What if the NDIS and Aged Care Merged Their Play Books!

The NDIS, which is managed by the Department of Social Services, introduced new concepts to the disability sector. The change was difficult and organisations and customers both struggled with NDIS implementation, and some are still struggling even after years of having the program. Aged Care is managed by the Department of Health and there are reports after reports all recommending changes. Have you ever wondered if the people who run these programs ever meet to discuss lessons learned? It would be wonderful if they could share each programme’s pros and cons with the end users and stakeholders. I am sure the stakeholders and users want to know ways that one program could deliver better services in a more efficient way by adopting what works well with the other program.

Both programs serve particular population groups using taxpayers’ money, yet they run in completely different ways. The two programs run parallel and operate in totally different ways yet we have witnessed benefits from various components of each program. From my experience in disability and aged care I can tell you confidently that we could operate more efficiently and better serve the customers and deliver more to them for every dollar that we spend. In order to increase our efficiency and effectiveness we need to logically analyse both programmes to see what works, what does not work and why. We should then take what is working in both programs and create a standard model of service which we can then implement in both programs and in future programs. I have written several times that NDIS and Aged Care need to operate in tandem in order for the open and competitive market to work.

To maintain clarity, simplicity and ease of comparison, we can group the various areas of the process for both the NDIS and Aged Care into five main categories.

Eligibility

Eligibility for each program is pretty straight forward. People now understand that if you are eligible for the NDIS you are not eligible for Aged Care and vice versa. That makes the two programs tricky for those who are both elderly and disabled. You are eligible for the NDIS if you are an Australian citizen or resident or permanent visa holder who is under 65 years old and you meet the disability or early intervention requirements. If you turn 65 years old while benefiting from the NDIS you will continue to receive support similar to what you are currently receiving. If you are 65 years or over and then become disabled, you do not qualify for NDIS benefits but you will receive support from the Commonwealth Aged Care System.

This has been difficult for people to understand but it is obvious that those who are aged and disabled deserve appropriate care too and they are not adequately addressed under Aged Care Packages. Aged Care packages are designed to make the last few years of an elderly person over 80 years as comfortable as possible, but they are not good enough for a person over 65 years who is still strong but has developed a disability. The needs of such a person who develops disability after the age of 65 years require the type of assistance that the NDIS provides which promotes independence and can help a person to go back to work.

Still on eligibility, Aged Care income-tests the elderly for eligibility for home care packages while the disabled are not tested on income and are encouraged to work.

Information Gathering and Planning

In Aged Care, Regional Assessment Service (RAS) was initially meant to identify clients’ goals for greater independence and well-being as well as clients’ and carers’ needs for support. The idea was to respond to those needs and to support the clients in retaining or regaining skills that help with independence. Meanwhile the role of the Aged Care Assessment Team (ACAT) was initially to conduct comprehensive assessments for the elderly to assess whether they are eligible for a home care package, residential care in an aged care home or other services.

It is good to see that Aged Care will now merge the RAS and ACAT assessors into one role if they somehow link back to the GP in a more succinct way with oversight of the package as aged care needs a primary care focus. This would really drive that care integration that often lacks between social care, health care and person centred home care. With the merger of the roles we get the ideal information gathering, assessment and planning team. This model will be much more effective and efficient in the NDIS where it can replace the Local Area Coordinators from the NDIS partners and Planners from the NDIS. We can then have a streamlined process that focuses on community care and is based in our clients’ communities where they are familiar with resources to be used.

Implementation and Integration

A Support Coordinator is a person registered with the NDIS who helps a client to get started, to understand the care plan and its budgets, to find and connect with supports and services in the community and to achieve goals. Then there is the Plan Manager who helps the client by organizing providers, paying providers, assessing claims and invoices and tracking budgets. The Plan manager is optional since a client can choose to self manage or can ask the agency NDIA to perform the management role.

I like the idea of Support Coordinator and Plan Manager since it separates some critical duties and brings accountability and transparency to the spending of money and delivering of care services. On the contrary our elderly clients staying at home do not need case management but they need care navigation. They do not need to spend time and energy negotiating who provides care and how their package is managed. They need Support Coordinators similar to those in the NDIS but every elderly person must get the attention of the coordinators equally regardless of the complexity of their cases. Just like in the NDIS, the elderly also need a plan manager to pay their bills and to monitor their funds although the care manager and the client have ultimate say on how and where the money is spent.

Definitely Aged Care should be a use or lose model like the NDIS as it is allotted for per annum use based on needs.

When it comes to renovations to make the home client-friendly, the NDIS has a procedure in place that uses an OT to perform the assessments and make recommendations and extra funds may be allocated to the budget to have renovations completed. That is different from the Aged Care model where the client is expected to forgo some services in order to accumulate the funds. Aged Care needs to change their approach and copy the NDIS way to help clients to stay at home with assistance. After all it is better to keep the client at home with support as long as we can and not just for financial reasons. Research, after all, has proven that clients are happier and more confident when they stay within their communities than when they are in a home.

When it comes to choosing service providers, Aged Care has this under control and it is working very well. The clients choose their service providers and can move to another service provider if they have reasons to do so, as long as they pay all the bills from the old provider and they are refunded any advance payments to the provider. On the other hand the NDIS clients do not pick their providers. NDIS providers are required to go through a cumbersome registration process. Then when an NDIS client needs a service and money is available in the budget, the service is sourced on the open market at alleged market value. Just how genuine is that market value? We all know that providers shift their prices based on the funding source. If the NDIS can copy the Aged Care model and get their cap price funding model right the model could work very well for them.

Reviews

Annual or periodic reviews are required. In the NDIS program this is a very cumbersome process that could be streamlined. Even the system in Aged Care is not easy to handle.

Most clients have several providers and it is tiresome to fill in cumbersome forms for each service provider. The system can be simplified. For example the clients could a tick and flick a one page sheet that is compiled and analyzed using an algorithm. The questions asked can be as simple as yes, no and not sure. Let’s say the question is “Is the current support enough?” Then the possible answers that can be ticked are “Yes” or “No” or “Not sure.” If the answer is “yes” that is the end of the question. If the answer is “no” then more fact finding questions are asked. If the answer is “not sure” then the sheet should state that someone will be in touch with the client for more information.

A simplified review system will make it easy for clients to provide all information required and that information can be processed and made use of.

Quality and Complaints

National quality frameworks are already in place and aged care is currently undergoing a review in the light of recent events. The ombudsman is a really good starting point and they should also have oversight of the quality teams to ensure all consumers get what the government is paying for or the client is paying for. I am quite pleased to say the NDIS has got this right with the legislation that says the client is a customer and they are purchasing a product and if they are not happy or have a complaint they have the same consumer protection as any other consumer purchasing a product. Aged Care also needs to make its very vulnerable clients aware of their rights as consumers and have systems in place that make it easy for the elderly and their families to lodge their complaints. 

The administrative tribunal, as part of the complaint pathway, has really delivered some fair and balanced results across both sectors. It is an end of the road mechanism that has proven its effectiveness and should be considered for adoption as a regional concept of review for early intervention if required. This will essentially turn this process upside down and provide early intervention and recommendations without formal application to a tribunal (quasi tribunal of independent reviewers).

As we move forward in delivering our community based health and human service programs we need to open our minds and accept change. The reality is we need systems that can deliver quantity and quality at an affordable price. The only way to do this is to adopt and embrace changes that have proved to work in programs that are similar to ones we work in. As things stand right now, some of the Aged Care mechanisms would enhance the NDIS and some of the NDIS mechanisms would enhance Aged Care. Adopting those mechanisms that work from both programs and creating a new standard model of operation would improve the customer experience. The new model will enable agencies to deliver services via both programs and not literally have to pick and choose at the cost of the clients and other stakeholders.

I said some time ago that the NDIS would be better delivered under a Private insurance company. I still believe this today since people are resisting change that is not delivering the quality and quantity of service at an efficient price on the front end of the process. I am just hoping Aged Care gets this part right in 2021 so that our Not-for-Profit organizations can be major competitors in the market and deliver high quality services to the clients as is the case today.

I look forward to the ongoing development of NDIS and the 2021 Aged Care reform. I just hope that people think about how the two systems can work hand in hand and streamline the process to achieve outcomes.