Under the range of reforms being considered, the Department of Health and Aged Care is looking at the best approach to implementing delivery of an assistive technologies (AT) and home modifications (HM) scheme for older Australians.
Current Concerns - Under the current HCP system, feedback has been provided that accessing assistive technology and home modifications can often be delayed or missed due to the requirement of saving funds.
Objective – design and implementation of an AT – HM scheme with a wrap around service. The scheme to ensure that older Australians have timely access to safe assistive technology and home modifications that aims to help them live independently at home.
To create a robust system that caters for the full journey experienced by older Australians, stakeholders have recommended a wrap around service that includes:
· Preventative services
· Assessment, AT – HM prescription & referrals
· Trials and ordering
· Delivery and installation
· Follow up support/review and reassessment
We will look into each of these recommendations as an indication of elements to expect under this part of the reform.
Preventative services
Similar to other national health campaigns, consideration will be given to a large scale public health initiative which would focus on education on the benefits to a preventative approach to maintaining levels of independence.
Aged Care assessment and prescriptions
As you may be aware from our previous article In-Home Aged Care funding changes the assessment process and tool is at the trial stage of its reform. Part of this change would be to enable future assessors as part of the assessment process to assign some categories of AT - HM.
To ensure that safety is at the forefront of design, risk categories have been proposed to separate the different types of AT – HM. These categories include, low risk, under advice or prescribed and has been further outlined in table 1.
The level of training of the assessor may dictate their ability to assign within these risk categories. As an example, where an assessor does not have the qualifications required to prescribe moderate or high-risk AT – HM, the older person would be referred to an allied health professional for prescription.
Table 1: DoHA - Aged care engagement, 2022
Trials and ordering
Stakeholders have highlighted the importance of trialling equipment as part of a wrap around service. This includes the proposal of showrooms such as the Independent Living Centres that would enable trials of AT products with no conflicts of interest. Further to this, it has been identified that there should also be opportunities to have certain equipment trialled at home.
For remote and rural regions this concept may be more difficult, so consideration has been given to include:
· mobile providers offering trials by touring rural areas
· regional hubs to offer trial locations outside of capital cities
· additional funding for travel to town/city to access showrooms
· support for Allied health or professionals to travel to remote and rural locations, with trial products taken with them
Ordering of AT - HM could occur through a centralised online platform which would include the ability for equipment to be returned to further support the ability for trialling.
Delivery and Installation
The key for delivery and installation is to avoid delivery whereby items are delivered with no support for installation or next steps.
To support older Australians there is a focus to place responsibility onto the provider, care manager or care co-ordinator to ensure next steps are provided once the item is delivered (which would need to be recorded). This may then involve skilled staff such as allied health professionals to deliver follow up supports.
Follow up support with review and reassessment
To ensure a person is getting full benefits of the product a follow up call is often needed after the AT – HM product is set up. Dependent on the needs of an individual a review schedule could be implemented to ensure the AT – HM supports are being delivered when they are needed.
Reassessments could be triggered from these reviews if current needs are not met. The triggers for reassessment would be aligned with the reforms approach for reassessment.
Features of the proposed Scheme
Once the scheme has been finalised the sector should expect a detailed manual which will include, what is covered, clear roles and responsibilities and information to inform decisions to loan or purchase AT – HM.
The sector should also expect a clear inclusions and exclusions list of items to help mitigate any ambiguity that is currently identified as a source of contention between older Australians and the aged care workforce. An exceptions list has been proposed and drafted to meet the needs of people for items not covered in the inclusions and exclusions list.
Loan and outright purchase options
The loan and outright purchase options are a key part to the proposed funding model. Up-front funding would be provided for AT – HM, which would help reduce current wait times between the completion of assessment and receiving supports.
Loan scheme benefits include supporting older Australians whose needs will change rapidly and by reducing wastage.
To deliver loaned AT the following has been recommended:
· Inclusion of a detailed list of items that would indicate whether the item will be available for purchase or loan
· The creation of an IT platform which records the history of each item, including its maintenance to date and the ability to check loan item availability
· A process for additional loan stock to be made available should items not be available at the time
· options for private loan arrangements outside of the scheme
Purchase options may be more suitable in some instances, such as consumables for hygiene purposes. An assessor or prescribing allied health professional would have the ability to decide on what is most suitable between loan and purchase where an item is available in both categories.
Consumer Contributions
Given the costs of some items there is a likelihood that the scheme will include some level of consumer contribution. There was a strong recommendation for co-contributions to be means tested and capped, while ensuring there is a safety net to prevent co-contributions becoming a barrier to access AT – HM. Home Modifications
Two levels of home modifications have been suggested:
1. Minor home modifications – such as installation of grab rails, handrails and handheld showers
2. Major home modifications – for larger more complex modifications such as, platform steps, level entry showers and ramps.
Major home modifications would likely only be completed once and only on an older Australians primary residence. There may be expectations on the older Australians to remain living in this place of residence for a minimum 18 months or otherwise be required to reimburse the scheme for subsidised elements of the modification.
With home rentals becoming more prominent stakeholders have suggested there needs to be assistance provided to support older Australians requests for home modifications to their landlords.
There is still some additional information regarding the AT - HM scheme that was not covered in this article due to our aim to keep these articles succinct.
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