Optimizing In-Home Care Services to Avoid Residential Aged Care Admission: An Australian Pilot Study

Abstract

The aged care sector is evolving worldwide, due to demographic demand, Government policies and changing preferences. Alternative funding models across residential and community aged care are being explored including the potential to make the subsidy of services agnostic to setting, alternative funding models for residential care, and an increasing emphasis on consumer direction. Australia, like many countries in the OECD, is trending toward a model of aging-in-place, driven by technological advancement, and changing health policy, preferences and culture. Older Australians overwhelmingly (89%) nominate ‘‘living in my own home’’ or ‘‘living in a retirement village’’ as their preferred living arrangement; only 1% state a preference for living in residential aged care (RAC). Despite these clear preferences and theoretically supportive policy settings, over 240,000 Australians were in permanent RAC during 2018-19; and compared to other countries, Australia has a relatively high proportion (around 45%) of long term care recipients in residential care. In contrast, during 2018-19 the number of older Australians receiving care in their home via an Australian Government Home Care Package was markedly lower than those in RAC, at over 130,000. The Australian Government subsidized Home Care Packages (HCP) program provides home care services to assessed and approved clients, via packages from level 1 (entry level care, such as cleaning, shopping and transport) to level 4 (advanced care, such as personal and clinical care). Previous reviews into the Australian aged care system, however, have found that a level 4 package provides insufficient funds to care for some older people with significant care needs, and a new level 5 package has been suggested to delay or avoid entry into RAC. ECH Inc provides housing, care and services for older people, offering wellness and social programs, home services, day programs and housing to people living in the community. In 2016, ECH initiated a pilot study to test the capability of inhome services to support clients with complex needs in their home rather than being either transferred to RAC and/or a hospital admission, and designed a new model of care Enabling Responsive and Individual Care at Home (EnRICH). The EnRICH model was designed, adhering to principles of consumer-directed care, to objectively assess ECH’s standard of usual care and to enhance the capability of the organization to deliver an advanced care option which meets the increasingly complex care needs of the older population; in effect, ‘‘testing’’ a level 5 package.