After sustained pressure from just about everybody about obvious problems with the new assessment process, the Government has announced a new “Support at Home escalation pathway”.
But before we get too excited, let’s read the bureaucratic fine print buried in the spin.
The latest Departmental Aged Care Update says the pathway will be for people with “complex circumstances that are not fully captured by current arrangements” when they are assigned a home support classification level or a Support at Home priority category.
That bit of word soup is as close as we are likely to get to a Government acknowledgement that some older people are being assessed or prioritised badly.
And the escalation process? Assessment organisations will be able to “refer outcomes back to the Department for further consideration and possible adjustment in specified circumstances”.
So the system may get it wrong, but do not worry. There is now a process to ask the system to think about it again.
Not a fix
This is not a fix for the assessment problem and it is not a proper safeguard. It is a bureaucratic obstacle course dressed up as a response.
Once someone notices that the outcome looks wrong, they will need to decide if the case fits the “specified circumstances” and prepare the referral. The matter will then go back to the Department for “further consideration”. Then, maybe, there will be a “possible adjustment”.
The process is almost certain to be slow, hard to administer and difficult for older people and families to understand. In a system already known for waiting lists and opaque decisions, this does not remove complexity. It adds another layer.
As a band-aid, it does not even stick properly.
Judgement removed
Worse, it shifts the final decision away from the person with the clinical skills who has actually met the older person and hands it back to the Department. There is no guarantee that the departmental staffer making that decision will have the required clinical training, experience or understanding of the older person’s circumstances.
For decades, aged care assessment has relied on professional judgement. Not perfectly and not without issues, but the principle was sound: trained assessors meet the person, consider the context and make a judgement.
No reasonable case has been put forward for why that judgement should be replaced by a rigid, algorithm-driven system, only to be considered later through a cumbersome departmental escalation process.
If professional judgement is needed to fix the outcome after the system gets it wrong, then professional judgement should have been trusted before the outcome was issued.
Control is not fairness
We all want consistency, but consistency without judgement is not fairness. It is just uniform unfairness. This is what happens when reform is driven by control rather than trust.
Support at Home does not need another pathway into the same problem. It needs the Government to trust the people doing the work, fix the assessment design properly and stop making older Australians, families and providers pay the price for bad policy.