Home Modifications Aids and Equipment
Q1: What arrangements are currently in place for consumers to access home modifications and aids and equipment?
Current access to home modifications and aids and equipment schemes across the nation varies considerably from state to state.
Funding responsibility for home modifications and aids and equipment in aged care is divided between the Commonwealth, states and territories. Generally, the Commonwealth provides funding through programmes such as the CHSP (formerly HACC) and HCPP. The single point of entry to the aged care system, My Aged Care, screens and registers potential clients for Commonwealth funded services. Face-to-face assessment is undertaken by the Regional Assessment Service (RAS – for CHSP services) and Aged Care Assessment Teams (ACATs – for home care packages).
If the assessment identifies a need for home modifications (minor) and/or aids and equipment, eligibility and the method for delivering a service is dependent on whether the consumer is receiving home support through the CHSP or HCPP.
Commonwealth Home Support Programme
Generally, referrals for minor home modifications and aids and equipment come via the My Aged Care online portal to occupational therapists employed in organisations that are block funded to deliver allied health and home modification services through the CHSP. The referral is sent to an occupational therapist who undertakes a home visit, provides recommendations and liaises directly with the home modifications provider.
Examples of home modifications available through the CHSP include the installation of grab rails in the shower, ramps (permanent and temporary), internal and external hand rails next to steps, and the installation and fitting of emergency alarms. In some circumstances home modifications could also include bathroom and kitchen redesign.
The CHSP is intended to primarily fund simple home modifications (those that would incur a cost of less than $1000 to the Commonwealth). Modifications that cost more than $10,000 are not supported under the CHSP.
In the past there have been many complaints from occupational therapists who have had difficulty liaising with home modifications providers, and the Commonwealth responded by implementing a new process. Although this process is working towards a more streamlined approach, there continue to be inequities in levels of funding across the nation. This is also evident in the area of aids and equipment. CHSP-eligible consumers have access to a number of state-funded aids and equipment programs across Australia, such as the NSW Aids and Equipment Program, the Victorian Aids and Equipment Program (A&EP), the Victorian Statewide Equipment Program (SWEP), the Medical Aids Subsidy Scheme (MASS) in Queensland, the Disability Equipment Program (DEP) in the Northern Territory, and the Community Aids and Equipment Program (CAEP) in WA.
Home Care Packages
People who have been referred for an assessment by an ACAT are generally identified to have higher level needs and are better serviced with a range of ongoing services that are covered by a set value home care package (level 1, 2, 3 or 4). Home care packages are delivered on a Consumer Directed Care (CDC) basis.
The budget of a home care package is utilised to cover the costs of all expenses, including home modifications and aids and equipment. It should be noted that people on a Level 1 or 2 package can continue to have limited access to CHSP funding, but only where they have fully expended their package allocation. The CDC model enables consumers to choose their providers, and therefore they can purchase minor modifications and aids and equipment directly from various eligible suppliers.
The package administrator must liaise with the consumer and the provider to ensure quality and compliance for the various purchases undertaken. The Commonwealth has also stipulated in the relevant guidelines that it is preferred that aids and equipment are leased or hired.
Last year the National Aged Care Alliance (NACA) completed a discussion paper on the aged care and disability interface. This paper has reviewed the implementation of the National Disability Insurance Scheme (NDIS) and the range of support options available to people with disability who are under 65 to people with disability who are over 65 (under/over 50 for Aboriginal and Torres Strait Islander people). The paper provides information on the various aids and equipment programmes operating throughout the nation and provides a snapshot of the aged care and disability support systems, highlighting the similarities and differences between the two.
The discussion paper is available to download from NACA’s website.
My Aged Care Regional Assessment Service
Many of the difficulties with referrals and service implementation experienced by occupational therapists in the aged care field have been attributed to the introduction of the RAS. Some of the problems identified include:
- Inaccurate referrals from RAS assessors (eg. limited detail, cross-referral, duplication);
- Reports from occupational therapists and other health professionals of difficulties referring people for aged care services;
- Lengthy delays and mistakes, both in terms of receipt and on referral of occupational therapist assessments to home modifications providers;
- Misinformation about home maintenance services on the My Aged Care website;
- Misunderstanding about when direct to service referrals can occur, particularly between hospitals and community providers;
- Inability for occupational therapists and home modifications providers to connect with each other when delivering a service to the same client.
The Commonwealth Department of Health is continually reviewing these issues and responding to feedback from health professionals, service providers and aged care consumers. The implementation of a referral code that enables an occupational therapist to communicate directly with a home modifications provider is a result of the Department acting on feedback and developing solutions to these problems.
From September to December 2016, the Department ran a series of co-design workshops and accelerated design sprints to develop potential solutions to many of the issues with the My Aged Care system. These workshops were attended by aged care sector stakeholders including assessors, service providers, and client and State Government representatives.
A number of specific solutions were proposed to address issues with home modifications referrals. These included communication and training to improve understanding of occupational therapy assessments, a pathway for clients with an urgent need for home modifications, and a process to allow direct to service referrals for home modifications prescribed by an occupational therapist (where the occupational therapist has demonstrated that a RAS assessment is not required).
To track the progress of solutions proposed during the accelerated design sprints, visit the DOH website.