For more than a decade, the Federal Government persisted with a plan almost everyone in the sector could see was dumb: force every form of home support into one large, individualised, market-driven system. CHSP would disappear into Support at Home along with much of what makes community aged care work.
After all the stuff-ups with Support at Home, that is no longer the plan. The government has now committed to keeping CHSP separate, with consultation beginning soon on what needs to change. This is a major policy reversal and the CHSP Alliance deserves real credit for helping make it happen.
But keeping CHSP separate is only the first step; it now needs rebuilding.
After years of neglect, I don’t reckon anyone is happy with CHSP as it stands. It is badly underfunded, waiting lists are large and mostly invisible and assessment is ridiculously complicated for an older person who needs a few meals, some transport or help around the house. Rural services and other thin markets are under enormous pressure.
The challenge now is to renew CHSP without destroying what makes it different.
As we heard repeatedly at the National CHSP Conference, taking CHSP out of the individualised funding nightmare opens up fabulous possibilities. Grant funding can foster local relationships, allow more flexible support, sustain community infrastructure and underpin the work of volunteers. As we have learned from Support at Home, the funding mechanism is the secret sauce that has a huge influence on how everyone behaves. Individualised funding breaks care into services, prices and transactions, while grant funding gives a local organisation enough room to ask what its community actually needs.
That might mean sustaining a small service in a town where a conventional market will never work. It also allows services to respond when people’s lives do not fit neatly into service codes. A local community group may notice that someone is becoming isolated or frail long before the problem appears in a formal assessment. A trusted local worker may see that someone needs a little more help this month and a little less the next. That flexibility is one of CHSP’s greatest strengths.
Volunteers are part of the success of CHSP too, they are not just a source of cheap labour. A volunteer can be a familiar face, a social connection and the person who notices that something has changed. Removing volunteers means losing part of the community in community care.
But none of this means we should keep CHSP exactly as it is. A renewed CHSP should be better funded, easier to enter and far more transparent about who is waiting and what they are waiting for. It needs to use evidence to measure whether people are actually living better and keep looking for better ways to help. Grant funding must support innovation, not protect services simply because they have always existed.
So there are two ways to waste this opportunity: leave CHSP as it is, or ‘fix’ it by imposing tighter controls, more reporting and more attempts to prescribe exactly what every dollar buys. Go too far down that path and CHSP simply becomes individualised funding in disguise.
Public money must be accountable and older people must be safe, but regulation must match the risk. Providers should be held accountable for results without losing the freedom to respond to local people and changing circumstances.
That is the balance the consultation must get right: change CHSP, improve it and expect more from it, while protecting the grant-funded mechanism that makes trust, flexibility, local relationships, infrastructure and volunteers possible.
CHSP has been given a rare second chance to become Australia’s primary aged care program: a locally planned, preventive first layer of support, grounded in community life. Over-control the rebuild and we will get Support at Home by stealth; change too little and it will be the same CHSP, different day.