| Letter to Prime Minister: Consumer Directed Care (CDC) |
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19 August 2010 Open Letter to the Prime Minister Julia Gillard Dear Prime Minister, I have taken this opportunity to write to you directly and put my submission to you rather than the Productivity Commission in their current consultation with respect to Caring for Older Australians. The submissions closed recently. I would like to put to you that as Australian citizens we all should respect the contribution made by our elderly citizens. Their hard work and has set the foundations for future generations. We as beneficiaries would not be as well-off as we are today if not for the sacrifices made by them. All citizens in this country contribute to the betterment of this great nation. I say to you Minster as a community we have done excessive research in the aged care sector. There have been volumes written on the state of the elderly in our community, their needs. Currently the flavour of the month is Consumer Directed Care (CDC). What is lacking Prime Minster is common sense. The Productivity Commission in its last report on the cost of institutional care of our elderly indicated that it costs the community some $150,000 to $200,000 per year to keep our elderly citizens in the aged care sector, ie nursing homes and Hostel type accommodation. Our most vulnerable citizens are housed in these institutions. However, very little is written about of the care delivered, the level of satisfaction of the residents, the level of satisfaction of the family members of these vulnerable citizens who care and tend to their needs. Indeed as a community we face an explosive or exponential demand for accommodation and support in these institutional settings. As a community we have allowed this sector to grow to the extent that funds which are derived from the community are increasingly eaten up by the very structure that has been created by Parliament through legislation to provide for our most vulnerable. At the moment we have a very complex system of care that is fragmented, disjointed and lacks any real direction in terms of vision and how we should deal with our elderly let alone how we should deal with the upcoming baby boomers who will not take the one size fits all approach that has been the cornerstone of the care model of our vulnerable citizens. Every bureaucrat and provider that I have had the pleasure to talk to speaks of a system in disarray. The system has become too complex and unwieldy. A system as referred to earlier that is disjointed. States fight amongst each other. Local governments have become territorial and parochial in determining who shall receive a service. There is much confusion about who is actually responsible for the delivery of services to our vulnerable citizens. In my attempt to manoeuvre through this system in order to get vital support for the care of my mother I was struck by the stupidity of the whole process. Providers and bureaucrats did things because they were done in the past. Even though it was self evident that the system was wasteful and insensitive to the needs of the individual and the family caregivers, they nonetheless did things because it was policy. When the Providers were asked to demonstrate the regulatory basis of their policies they merely stated that this how things re done! Not one consumer I came across was happy with the system. But the system rolled on. Many consumers and their families I was to find out were too afraid to speak up for fear of losing even the little bit of care provided! The system destroyed many a young social worker and personal care worker as well as dedicated nurses. I thought about this mess we were in and determined that I could do a better job of managing my mother’s allocated fund. My mother was assessed and was offered an EACH Dementia package. The Provider in receipt of the EACH indicated to me that at best the number of hours of direct support hat could be provided for the care of my mother would be about 15 hours per week. This equated to about $300 per week. Indeed I was to find that this was above the average offered to other clients! I questioned the efficiency of the organization and told them that if they were to allow me to self manage the fund I could get greater number of hours of care. This was my primary objective. I was told by the Provider and the Department of Health and Ageing and Ministerial advisers that my proposal was not allowable under regulations and legislation. However, the harder I pushed the more resistance I experienced. Eventually I was able to find an organization where I parked my mother’s fund, an EACH Dementia package. I paid this organization a fee for administration. This amounted to about 10% of the total package. Essentially I was able to operate a Consumer directed model of Care. This happened under the existing regulations in 2006. The other motivating factor was to demonstrate that family caregivers are not only responsible but the best people who when supported can do a great job of managing their loved ones care and getting better quality care value for money in the process. I saved the system hundreds of thousands of dollars by running self managed or Consumer Directed model of Care. Importantly, I was able to more than double the number of hours for my mother’s care she received from the same funding bucket. There are many precedent cases like the one I have made reference to - but not as well publicised. Now Prime Minster I wish to ask as I did the previous Ministers for aged Care both Labour and Liberal. Please explain to me how a package of $48,000 can only buy $15000 of direct care. I ask you tell the Australian people what happens to the $33000? Keep in mind that government figures point to the fact that $256.3 million dollars on EAC and EACH D packages. The figure for Community Aged Care Packages is $479.7 million for the same period. If the percentage that does not reach the end user is more than two thirds ten it is apparent to me that even these crude figures speak of a system of administration that is wasteful and inefficient. Furthermore how can you explain the current system that encourages dependence on the professional sector and relegates the role of the family caregiver to that of ‘informal care’? Yes there are bad families however there are bad providers and bad bureaucrats and systems people generally. We do not stop paying them do we? The other matters that need to be raised in the current debate are the unspoken concepts of the residual and co-payments. In order to facilitate the entry of for profits into the sector the legislation was changed to allow organizations to keep any unspent money from government packages. Prime Minster, this change allows a system to act in most cases not in the best interest of the individual not the family caregivers. Again, I ask how can you explain what happens to community funds in a package of $48,000 that arrives at the door of the funds holder and only about a third arrive at the door of the person requiring the care. In most cases, Prime Minister, (and I believe this is an unspoken industry standard) that about 30% of a fund actually targets the individual for whom the moneys were originally intended. Furthermore, out of this 30% more moneys are eaten up because organizations holding the funds outsource the delivery of services the elderly citizen. So, essentially what the consumer, our vulnerable elderly citizen if they are lucky, receives about 15% of the original fund. Plus there is often a demand made by Providers for our elderly citizens to contribute for the delivery of care. This, Prime Mister, I believe is not a very good outcome for our community. We cannot continue as a community to be so wasteful and disrespectful of our vulnerable citizens. My main concern is the fact that the there are billions of dollars being pumped into a care system. This wasteful system essentially tells our elderly citizens and their family care givers to wait to be assessed, and hopefully get help. Increasingly the system which has it focus on the profit motive or retaining the residual (even the not for profits are mimicking their corporate competitors and becoming more corporate in the process), the cost and share of the burden has been pushed upon our vulnerable and their family caregivers. Another matter relates to the entry of the for profit providers. Their entry has resulted in the marginalization of the community based organizations in this sector. The spirit of community caring has been diluted. The sector now speaks of “clients”, “participants” and other such terms. We no longer talk of community care but rather formal and informal care. As stated, the role of individuals and their family caregivers is relegated to mere spectators. The system as it currently operates does not provide sufficient resources to keep people in their own homes and in their communities for as long as possible. The system is being driven by these large and often corporate interests who frustrate and essentially pressure people into making decisions to move their loved ones into institutional care. Institutional care is about meeting targets meeting profit margins and reducing costs. Provision of care by many of our church based providers is about creating dependence. As a country we have lost that vision of citizens being encouraged to assist and help themselves. We have a choice now in this current environment to increase community capacity, increasing community involvement and allowing and really empowering individuals to utilise their skills and knowledge to self manage their care. Prime Minster I can hear the march of the baby boomers and I think thy will not accept the outdated “one size fits all” model of care that has not moved with the times. The system cannot continue to grow exponentially. As a community we do not have the resources to facilitate such growth. The global financial crisis made this quite clear I believe. Otherwise we wouldn’t have the current enquiry. WE can not shift resources from the community to the for profit sector or to the corporate not for profits who desire for the residual. Care is about care and respect for those elderly citizens who have worked to make this country great. We need to respect them by allowing them to age in place, but more importantly we need to respect them more by providing the resources in an effective manner. Consumer directed for me. Prime Minster we need to equalise the current lopsided relationship. True community means access to resources on an equal footing. At the moment we do not have a level playing field in the aged care sector. George Vassiliou Newer articles:
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