care and CHSP sectors as recommended by the Legislated Review.
7) Facilitating care recipients’ and carers’ easy access to information on respite care options (through CHSP, home care, residential and other DSS services) and in doing so help care recipients and carers readily obtain care when and where they need it.
8) Ensuring Government agencies adopt a co-ordinated approach to the delivery of, and information dissemination around, respite care, including working with providers to establish real time information on the availability of respite care.
9) Recognising that the use of respite care for purposes other than supporting people to live at home for as long as possible and their carers can be responding to a market demand for other uses of respite, but that this should not be crowding out consumers with genuine respite care needs.
10) Examining the need for specific arrangements that facilitate the transition of a resident into permanent care, particularly in the context of the current review of residential aged care funding models following the RUCS exercise.
11) Allowing the market to respond to consumer demand and in turn the numbers of respite places that providers offer based on funding arrangements that do not act as a disincentive or incentive to the provision of respite care. Given that respite care is central to the aged care system, there should be an expectation that all providers be prepared to offer respite care.
12) If neutrality in the funding of respite and permanent residential care is achieved, the Government should remove the minimum and maximum allocation rules for respite care and allow providers respond to consumer demand for respite, subject to appropriate transitional arrangements and monitoring of the impacts of such as change on respite availability.
13) Renaming the current respite care supplement as the respite care accommodation supplement to reduce confusion as to its purpose and paying the supplement irrespective of whether a person has been assessed as low or high level care, with rates aligned with those that apply for permanent residents .
14) Reviewing the respite incentive supplement in the context of the outcomes of the University of Wollongong work on broader residential care funding reform. If the relative rates of funding between respite residents and permanent residents are set appropriately, there may not be a need for a separate incentive supplement with all the associated administrative red tape that it brings.
15) Recognising that if the incentive supplement is to continue, the administrative processes that support the incentive supplement are inefficient and should be changed. The current process whereby some providers have a minimum respite allocation and others a maximum allocation is highly confusing and likely contributes to some providers missing out on respite subsidy they should receive.
16) Reconsidering the limitation of 63 days per year per respite client in residential care because it imposes administration burdens on providers, consumers and the Government, and is not readily tracked. ACFA recommends keeping a cap on respite care, but suggests that consideration be given to whether it be less than 63 days and to introducing some form of means testing after a specified period of respite use. The latter would address concerns that other uses of respite care may crowd out respite for supporting people wishing to live at home for as long as possible (and their carers).
17) ACFA does not see the need for any changes to how home care packages can be used to access respite care. While there are issues around different fee structures which should be considered, the purchasing of respite care should remain an appropriate use of home care packages.
18) Similarly, noting that other than in relation to fee contributions, ACFA does not consider there is a need for any major changes to how CHSP respite services are offered.
19) Recognising that cottage respite is in effect another type of short-term residential respite care, when considering neutrality of funding settings following the RUCS study, consideration be given to whether the current funding model for cottage respite is appropriate.
See the Australian Government Aged Care Financing Authority Report on respite for aged care recipients at https://agedcare.health.gov.au/sites/default/files/documents/11_2018/acfa_report_on_respite_care_for_aged_care_recipients.pdf
11 December 2018.