Commercial vultures must be booted from the NDIS, aged care and home care

Quite rightly, we are witnessing widespread fury and frustration over the administration of the National Disability Insurance Scheme. It seems that every second day there is another disclosure over the shortcomings of a system that promised so much but delivers so inconsistently and seems plagued by intractable problems.

This week we learned that the increasingly litigious and combative approach taken to the administration of what is supposed to be a system providing care to the most vulnerable people in our community has triggered mass resignations from the NDIS legal branch.

An NDIS protest in Geelong in March.Credit:Justin McManus

There is a matching furore over aged care. The levels of disillusionment in both aged and disability care focus on standards, conditions and regulation, or the lack of it. Despite endless scandals and expensive reports and inquiries, the structural flaws in both sectors – now dependent on a hybrid private/government system – are set to continue, particularly in the “for-profit” sector.

Is anyone surprised that re-directing a “care” model into a “business” model has led to declining standards? The problem starts at the top. The original NDIS, for instance, was governed by a diverse board of directors mixing lived experience with expertise in delivering complex care. Now it is run by bean counters and consultants.

Little has been said though about another struggling scheme, designed to assist the elderly, to help some of the most vulnerable people to stay living at home for as long as manageable. Loudly announced and heavily promoted, the “Home Care Package” was initially created to promote “ageing in place” by matching personal contributions from the elderly still living at home with government assistance, all professionally managed but with minimum bureaucracy.

Slippage in delivery now means it has become so bureaucratic and unwieldly that it delivers far less than promised and is showing all the hallmarks of the same waste and inefficiency that has been steadily draining morale and personnel from both the NDIS and aged care.

In simple terms, the federal government provides means-tested funds that match contributions from families to subsidise older Australians in their desire to stay at home and not go into nursing homes. Most older people prefer to stay at home if they can, but need expensive support to do so. Older people are often asset rich but cash poor – particularly in a low interest rate economy. Some limited financial assistance is offered for the support needed – cleaning, gardening, simple household repairs and some personal care – which can turn out to be the difference between staying at home and going into institutional care.

Needless to explain, it is also much cheaper for the government than creating the expensive infrastructure that old age homes require.

Somehow, this simple idea that in theory makes compelling sense has instead, in practice, become a nightmare and sometimes even a rip-off.

A Home Care Package comes in different levels of care ranging from low needs to high needs. Upon being assessed as eligible, the recipient signs up with a registered “provider” which is responsible for delivering services and in turn collects a fee every month. The administration and management fees are entirely separate from what is charged for actually delivering whatever service is needed.

From personal experience, the process has become tyranny by paperwork. Even the initial application process is harrowing and intrusive. It requires disclosure of highly personal medical information to a stranger, as well as full financial disclosure, which makes many older people suspicious and anxious. There must be a simpler way of separating out those who do need help from those that have the money to look after themselves.

From the most complex problem to the simplest request for access to your own money in the package account, applications are met with a deluge of paperwork. Even the most obvious and unarguable request for access to funds is tied up in a labyrinth of regulation.

A simple replacement of, for instance, a broken household appliance – in my experience the kitchen stove at our nonagenarian parents’ home – was met with the demand we provide an occupational therapist report and lengthy written assessment before approval for the purchase and installation of the most basic model of new stove was granted. When I discovered that the waiting time and delay in getting a report was two to three months and that this redundant report (only stating the bleeding obvious) would cost almost as much as the stove, I confess to getting somewhat irritated.

How can it even be arguable that two nonagenarians need a simple working stove to stay in their home? It is self-evident.

Not for one moment is this acceptable, but imagine how much harder – indeed impossible – it would be for a family less experienced, less confident, less familiar with the world of bureaucracy, trying to navigate so many traps? What of families with limited literacy or language skills? Those who have come to this country from a culture where the government is not your friend and officials are to be regarded with suspicion and hostility?

What happens to them? Do they just give up?

Controlling cost is crucial to making any of these “caring” schemes sustainable. Nobody can advocate for a blank cheque, nor is there any appetite for unlimited resources to be untapped. There are so many competing demands on taxpayer funds we must be cautious and prudent in allocating money and seeing that it is well spent.

Whether we are analysing care for the disabled, the elderly or those struggling with mental illness, the approach needs to be the same – quality of care is not negotiable. The challenge is to strike the proper balance between quality and cost. This model has clearly failed.

Unless the rent seekers and commercial vultures are shown the door, none of the essential changes to restore customer-centric care can be made.

Jon Faine is a regular columnist and former ABC Radio Melbourne broadcaster.

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