On 18 October 2022, the Department published the Discussion Paper which sets out a proposed structure for the new In-Home Aged Care Program and seeks feedback from the sector by 25 November 2022.

Since the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Act 2021 (Cth) came into effect in July 2021, the Department has now completed its first round of home care assurance reviews.

In-Home Aged Care Program (previously the Support at Home Program)

The new Government is in the process of moving away from the previously published Support at Home Program. The description of the 'Support at Home Program Overview' has been updated to state that the document, which was published in January 2022, represents the design of the new Support at Home Program 'at that time' which suggests any proposed Support at Home Program structure proposed by the previous Government may not be adopted by the new Government. Of the post-Morrison Government reforms, the Department has recently held a webinar during which the Minister for Aged Care said that the Government would be using the additional time to consult with aged care stakeholders on home care reforms, and that the reformed home care program would tie into the development of a new Aged Care Act. Separately, the Department has stated on its website that 'no one will lose any in-home aged care services they currently have in place through the Commonwealth Home Support Program or the Home Care Packages Program '.

For completeness, we note that the Department appears to be moving away from the 'Support at Home Program' terminology, and is now using 'In-Home Aged Care Program'.

The Department has published a consultation calendar, outlining steps that will be taken to consult with the sector in relation to reform of the In-Home Aged Care Program. These milestones will be completed between now and the end of the calendar year. Although there are no specific dates, the next step in the consultation process is the publication of an In-Home Aged Care Program discussion paper. It appears that reform of home care will be closely tied to the development of the new Aged Care Act.

The Department is seeking feedback from the sector on the Discussion Paper, to inform the ongoing reform of in-home aged care. We note that residential respite care is included in the Discussion Paper as part of the overview of 'current in-home aged care programs' section. Accordingly, it may be that providers of residential aged care, who have also provided respite care but are otherwise not involved in the provision of in-home aged care may have valuable feedback to the Discussion Paper.

Although it is still unclear what the final in-home aged care program might look like, the Discussion Paper does set out an 'indicative model' for the new program, which will give the sector some idea of the direction the Government is taking for in-home aged care, along with targeted discussion questions to facilitate feedback.

The Discussion Paper highlights five key issues with the current in-home aged care program:

1. Program complexity: current arrangements are complex and difficult to navigate for older Australians, particularly due to the existence of different assessment organisations for the various in-home aged care programs. Recommendation 35 from the Royal Commission Final Report, which recommended that existing in-home aged care programs be consolidated and simplified into one 'Care at Home Category' is cited.
2. Access to services: it is noted that older Australians are facing wait times of 3 to 6 months to access in-home aged care, and that although they can access the Commonwealth Home Support Program (CHSP) while waiting for a home care package, this funding often does not meet their needs.
3. Alignment with needs: the alignment to needs issue is twofold, with the Discussion Paper noting that assessments need to more accurately identify the needs of older Australians, and funding needs to be directed in a manner that better meets these identified needs.
4. Value for money: concerns are raised that recipients of home care packages do not receive the value of their home care package, particularly highlighting the amount of funds that are spent on administrative and care management fees. It is noted that it is unclear to older Australians receiving CHSP services what administrative fees a provider charges, as these fees are funded directly to providers in the form of 'grants'.
5. Support for independence: the Discussion Paper notes that older Australians accessing home care packages need to 'save up' package funds in order to purchase high cost capital items such as aids and equipment or home modifications. There is limited funding for this kind of support available for those accessing funding through the CHSP, or through the short-term restorative care program.

The Discussion Paper sets out the following objectives that are proposed to guide the final design of reform of in-home aged care:

1. Reform to in-home aged care should simplify current arrangements for older Australians by consolidating assessment arrangements and programs that are currently cumbersome for older Australians to navigate.
2. Services should represent value for money for government and older Australians.
3. Services should be underpinned by a robust evidence base on how to meet a person’s assessed needs and support independence.
4. Older Australians should have timely access to a full range of services that meet their assessed aged care needs.
5. People who can afford to contribute to the cost of their care should do so.
6. Older Australians should have choice and control over services that meet their assessed aged care needs.
7. Funding and quality assurance arrangements should ensure that older Australians receive services that are safe and high quality.
8. Aged care expenditure over time should be predictable and fiscally sustainable.

The Discussion Paper sets out a proposed model for reformed in-home aged care, and sets out the following discussion questions:

1. How can innovation and investment in in-home aged care be fostered under the reforms?
2. How might we support innovative approaches to safely deliver higher levels of care at home?
3. How might we enable innovation in home care for providers working in congregate care settings?
4. How might we encourage innovations that increase the quality of care?

Feedback on the Discussion Paper was due on 25 November 2022.

We will keep you updated as further information is available on reform of the In-Home Aged Care Program and consultation opportunities as they arise.

Home Care Assurance Review

The Department is committed to review home care providers on an ongoing basis to ensure the maximum amount of the Australian Government's subsidy for home care packages directly supports older Australians to remain in their own homes for as long as possible. While the reviews have been occurring since October 2021, it wasn't until August this year that the Department released the first public summary report, outlining the findings of the review (Summary Report).

In this review, the Department considered:

• what providers are charging for home care and how the subsidy is being used;
• how providers financially account for home care services;
• the nature and type of providers' dealings with clients; and
• whether providers are consistently applying their pricing methodology to variable charges.

During the home care assurance review process, the Department was able to, and did, compel approved providers to provide information or documents, or even make available their officers, employees or agents to answer questions relevant to the review. When an assurance review is undertaken, approved providers are notified in writing when they have been selected for an assurance review and afforded at least 14 days to collate all information in line with the purpose of the review. The Department's objective is to avoid reviewing a provider more than once in a 12 month period; however, this may incidentally occur.

100 approved providers participated in the first assurance review process (95 were compelled, and 5 volunteered to participate) and the documentation for 1,000 care recipients was examined by the reviewers. The process was delayed due to COVID-19 related delays, as well as delays associated with commencing a new review program, that the Department is aiming to improve in future as further assurance reviews are carried out.

Generally speaking, it is the Department's intention that reports published following assurance reviews will be presented in general terms, however there is a mechanism in the Aged Care Act 1997 (Cth) which enables the Department to publish individual reports about particular home care assurance reviews. It does not appear that this has occurred and providers to whom individual reports relate should be informed if this is occurring.

The Department states on its website that the approved providers who participated in the assurance review process have received individual reports, and will be monitored for how they follow up the recommendations and findings made in the reports.

The findings in the Summary Report are high level and provide an overview of what the Department found through the assurance review process. The Department has also held a webinar summarising the findings in the Summary Report, that can be viewed on YouTube.

The next round of assurance reviews commenced in September 2022. The Department has published a Home Care Packages Program Assurance Annual Plan 2022-23, which identifies three planned assurance review focus areas (unspent funds, pricing transparency requirements, and excluded goods) and four possible assurance review focus areas (HCP Provider business processes, third party service delivery, supporting self-managed care recipients, and capping of administration and management charges) for the 2022 – 23 assurance review period.

As a pre-emptive measure, home care providers should review the Summary Report and identify any areas of concern identified by the Department that may be applicable within their organisation. We also recommend that providers consider the planned and possible assurance review focus areas, to ensure that if requested to participate in an assurance review, the provider is prepared to respond to the Department.