The aged care system

Since 1 July 2019, all older people with disability who do not meet the age eligibility requirements for the NDIS or the Commonwealth Continuity of Support Programme have been required to access services from the aged care system.

There are two main programs that exist under the aged care system to provide support to people in their own homes. These are the Commonwealth Home Support Program and the Home Care Packages Program.

The Commonwealth Home Support Program (CHSP)

The Commonwealth Home Support Program (CHSP) provides a range of entry-level services to support older people who require assistance at home.

The CHSP can provide up to $500 of funding per person per calendar year for aids and equipment. While this cap can be increased to $1,000 with supporting evidence from an occupational therapist, information about the cap increase is not always communicated to consumers.

Under the Commonwealth Home Support Program, funding for assistive technology is provided under a service category entitled ‘Goods, Equipment and Assistive Technology’. Access is hindered by the fact that not all aged care planning regions are funded for this service type under the CHSP. Even in regions where funding is available, it still may not be available for all types of assistive technology that are required by people with disability.viii

There are ongoing boundary disputes that exist in relation to funding for assistive technology for people with disability who are over the age of 65.

The Commonwealth Home Support Program Manual states:

“The CHSP is not designed to replace existing state-managed schemes which provide medical aids and equipment (e.g. Medical Aids Subsidy Scheme). CHSP service providers are encouraged to access these state and territory aids and equipment programs where appropriate.” ⁱⁱ

While this implies that consumers can access support through state-based assistive technology programs instead of using the limited funds available under the Commonwealth Home Support Program, there is no national consistency in how this applies. Furthermore, existing state-based aids and equipment programs are currently falling short of peoples needs.

Home Care Packages Program

The funding available under the Commonwealth Home Support Program falls short of the needs of many people with disability. As a result, most people with disability are forced to access services under a Home Care Package instead.

The Home Care Packages Program provides support to older people with complex needs to help them stay at home. There are four levels of annual funding available under the Home Care Packages Program. This funding is set at pre-determined levels.

The four funding levels are as follows:

Level 1: $8,927.90
Level 2: $15,705.95
Level 3: $34,174.95
Level 4: $51,808.10 x

Many older people with disability with higher support needs will be assessed as eligible for either a level 3 or 4 package. Unfortunately, the waiting list to receive one of these packages currently sits at around 12-18 months. As a result, 19,000 Older Australians per year are being forced into residential care because they can’t access the support they need to stay at home.xi

Cost is also an issue. While NDIS participants have access to fully funded aids and equipment and are not required to make any financial contribution towards their care and support needs, people who fall under the aged care system are required to pay a range of different fees, including a daily basic fee and an income-tested care fee.xii

Finally, older people with disability can have significant difficulty funding the aids, equipment and home modifications they need out of a home care package. The limited funds available mean that people with disability are often forced to trade off one vital service to be able to afford another. If someone needed a new power-assisted wheelchair to be funded in a particular calendar year, for example, this could leave them with little to no funding left over to cover the costs of attendant care support, home maintenance or any of the other services they may need.

Case study: Graham and Aaron

Graham and Aaron both have Motor Neurone Disease (MND). They have lived in the same regional community since childhood and played football together in the same premiership teams many years ago. They have maintained a close friendship over the years and still mix in the same social circles.

Graham is 66 years old. He is not eligible for the NDIS as he was unable to apply for the scheme before his 65th birthday. He has been assessed as being eligible for a level 4 home care package under the aged care system but was advised that he would need to wait 12-18 months for a suitable package to become available.

Graham has been forced to self-fund ramp access to his home and modifications to his bathroom in the meantime. Without these urgent modifications, he would not have been able to remain living in his own home. While he has received some support to subsidise the cost of these modifications through state funding, donations, and fundraising events, his out of pocket expenses have still been significant.

Things have been much more straight-forward for Aaron, who is 64 years old and is able to access support under the NDIS. His NDIS plan has enabled him to access fully funded assistive technology, including bathroom modifications and ramp access to his home. He is also able to ask for his NDIS plan to be reviewed if his circumstances change and he feels that he no longer has enough funding available to meet his needs.

Case study: Margaret

67-year-old Margaret was diagnosed with Parkinson’s Disease 11 years ago. She lives at home with her husband Kevin and her need for assistance has increased significantly in the past 2 years.

Margaret has been assessed as being eligible for a level 4 Home Care Package under the aged care system. She has now been waiting 18 months for a level 4 package to become available but has been granted access to a level 2 package in the meantime. The level 2 package does not meet Margaret’s needs, resulting in added emotional and financial stress for her and her family.

Margaret urgently needs a powered adjustable bed. This would assist her to safely get in and out of bed, reduce carer strain and stress, reduce the risk of aspiration-related pneumonia and improve much-needed sleep for Margaret and Kevin. Margaret also needs a powered lift chair that would assist her to stand up from a sitting position, which would reduce her dependence on Kevin.

Margaret and Kevin are unable to self-fund the bed and chair that Margaret needs as they have already paid for other essential equipment and services that the aged care system has not been able to provide. They are both experiencing a decline in health as a result.