0:01

Welcome to the Community Therapy podcast

0:01

where we talk all things community

0:05

healthcare. I'm your host, Scott Lynch.

0:08

Today we're chatting to Lorraine Poulos

0:08

about the Support at Home Reform Pathway.

0:14

Lorraine is the Managing Director of LPA,

0:14

Australia's largest home care consultancy

0:20

and training organization.

0:22

Lorraine is an experienced healthcare

0:22

executive having worked in the health,

0:26

aged and community sectors for over 35

0:26

years.

0:30

She is a member of two not -for -profit

0:30

boards and a former health minister

0:34

nominee on the New South Wales Medical

0:34

Council for over 10 years.

0:39

Lorraine and her team have been supporting

0:39

the sector for over 15 years in aged care

0:43

with a particular focus on home care.

0:46

Lorraine brings a passionate, practical

0:46

approach to everything she does.

0:50

Welcome, Lorraine. Great, thanks Scott, so nice to be with

0:52

you again and well done on the great work

0:57

that you do. No, thank you.

0:59

You're buttering me up for a lovely

0:59

podcast.

1:02

Thank you. I'm really excited for today's podcast.

1:07

In -home aged care is experiencing

1:07

constant change under the reform pathway

1:12

from the Department of Health and Aging.

1:14

Many of these reform pathways started

1:14

after the Royal Commission, but there

1:19

seems to be constant reviews and

1:19

commissioned reviews.

1:24

providers are dealing with this change

1:24

during peak macro and economic pressures

1:29

at present, inflation, etc.

1:32

And they're navigating arguably the most

1:32

significant industry reforms that many may

1:38

experience in their careers.

1:40

And I can speak to that as myself as still

1:40

I think I can claim somewhat young in my

1:47

career, but I have been nearly 15 years in

1:47

aged care now as well but and have

1:53

navigated some industry change, especially in

1:54

residential aged care of ENAC to ACFEE.

2:00

So within in -home aged care, single

2:00

assessment workforce, support at home

2:04

merger of home care and STRC, quality

2:04

indicators coming, so much more.

2:10

What's the general sentiment and readiness

2:10

to change for the providers that you're

2:14

supporting? that have great questions got.

2:18

So what we're seeing at LPA is that there

2:18

was a lot of energy, lots of work being

2:25

done in the previous 18 months.

2:27

And then when the department announced

2:27

that the delay of the Supported Home

2:33

Program to 2025 for home care packages and

2:33

short -term restorative care program.

2:42

and then a further delay to 2027 for the

2:42

CHSP services.

2:48

That sort of gave people, I guess, two,

2:48

how we see it, two sort of sentiments.

2:54

One was, oh, well, when is it going to

2:54

change?

2:58

And the unknowns, so that, I guess, that

2:58

anxiety around the unknowns.

3:05

And then as, whereas for other providers

3:05

who have been proactively looking at the

3:10

models, I'm starting to see that the profits that

3:11

they were making previously has started to

3:18

shrink. So it's given them a bit of an opportunity

3:18

to take stock and have a look and see

3:23

where they're going in the future. So it's sort of two schools of thought and

3:24

action.

3:30

What we're doing is encouraging providers

3:30

to keep that momentum going because the

3:37

lights just won't go off in June 2020.

3:40

five and June 2027, all throughout that

3:40

period, there are reforms and changes.

3:49

And I think what you said is so true, that

3:49

change fatigue.

3:54

We would argue that in most businesses,

3:54

you have to change and adapt.

4:00

And whilst it's hard sometimes for

4:00

providers that have been reliant

4:05

predominantly on government funding and

4:05

one source of government funding.

4:10

to adapt those models into a more of a

4:10

business type approach.

4:15

And I think that's probably why the

4:15

Commonwealth Home Support Services have

4:21

been delayed because, you know, there's

4:21

approximately 900 ,000 to a million people

4:26

on that program. And that's a lot of people to transition

4:28

into the support at home.

4:32

And also for... those Commonwealth Home Support providers

4:34

to be able to decide whether they're going

4:39

to be in home care or out of home care.

4:43

Many of them are local government

4:43

providers.

4:45

We've seen a big exit from local councils

4:45

in who are providing those CHSP programs

4:54

because they're no longer getting a grant.

4:57

So there's no, I guess, guarantee that

4:57

they're going to get that income because

5:02

it's funded. and it's already moved towards that

5:04

activity -based funding model.

5:08

So lots of change and, yeah, as you said,

5:08

change fatigue.

5:14

Yeah, so what would be the biggest

5:14

challenge that you're finding in general?

5:22

Each provider, each type of provider,

5:22

council, for -profit, not -for -profit,

5:27

large organizations, small, franchised

5:27

component.

5:32

We've got lots of different, I guess,

5:32

types of providers now in the market.

5:37

But what's a general or really common

5:37

challenge that's permeating

5:42

all of those types of providers as they're

5:42

gearing up and trying to navigate change,

5:50

irrespective of where they are in their

5:50

change journey.

5:53

Yeah, for me, I think it is uncertainty,

5:53

not knowing.

6:01

Someone said recently in a consultation

6:01

with part of the support at home reform

6:08

consultations, can you just make a

6:08

decision, either rip the bandaid off,

6:13

because it's very hard for us to be

6:13

planning our businesses.

6:17

We're worried about the future role, for

6:17

instance, of our...

6:21

care managers and coordinators, they're

6:21

starting to get a little bit unsettled.

6:26

We're worried about when, particularly in

6:26

home care packages, when will the package

6:32

management subsidy or ability to charge

6:32

that, when will that stop?

6:39

We know that that package management

6:39

charge is going to be rolled in to the

6:48

hourly rate. But if you're not selling any widgets,

6:49

Scott, then you're not going to get that

6:55

10 to 15 % of package management.

6:59

And in care management, there are many

6:59

people in home care packages who don't

7:06

really access much care management.

7:08

They're fairly low level. So we've seen some promising feedback from

7:10

government that they will continue to

7:15

fund. They understand care management.

7:18

whether it's low or low care management or

7:18

complex care management.

7:21

So we think that's a really positive sign.

7:26

Also, I think that there will be a much

7:26

greater opportunity for new entrants into

7:34

the market. Now, we know from the Royal Commission

7:35

into both aged care and disability

7:40

services that that poses a risk as well.

7:44

Hmm. in the reforms there is anticipated to be

7:45

provider obligations or rules we're

7:50

hearing about. And that is a concern to some current

7:52

providers.

7:56

Will they be able to meet those

7:56

obligations and rules?

7:59

So they're already looking at their

7:59

governance structures.

8:02

But I guess it's the unknown. So we've got enough information.

8:07

And for me, I have this analogy, it looks

8:07

like a fish, smells like a fish, it's

8:11

going to be a fish. So get yourself ready for it.

8:14

You don't know if it's salmon or

8:14

barramundi, but it's fish.

8:18

Whereas other people, they actually want

8:18

the black and white.

8:21

And they say, why would we do all this

8:21

work, Lorraine, if we don't know?

8:26

Government could change their mind.

8:30

So uncertainty, I think, is it.

8:33

Yeah, I agree. As like community therapy providing allied

8:34

health services, we're not an approved

8:39

aged care provider, but we partner with

8:39

countless approved aged care providers and

8:44

we can sense that from our partner

8:44

organizations.

8:48

And most of my role day to day is

8:48

stakeholder meetings, meetings with

8:52

executive teams across home care, STRCC,

8:52

HSP, and you can sense that change

8:58

management fatigue. It's, it's

9:02

trying to adapt to constant change from

9:02

the department, but then also trying to

9:09

then roll out that change management

9:09

internally.

9:11

And as a leader, you're then supporting

9:11

and trying to have smooth change

9:17

management for your team. So there's that sense of, you know,

9:19

balancing, I guess, that psychosocial,

9:23

psychological safety as a leader of how do

9:23

you manage your change management fatigue,

9:30

but at the same time, you're trying to ensure great change

9:31

management processes for everyone that

9:36

you're supporting across an organization

9:36

and, and also consumers as well.

9:42

So the, it's so challenging to navigate

9:42

the aged care system as it is.

9:48

And we're then going to see even further

9:48

change.

9:53

And at times consumers are starting to be

9:53

aware of that.

9:58

upcoming changes and they ask providers

9:58

and as providers we don't have all the

10:04

answers yet so you sort of have change

10:04

questions coming left right and centre

10:09

which is quite challenging but I think you

10:09

put it really well of you can't always

10:15

know all the answers but we know there is

10:15

a reform process that is continually

10:20

marching forward so I think smooth change

10:20

management is always about what things

10:26

Do you know for certain that you're going

10:26

to have to change?

10:29

Is this efficiencies across your system,

10:29

your care management system?

10:33

Does it need to be more flexible?

10:36

Does it need to be more mobile friendly?

10:38

What sort of things are you doing across

10:38

staff retention, staff culture?

10:43

Really map out those things across the

10:43

strategic and operational plan that are

10:49

going to make it easier for dealing with.

10:53

new change that is just going to come that

10:53

you may not be certain of what it is, but

10:57

you know it's coming. So you might as well get rid of the

10:58

certain things now.

11:01

Exactly. And look, I think for many of us that have

11:02

worked in the health and aged care sector

11:07

for many years, there's always change and

11:07

there will always be change and we have

11:12

adapted. I think the planned changes over the next

11:13

two to three years are quite, they're

11:20

huge. There's a new aged care act.

11:23

Now the aged care act is meant to be

11:23

passed by July this year.

11:27

Now of course we're hearing that maybe it

11:27

won't.

11:29

What does that mean? So that means that a lot of the

11:31

legislative changes, including the aged

11:35

care standards, will they be able to be

11:35

put into practice?

11:39

Will we be assessed against those aged

11:39

care standards?

11:42

So it's that sort of uncertainty as well.

11:44

But I think, you know, I was reflecting

11:44

yesterday, there was a beautiful document.

11:49

I mean, I thought it was a beautiful

11:49

document, but then I don't have a liar.

11:52

So, my husband's watching football and I'm

11:52

reading Corinne's cases.

11:58

So yeah, I don't, I think.

12:00

a lot to that. My wife, Alexis, is always like, oh, what

12:02

are you looking at?

12:05

I'm like, I'm reading the aged care

12:05

newsletter that just come out from the

12:10

department. all right. I mean, I do swim and I do sing, so I do

12:11

have another life.

12:15

And there was a document called the HK

12:15

Roadmap, and some of your listeners would

12:20

have seen that document. And a lot of what was planned and talked

12:22

about...

12:25

in that document, which had bipartisan

12:25

approach, it had approval from the peaks

12:29

in general. A lot of that is coming to fruition now.

12:32

Deregulation of the market, that would

12:32

then, that contestability would perhaps

12:38

drive quality. We're starting to see new models of aged

12:40

care where providers are getting ready to

12:45

build, just build aged care facilities

12:45

that maybe...

12:48

won't have the constraints of the current

12:48

model.

12:53

And we can see in the plans for the

12:53

registration categories that those low

12:58

risk service types such as domestic

12:58

assistance, social support will not have

13:05

that intensive requirement around meeting

13:05

the standards, which I think is a good

13:09

thing. However, for providers, there will still

13:10

be those rules and obligations to protect

13:16

the public. You know, we're accepting government

13:17

funding.

13:19

You've got to agree to those rules is sort

13:19

of an easy, for me, a simple way of

13:24

describing to providers why they've got to

13:24

do that.

13:27

And I think that is an opportunity for

13:27

current providers to expand their current

13:34

service type. But it's also a risk for current

13:35

providers, for example, common law home

13:40

support providers, because as that market

13:40

opens up,

13:45

we saw what happened in NDIS.

13:47

Huge number of providers and some of the

13:47

challenges that came with that.

13:52

So the traditional model of not looking at

13:52

your billable hours, relying on grant

13:57

funding, unfortunately that has gone.

14:00

And I say unfortunately, because for me

14:00

there's this amazing social capital that

14:07

happens with those small local community,

14:07

neighbourhood type services.

14:13

I'm not saying that, private for -profits don't also have that

14:14

model.

14:19

I do, I've seen really good efficient

14:19

models and providers like you and I that

14:25

have come out of provider land and have

14:25

set up businesses because they want to

14:29

make a difference. So I think it's a myth to assume that all

14:30

private providers are not doing the right

14:35

thing, they are doing the right thing and

14:35

they innovate and they want to grow their

14:39

business. But I do think on the flip side, that's

14:40

social capital where someone can walk into

14:45

a neighbourhood centre, maybe get some

14:45

advice, or the CHSP coordinator might

14:50

spend a couple of hours, for which they're

14:50

not funded, doing care management.

14:56

So I think there's two in the future we're

14:56

thinking about opportunities.

15:01

And I know for many CHSP providers who are

15:01

providing service types such as personal

15:09

care. community nursing, they're actually doing

15:10

unfunded care management with some very

15:16

complex clients, Scott, because those

15:16

clients do sometimes they're self -funded

15:22

retirees and if they go into a home care

15:22

package they have to have their income

15:27

tested amount charged which can be up to

15:27

$29, $30 a day.

15:32

Mm -hmm. And for a level one too, they're not going

15:33

to be that much better off, number one.

15:38

And then the second part of it is that

15:38

those CHSP clients, really the provider

15:46

should be funded for that care management.

15:49

So we're encouraging providers to keep a

15:49

note of that additional care management,

15:55

so long as it's legitimate according to

15:55

what we understand case management or care

16:01

management is. around assessing, evaluating, monitoring,

16:03

transitioning, those beautiful concepts of

16:09

case management. Keep an eye on that because once the

16:10

supported home program merges, so CHSP and

16:18

home care packages, there is, I think, an

16:18

opportunity for providers to maybe gain

16:27

funding for services which they haven't

16:27

been claiming.

16:32

The other area I think which is of great

16:32

interest to me is that providers could

16:40

start to be thinking about what

16:40

innovations they can do now if they've got

16:47

reserves and start thinking about a social

16:47

support program based on the short -term

16:55

restorative care model. So that therapy model start now so that

16:56

when

17:01

deregulation happens or the opening up of

17:01

the market happens, you've got an

17:06

attractive product. And the other thing in the reforms which I

17:07

think is an optimistic one is that the

17:13

prices will be set very similar to NDIS

17:13

and we don't know what those prices are

17:19

but if we look for instance in aged care

17:19

at the veterans home care and veterans

17:24

community nursing funding, it's quite

17:24

generous compared to what some

17:31

package providers are charging their

17:31

clients.

17:34

And we know with the quality assurance

17:34

reviews that the Commonwealth has

17:39

undertaken with providers, getting them to

17:39

justify their pricing, making sure that

17:46

the care management for which they're

17:46

charging is actually being provided and

17:50

they've got evidence that they have

17:50

provided that.

17:53

I think that has tightened up.

17:56

and may provide us more aware of their

17:56

obligations and has stopped some of that

18:01

potential overcharging.

18:04

And we've had lots of advocacy from the

18:04

advocacy groups like COTA and OPAN and

18:11

others around, well, why is this a

18:11

reasonable charge in a package?

18:17

So in summary, there are some positives.

18:22

The pricing might be better for

18:22

individuals.

18:26

for providers and it's a bit of a more of

18:26

a level playing field.

18:31

So you might find that providers will exit

18:31

because they maybe have been charging too

18:37

much. We'll all have to become a lot more

18:37

efficient.

18:40

And then the other little area of interest

18:40

for me is that around care management,

18:45

case management. So many of you will know that that's been

18:46

an area of passion of mine for a very long

18:51

time. And I rolled out the Case Management

18:51

Society of Australia's

18:56

certification program across the country.

18:58

Now, the case management society has been

18:58

very quiet.

19:02

There's, you know, we don't hear from them

19:02

anymore.

19:05

I think they've missed an opportunity to

19:05

advocate for the sector around those

19:09

beautiful skills that we see care managers

19:09

or case managers exhibiting every day.

19:18

But that care management is a separate

19:18

service type.

19:22

So in the model,

19:24

individuals can choose a separate care

19:24

manager.

19:28

We would hope they would stay with one

19:28

provider but I think that will be an

19:34

opportunity for new players to come in and

19:34

or current providers need to be aware of

19:39

that, need to be conscious that it's not a

19:39

given that the current service types and

19:45

care management that you're providing will

19:45

be what potential clients want.

19:53

I think I've gone around the shop there.

19:55

I've taken notes as we've went.

19:57

You've covered so many wonderful things.

20:00

One thing, I'll summarise a couple of my

20:00

thoughts there.

20:04

I think you've drawn attention to over

20:04

this, let's just call it at least a

20:10

decade, there's a significant rise in

20:10

acuity and complexity of care in the

20:15

community. I can reflect back on my first days of

20:16

residential aged care over a decade ago

20:22

and half of the car parts. would be full with residence car parks and

20:24

residence cars.

20:28

And now consumers that we support in the

20:28

community every day, many of the most

20:35

complex consumers that I would have seen

20:35

over a decade ago in residential aged

20:40

care. We know length of stay in residential aged

20:40

care is quite short now, more trending

20:45

towards that six month mark for new

20:45

entrants into residential aged care.

20:50

So. The complexity of care in community is

20:51

rising and will only continue to rise.

20:57

And it's a real need to continue to

20:57

recognise and advocate for the importance

21:04

and value and necessity of care management

21:04

and really good care management.

21:09

As allied health professionals, like

21:09

community therapy team out in the field

21:13

every day, we rely on really good care

21:13

managers.

21:17

We need them to be contactable.

21:20

and we need them to be really aware of

21:20

their consumers needs and that's only

21:25

growing over time that need.

21:28

So I think you pressed that point nicely.

21:31

been getting a lot of requests and we do a

21:31

lot of health skills for care managers

21:39

because health literacy is something that

21:39

all of us can understand.

21:43

And I think the traditional social work,

21:43

psychosocial or welfare model that we have

21:49

had in home care has changed dramatically

21:49

and so it should.

21:55

And some care managers are frightened

21:55

about

21:58

And we just reassure them that if you have

21:58

a really good model with a clinical lead

22:04

and you've got very strong pathways for

22:04

referrals, you've got a very clear

22:11

understanding of what your scope of

22:11

practice is and the importance, Scott, of

22:16

that beautiful multidisciplinary team.

22:19

I can't overestimate how important having

22:19

an OT, a recreational...

22:28

officer or therapist, you know, an

22:28

exercise physiologist, trying to build

22:34

your team so that you're ready for the

22:34

future opportunities is something that I

22:40

would really encourage. And for providers to start doing the work

22:41

around the clinical education.

22:47

We've got a nurse practitioner and a team

22:47

of clinicians who we provide clinical

22:54

packages. So we will...

22:57

chair the clinical governance committee,

22:57

provide support.

23:01

If there's a very sticky situation in the

23:01

community, they can reach out to the

23:04

nurse, the nurse can then go to a nurse

23:04

practitioner.

23:09

Just to, because of workforce, that's a

23:09

big issue in the future, is having a

23:15

workforce that's skilled enough to be able

23:15

to provide quality care.

23:21

And one of the initiatives that, or one of

23:21

the, I guess,

23:27

discussions that we're hearing a lot in

23:27

the reforms is around conducting check

23:33

-ins. So clinical and non -clinical check -ins

23:34

on people and the importance of doing that

23:40

so that we can recognise that early

23:40

deterioration.

23:44

That's only good if you've got someone

23:44

within the team or some resource like your

23:51

organisation or ours that you can say,

23:51

well Scott,

23:55

we've got this client and we're seeing AV

23:55

and see what do you think?

23:59

And some providers don't have a clinician.

24:01

So part of the strengthening governance

24:01

around the quality advisory bodies and

24:07

also just the governance in general came

24:07

out in both royal commissions, the lack of

24:13

clinicians on boards, the lack of clinical

24:13

input.

24:16

And I think the commissioners in both of

24:16

those inquiries were quite surprised that

24:23

you're providing a

24:25

know, a clinical care model and yet you

24:25

don't have clinicians.

24:29

It's a bit like, well, we're doing food,

24:29

but we don't have anyone on the board

24:32

that's ever worked in manufacturing of

24:32

food.

24:35

So, you know, when you think of it

24:35

objectively, that's quite a reasonable

24:41

observation. However, my argument is that, well, of

24:43

course we didn't because in particularly

24:48

home care, because it was a social model.

24:51

There weren't people being looked after at

24:51

home.

24:55

And as we move into that more user pays

24:55

model and people wanting people, baby

25:02

boomers thinking about reverse mortgages

25:02

and how they might fund their care.

25:08

Just to give you a personal example, a

25:08

friend of mine's husband's not well and

25:13

she was really confused about what she

25:13

should do.

25:16

So I just sat down with her and wrote down

25:16

some options and said, well, look, if you

25:20

were to have your...

25:22

husband looked after at home for the next

25:22

year or so, put aside $350 ,000.

25:29

And I said, but if you look at your

25:29

wealth, both capital and your investments,

25:36

that's nothing in terms of having a good

25:36

life.

25:40

The flip side is, you are managing like a

25:40

little business and you won't always find

25:45

the staff that you need. But...

25:49

that that is an option. And I think that model will really start

25:50

to come.

25:53

And we've seen that already where in

25:53

wealthy areas, people do have 24 hour

25:58

care. And the proposal that there will be end of

25:59

life packages, I was part of that

26:05

consultation recently within the reforms.

26:08

It was a very interesting discussion

26:08

about, you know, when someone's nearing

26:13

the end of life and that it's being

26:13

diagnosed by a nurse practitioner or...

26:18

adopter that end of life is close, that

26:18

they can access the highest level of

26:25

funding equivalent to residential.

26:28

So that's a very positive thing.

26:32

I'm going off track again aren't I? no, that's no, this is the type of

26:34

conversation I was looking for because our

26:39

listeners are across a range of areas, but

26:39

our listeners wanted to hear, you know,

26:46

all aspects of the complexity and we're

26:46

all used to this as well.

26:50

So it's nice, you know, listening and

26:50

sometimes for me listening to

26:55

conversations like this is validating.

26:58

because you're just continuing to hear all

26:58

of the thoughts that are in your own mind

27:03

said by others and the complexity.

27:05

But some of the other things that drew to

27:05

my attention from what you've been saying

27:09

is there's always pros and cons of

27:09

different funding models.

27:13

So there's CHSP has its pros, it has its

27:13

cons.

27:16

Support at home will have its pros and has

27:16

its cons.

27:19

ACVI and residential aged care, same thing

27:19

versus ENAC.

27:22

So I think it's always about recognizing

27:22

the pros and

27:27

taking advantage of those opportunities to

27:27

drive good clinical care and outcomes and

27:32

experience for consumers and then, and for

27:32

your team.

27:37

But you have to then really recognise and

27:37

identify those constraints and okay, what

27:42

is the barrier here from this model?

27:45

And how do we identify some opportunities

27:45

there as well?

27:50

Often the frictions in the model do

27:50

present those opportunities and you

27:55

identified. one of those correctly of support at home.

27:59

CHSP eventually coming into that in and

27:59

around 2027.

28:04

See if the timeline stays to that this

28:04

time.

28:08

But that social model, social prescribing,

28:08

social groups may fall away a little bit

28:13

and we go very one to one.

28:15

Well, there's then a big opportunity and a

28:15

big yearning for that from consumers and

28:21

the public. So if you can...

28:23

get on the front foot now and start

28:23

embedding those types of models and you'll

28:27

be well prepared through to then.

28:31

I think around pricing, what came to mind

28:31

for me of at least seeing iHackers work

28:36

across ENAC.

28:40

So if you're not aware of iHackers, the

28:40

Independent Health and Aged Care Pricing

28:45

Authority, I've been quite impressed.

28:51

by their work so far, at least in

28:51

residential aged care.

28:54

I feel that they are, they did an increase

28:54

in the rate probably beyond what the

29:01

industry were expecting, which was

29:01

refreshing and was more representative of

29:07

what the true cost of care is.

29:09

Many would argue it needs to go further,

29:09

but at least went probably further than

29:13

most thought it would initially.

29:16

And... that will, sorry to interrupt, Scott, but

29:16

I think that will happen.

29:21

I was presenting at the National Aqua

29:21

Conference last year and they presented

29:27

after me in the same session and they

29:27

indicated that the pricing, their goal was

29:37

to have the prices determined by the end

29:37

of this year.

29:40

So I think that's really...

29:44

exciting for us. We can then plan a bit more if they stick

29:45

to the timeline.

29:49

And the other interesting point that we're

29:49

still fairly silent on and for providers

29:59

they're watching this closely is what will

29:59

the contribution be from consumers or

30:06

people. Now I think we have to take our provider

30:07

hat off for a minute and think about

30:12

fiscal responsibility. There's a whole, we've got children and

30:14

there's a whole group of young people in

30:20

this society, this wonderful country of

30:20

ours.

30:24

And should they be responsible for paying

30:24

for our aged care?

30:29

There's so many baby boomers and of course

30:29

government wants us to be healthy.

30:34

So how will that come to play?

30:37

We still haven't got anything concrete and

30:37

of course it'll be an election issue.

30:41

I remember when John Howard said,

30:43

nobody will ever have to sell their home

30:43

to go into aged care.

30:47

Well, very slowly over a period of time,

30:47

it's a given now that everyone has to

30:53

contribute. It wasn't realistic.

30:56

So that's for me a bit interesting too,

30:56

because once that gets announced, what the

31:04

contribution rate will be, it is

31:04

potentially a political hot potato or...

31:11

They could just do what has happened in

31:11

the common home support where you have a

31:16

consumer, a fee contribution policy.

31:19

It has to be up on your website. People have to be asked to contribute and

31:20

you might pay $15 for your personal care

31:27

and $10 for your social support.

31:29

So maybe that's how it will come into play

31:29

and it won't be income tested.

31:35

Certainly at the moment, my understanding

31:35

is that there's no, there's no suggestion

31:40

that. be means tested but income tested and I

31:40

sort of think that's a fair thing.

31:46

Others would argue that people, older

31:46

people may not want to pay for their care

31:52

they will forego that and we have seen

31:52

that.

31:58

That I guess is a concern so if you're

31:58

going to not allow someone to enter

32:03

because they can't afford to pay or they

32:03

don't want to pay, not can't afford to pay

32:07

sorry want to pay, might be an issue.

32:10

But also I think what we saw in home care

32:10

packages, so in the very beginning of home

32:18

care packages and now the provider I

32:18

worked for, we ran the very first home

32:23

care package program. And you were expected to pay and everyone

32:24

was charged a daily fee, different to the

32:31

income tested amount for daily fee.

32:34

Then what happened with the deregulation

32:34

into

32:37

consumer directed care in 2015 and then

32:37

the opening up of the market in 2017, we

32:44

saw that two things.

32:46

One, individuals, consumers said, why

32:46

would I contribute to my care when I've

32:51

got unspent funds? And then the second one was new providers

32:53

wanting to grow their business and said,

32:59

we're just not going to charge a daily fee

32:59

because the time and effort and pain that

33:04

it takes to collect that day fee.

33:06

it's not worth it and we'd rather get the

33:06

package management and the care management

33:11

income. Now that's where we've landed and we've

33:13

got all these two billion plus unspent

33:18

funds. So getting back to my original comment, I

33:19

think we've got a fiscal responsibility as

33:24

a society to make sure that the money

33:24

that's being allocated by government is

33:29

spent where it needs to be spent so that

33:29

it gets given to more people.

33:36

that need it.

33:38

Whether that's going to be palatable to

33:38

the community, I don't know.

33:42

I know what your thoughts are on that.

33:44

Yeah, I think, you know, I've seen that in

33:44

and around residential aged care comments

33:51

as well of, you know, re -looking at this

33:51

and see that at a government level, it's

33:57

kind of, you know, the inquiry results are

33:57

sort of just continuing to be pushed back

34:03

week by week and month by month. So I agree that it is a big political.

34:09

item. Aged care is and always will be and will

34:10

continue to rise with the in, you know,

34:16

the baby boomer aged care wave, you know,

34:16

coming towards us.

34:21

So, but at the same time, I think across

34:21

providers, but also consumers, and our new

34:30

older adult consumers coming like I can

34:30

speak to my grandparents and my my mom

34:36

that they have a sense of fiscal responsibility

34:37

as well as an average consumer, more

34:43

broadly of, you know, really wanting to

34:43

make sure that at a broad level, you know,

34:52

government programs are fit for purpose

34:52

and giving a return on investment.

34:57

And I think the NDIS has brought that

34:57

conversation front and center as well.

35:01

And we're seeing that starting to permeate

35:01

most health components of the sector.

35:06

We want our private health insurance being

35:06

fit for purpose.

35:10

We want our public health systems being

35:10

fit for purpose.

35:14

And there's this general sense of the

35:14

health landscape, the aged care burden,

35:21

changing all aspects of that care.

35:24

And it's not just the aged care system

35:24

that is adapting to that.

35:29

We're seeing public health, primary health

35:29

networks really up their focus on.

35:34

How do we support the aging consumer?

35:37

Just at the time of recording, just last

35:37

night I was at an event which was a

35:43

innovation challenge purposely for mental

35:43

health for older adults on the Central

35:49

Coast. And that was commissioned by a primary

35:50

health network, Central Coast Local Health

35:54

District and the uni, the I2N network.

35:58

So it sort of draws this attention to age

35:58

care is...

36:04

becoming on the, well, is on the radar of

36:04

all areas of health and department.

36:12

So I don't feel that it's hard.

36:16

It's always hard as government. You're a politician and you can be very

36:18

siloed and get your blinkers on there.

36:23

And but for our politicians, if you're

36:23

listening, I think they need to be

36:31

brave and just continue to move forward

36:31

with their agenda and be careful of who

36:36

they're listening to here. And remember that most of society do want

36:38

to see good stewardship of resources.

36:46

And that's what we trust our politicians

36:46

to move forward with.

36:49

So I don't think they need to be fearful

36:49

of, you know, putting a line in the sand

36:52

and saying, this is what's needed for the

36:52

next 20 years.

36:55

So let's move forward with it.

36:58

So hopefully they have the

37:00

Hopefully they're brave enough to do that

37:00

before an election and not having to wait

37:07

to after an election result where they do

37:07

that.

37:10

That would be my two cents on it.

37:12

I do think you touch nicely on that

37:12

providers should feel optimistic that

37:21

through this year they will get most of

37:21

the answers that they kind of need to some

37:28

of the uncertain areas. What is that quarterly budget going to

37:30

look like?

37:32

What's the care management going to look like? What sort of caps may be on quarterly

37:34

budget to quarterly budget and what's the

37:40

pricing schedule and they can really start

37:40

to plan things out.

37:48

You touched on a couple of opportunities,

37:48

but I think I'd pose a similar question

37:54

that I did with the challenge question.

37:57

across all different types of providers,

37:57

profit, non -for -profit, franchise, big,

38:01

small. What do you think their general biggest

38:02

opportunity is that they're not really

38:08

looking at at present? Is it something like group programs or is

38:10

it more that their care management systems

38:15

are old and not ready for the future?

38:17

Where's their opportunity that in general

38:17

they're not taking advantage of?

38:24

Well, that's a difficult question because

38:24

we see providers that are quite naive in

38:30

their business models and we help them

38:30

invigorate that and either meet standards

38:37

or get ready for the future.

38:39

So that's a bit difficult. They might still be using spreadsheets.

38:42

So then we would be saying you need to get

38:42

a really good CRM, one that's going to

38:47

interface with government. So I think in the digital space,

38:52

However, the cohort of consumers, older

38:52

people are not necessarily ready for it

38:59

and that will take a bit of time.

39:02

So I think for me it's that they are maybe

39:02

burying their head in the sand about the

39:13

implications of activity -based funding.

39:17

And rather than saying I've got 400

39:17

clients,

39:21

or 400 packages, we try and get them to

39:21

think about, I've got, we sell 400 hours

39:29

of service every week in this particular

39:29

category, understanding what are the

39:35

service types and doing some scenario

39:35

planning around, well, if we've got X

39:42

number of personal care hours and they pay

39:42

us Y, this is what it might look like.

39:48

That plus the care management really

39:48

understanding who's got high acuity

39:54

levels, who are they on your clinical risk

39:54

register, do you have a clinical meeting

40:00

where you discuss those, all of that costs

40:00

money and all of that costs infrastructure

40:05

and knowledge and systems and processes

40:05

for good quality care.

40:11

So not recognising that.

40:14

Where we've got... providers that may have got residential

40:15

care, independent living units and home

40:20

care. Where those providers have historically

40:20

treated those businesses as sustainable

40:26

businesses in their own right and funded

40:26

and resourced those businesses well, they

40:32

seem to be doing okay.

40:34

But the ones that perhaps haven't, and

40:34

residential has been the most important

40:39

part of their business, we're seeing those

40:39

providers struggling.

40:44

And now the boards are asking questions.

40:46

Why are we in this Commonwealth Home

40:46

Support Program?

40:50

Not meeting their targets, governments now

40:50

saying, right, tell us why you should

40:54

continue to get this funding. Give us a business case scenario for that.

41:00

So that's where we're still seeing that

41:00

they're either burying their head in the

41:05

sand or they're very worried about it.

41:08

And then it's like, well, I think maybe we

41:08

should exit.

41:12

And that's a choice. might be a choice.

41:14

Let others do that really well and let's

41:14

specialise.

41:18

Yeah. provider's found themselves in their

41:19

journey.

41:22

but I do think there's lots of

41:22

opportunities and that will take

41:26

innovation and energy. And look, Scott, as you and I know, that

41:28

often comes down to leadership and

41:33

individuals at that leadership level that

41:33

are prepared to take that risk or prepared

41:38

to invest. And I think it's a shame that, you know,

41:39

we've just come out of COVID, so that was

41:43

really difficult for providers.

41:46

So that put the brakes on innovation a

41:46

lot.

41:50

However, the flip side is that it allowed

41:50

us to do things a little bit differently,

41:56

but not that differently, I don't think.

41:58

I think for me, you know, I really love

41:58

Stephen Covey's stages of choice.

42:06

You know, I read the seven habits of

42:06

highly effective people.

42:09

I don't think I'll get any of those

42:09

habits.

42:12

He wrote another beautiful book about the

42:12

eighth habit.

42:16

And in that he talks about those stages of

42:16

choice.

42:18

And I refer to them a lot, which is...

42:21

You know, we can rebel or quit against all

42:21

these changes.

42:24

And then when you go up the ladder of

42:24

those stages of choice, the top one is

42:29

creatively excited. And some of us are creatively excited.

42:33

Some of us are just happy, cheerfully

42:33

cooperative.

42:36

They're happy to go along. Others are willingly complying.

42:41

Let's just go with it. We're dependent on government funding.

42:45

And some people might...

42:47

we would hope not choose to go into that

42:47

maliciously obeying.

42:51

Well, we'll do it, it's not gonna work. It won't work, it hasn't worked before.

42:54

They change their mind all the time.

42:56

I would hope we could probably get to that

42:56

creatively excited.

43:01

But there are some people that have just

43:01

said, this is too much.

43:05

And remember when we first introduced

43:05

consumer directed care and budgets.

43:10

And I remember running around the country

43:10

and it was like.

43:13

Heh. is Monday, I must be in Melbourne.

43:15

Oh no, it's Tuesday, so I'm in Brisbane.

43:18

Doing the CDC budgeting training for the

43:18

peaks all around the country.

43:23

People, I said, you can't come to the

43:23

training without a laptop.

43:26

That was huge for people because they had

43:26

to practice doing a spreadsheet.

43:32

And I remember one day this person said,

43:32

that's it, I'm out.

43:35

I did not join, I did not become a social

43:35

worker to be plugging figures in.

43:41

And I think that's... To me that encapsulates how some people

43:43

would be feeling.

43:47

This is all too hard and that's a choice.

43:50

Yeah, but I would hope that they don't

43:50

make that choice.

43:54

Yeah, I think like the one of the last

43:54

things I would finish on today and then

43:58

I'll ask for like one, you know, summary

43:58

thing from you as well.

44:02

But I'm just going to piggyback on what

44:02

you've said there around, you know, stages

44:06

of choices with change management,

44:06

depending on where you are personally,

44:12

where you are professionally, where you

44:12

are with all aspects of life, your

44:18

resilience to that change can change day

44:18

to day.

44:21

Something could happen. You could get a phone call from a family

44:22

member.

44:24

and then tomorrow the department releases

44:24

the thing and it breaks you.

44:29

You don't have that resilience.

44:31

So I think no matter where you are in that

44:31

choice, whether today's the day that

44:37

you're feeling ready and excited or, and

44:37

you've stayed like that forever or you're

44:43

swapping and changing, for anyone, it's

44:43

just get help.

44:48

So you need to reach out to someone like

44:48

yourself and your group at LPA or...

44:53

going, okay, I don't need to make this

44:53

harder than it already is.

44:58

Let me pay for some level of support, at

44:58

least have a bit of an introduction to and

45:05

an exploration of like, okay, am I on the

45:05

right track?

45:09

Do we have the capability with our current

45:09

organization and structure to continue to

45:16

take this on? Or are there areas and opportunities that

45:17

sometimes may be more efficient?

45:21

And I think you... drew onto a nice one for providers of

45:23

being able to outsource some of their

45:28

clinical governance. So that can be really hard for an

45:30

organization to build, especially if

45:34

they're coming from a history of

45:34

predominantly domestic assistance and

45:40

social support and transport and groups,

45:40

et cetera.

45:44

That's going to take a lot of time and

45:44

energy and capital to build that out, both

45:49

in recruitment and training and then...

45:52

If you don't have those governance models,

45:52

you're going to build them out and you've

45:57

already got a lot of other things. So sometimes depending on what your

45:58

capabilities are, you are better

46:02

outsourcing that and getting that help.

46:05

So that would be my number one tip of

46:05

after this session today, if you've been

46:10

good enough to listen all the way to this

46:10

stage, you should sit down and just write

46:16

down, okay, where are we with these

46:16

things?

46:18

How comfortable do I feel with?

46:21

leading my organization through to support

46:21

at home and beyond.

46:26

And if you can honestly say to yourself

46:26

there and be honest of going, actually,

46:32

I'm a bit worried. I'm more worried than I think I should be.

46:35

You should pick up the phone, send an

46:35

email to LPA, give the shout out here and

46:41

get some support. That would be my tip.

46:43

Look, thanks for that plug, Scott.

46:47

That's not necessary, but thank you.

46:49

I guess my final messages would be, you

46:49

know, I wrote down before resilience, and

46:55

that's a word that gets bandied around a

46:55

lot.

46:58

What does that mean? That means that as leaders, things are

46:59

hard.

47:02

And that's why we are leaders.

47:06

We solve one problem and we think, yeah,

47:06

and then another one comes.

47:11

And what happens, we learn from those that

47:11

problem solving, well that worked this

47:17

time. So having that resilience, being open, I

47:18

think debate is healthy, but debate that

47:25

is not looking for the big picture

47:25

solution is just a waste of time.

47:30

It's just a talk fest. We need to have solutions.

47:34

So if you've got, and during the

47:34

consultations with the department, I

47:38

think, you know, there has been some

47:38

really good.

47:41

solutions put forward and I think

47:41

government has listened and that's a good

47:44

thing and those consultations continue.

47:47

So I would say slow down, be ready but

47:47

realise that as leaders our jobs are hard

47:57

and if we're standing still in the

47:57

stagnant then nothing will change and that

48:03

change will be forced upon us so we're

48:03

much better off being part of it.

48:08

But thank you I just really enjoyed.

48:10

It's been lovely. And I hope it's just one or two things.

48:13

In all the work that we do, we say to our

48:13

clients that we work with, or our

48:20

customers, is well, you know your

48:20

solution.

48:23

Sometimes you just need a little bit of

48:23

guidance, or you need to be able to say,

48:27

I'm thinking this is the right decision.

48:30

What do you think? And give us the evidence that sits behind

48:32

us.

48:35

But I don't think it's all the sky's

48:35

falling.

48:39

I there's lots of opportunities and the

48:39

demographics of older people is only

48:47

getting larger. So I think it gives room for optimism and

48:48

innovation.

48:51

I like that. That's a lovely way to finish.

48:53

It's been a real pleasure chatting to you

48:53

and I hope our listeners are walking away

48:58

with a list of ideas to review and action

48:58

to improve their readiness for change.

49:05

Maybe their stage of change as well.

49:08

But make yourself a coffee or tea, get pen

49:08

and paper out and just take some notes.

49:13

Sometimes it's about holding space for

49:13

yourself to give yourself that 15 minutes,

49:18

30 minutes in your day as a leader to...

49:21

reflect on a session like this to then

49:21

think about what changes you may need to

49:26

put in place. Everyone will find show notes and links in

49:28

this episode on our website,

49:32

communitytherapy .com .au slash podcast.

49:34

Thank you for listening once again, and I

49:34

look forward to chatting to you in the

49:39

next episode. Thanks so much, Lorraine.

49:41

Thanks, Scott.