Aged Care Legislated Review Better Caring Pty Limited

Aged Care Legislated Review – Better Caring Pty Limited

Table of Contents

Page | 1 1. Tell us about you

1.1 What is your full name? -

1.2 What stakeholder category do you most identify with? Professional organisation

1.3 Are you providing a submission as an individual or on behalf of an organisation? Organisation

1.4 Do you identify with any special needs groups? Nil

1.5 What is your organisation’s name? Better Caring Pty Limited

1.6 Which category does your organisation most identify with? Other

1.7 Do we have your permission to publish parts of your response that are not personally identifiable? Yes, publish all parts of my response except my name and email address

Page | 2 2. Response to Criteria in the Legislation

2.1 Whether unmet demand for residential and home care places has been reduced Refers to Section 4(2)(a) in the Act In this context, unmet demand means: • a person who needs aged care services is unable to access the service they are eligible for e.g. a person with an Aged Care Assessment Team / Service (ACAT or ACAS ) approval for residential care is unable to find an available place; or • a person who needs home care services is able to access care, but not the level of care they need e.g. the person is eligible for a level 4 package but can only access a level 2 package. Response provided: In addition to a consumer’s ability to access a package, is the extent to which that package level can fund their care and support needs. The administrative costs that many providers factor into home care packages directly impacts the amount of support that can be accessed by the individual – directly impacting quality of life. This also has a direct impact on the availability of packages overall; if the total number of home care packages are drawn from one pool of funding, their efficient use will allow for a greater spread of that funding to a greater number of participants. Typically, a recipient of a Level 4 home care package from a traditional service provider, after paying administration, case management and service delivery charges, will receive 10 to 12 hours of care and support per week. A Level 2 home care package usually equates to between 2 to 4 hours per week. A consumer with a Level 4 need will generally require many more than 10-12 hours of support per week if they are to remain living in their own home. If a Level 2 recipient can fund more than 2 to 4 hours from their funding, they will delay having to be reassessed for a Level 3 package. Arguably, not only are these current service levels failing to meet the needs of individuals, they are demonstrating an inefficient use of the available funding that could be redistributed across a greater number of packages overall. Innovative solutions such as Better Caring can lower service overhead, significantly increasing the hours of care and support from the same funding, enabling people to remain for longer on a lower level package. Case Study: Lynn Lynn is recently the recipient of a Level 2 home care package, which she receives from a well-known large provider. In offering Lynn a package, the provider “generously” waived the daily contribution fee, offering her two hours of care each week, fully funded by the Government. When Lynn requested that meals on wheels be incorporated into her package three times a week, she was informed that her hours of care would be reduced to 3 hours a fortnight. After receiving her first monthly statement, Lynn attempted to gain an understanding of the numbers presented. Frustrated with the lack of transparency around her package funding and services, Lynn searched online for someone who could help her understand home care packages, eventually coming across and contacting Better Caring. Better Caring was able to explain individual CDC budgets and provide a simple breakdown the provider’s charges. Once familiar with the level of government funding supplied with a Level 2 package, Lynn was able to determine that that the initial 2 hours she was ‘entitled to’ each week through her provider, taking into account all the various fees and charges, was costing her package and the Government around $140 per hour. Better Caring provided Lynn with simple numbers showing that working with a more progressive provider, who had more competitive fees and who supported a consumer’s right to engage workers of their choice via the Better Caring platform, she could likely access 5 - 6 hours of care per week with the Page | 3 same Level 2 Home Care Package funding. In addition, not only would the worker be able to earn more per hour, the arrangement would allow Lynn sufficient hours each week to choose a worker that could prepare meals of her choice with her, removing her need for Meals on Wheels and building her capacity to remain living well, independently. At Lynn’s request, Better Caring spoke with her provider to ascertain whether they would be open to allowing Lynn some flexibility to engage care workers of her choice via the Better Caring platform. Unfortunately, this was denied on the basis of the provider’s own internal risk assessment and appetite, despite Better Caring operating with strict core standards, policies and procedures for safeguarding that are comparable to industry standards. It would seem a reasonable risk, given the potential improvements in Lynn’s life. Further, at Lynn’s request to her provider that she needed more than 2 hours of care to meet her needs, it was suggested by the provider that she be reassessed for a level 3 package. Rather than allowing Lynn to use her existing funding more efficiently and effectively, her provider suggested that the best approach be to ask for more money from the government. In Lynn’s own words: “It’s great the Government is providing funding for me to stay living at home. But I have to be a good steward of the money and ensure I’m getting value. Otherwise I’m doing the wrong thing by tax payers. If I can get more hours of support from my Level 2 Package then I don’t need to immediately go to a Level 3 package” Lynn’s comments illustrate the positive consumer behaviour that will emerge as consumers gain an understanding of CDC and can access alternative solutions.

2.2 Whether the number and mix of places for residential care and home care should continue to be controlled Refers to Section 4(2)(b) in the Act In this context: • the number and mix of packages and places refers to the number and location of residential aged care places and the number and level of home care packages allocated by Government; and • controlled means the process by which the government sets the number of residential care places or home care packages available. Response provided: Nil

2.3 Whether further steps could be taken to change key aged care services from a supply driven model to a consumer demand driven model Refers to Section 4(2)(c) in the Act In this context: • a supply driven model refers to the current system where the government controls the number, funding level and location of residential aged care places and the number and level of home care packages; • a consumer demand driven model refers to a model where once a consumer is assessed as needing care, they will receive appropriate funding, and can choose services from a provider of their choice and also choose how, where and what services will be delivered. Response provided:

Page | 4 The goal of a consumer demand-driven model is to enable consumers to obtain better outcomes and drive a market response that offers more diverse, high quality and better value options. Better Caring is an example of a true Consumer-Driven Model. Better Caring operates an online marketplace, www.bettercaring.com.au , where people who need support to remain living independently at home can directly find, connect with, and hire, local, independent care and support workers, within sensible safeguarding arrangements. Better Caring is a disruptive, technology-based, innovator empowering consumers and workers, while creating transparency and efficiency. Our approach challenges the existing market structure that places large hierarchical organisations between people who need care and support, and the people who are willing to offer care and support for every hour of service delivered. The existing structure adds a layer of cost and is often ineffective, reducing choice and flexibility. We believe that a model that directly connects workers and consumers in local communities, with organisations standing beside people (offering case management, independent advice and advocacy when needed) rather than between people, can profoundly improve outcomes for consumers, workers and government. Most consumers, either by themselves, of with the support of family, case managers or other advocates, can access the benefits of this model. Our model is completely consumer-driven, placing consumers and workers at the centre of the market. Consumers can choose what services they need, who supplies them and negotiate rates. Workers get to choose who they work for, when they work, where they work and how much they charge. By connecting people locally and providing choice to both consumer and worker, we provide the basis for strong community-based care and support relationships to form. Barriers to a true consumer-driven model The extent to which consumer choice improves consumer outcomes and drives better market-based solutions depends on the extent to which consumers can exercise real choice. ‘Real choice’ means the consumer: (i) is at the centre of the decision and is the expert in their life; (ii) is informed, which means they have access to easy to understand, transparent information, impartial advice and when needed, advocacy; (iii) has diverse options so that each individual can find the care and support important to their life (iv) can easily make choices, can easily change their minds, and are not subject to significant switching costs (including exit charges) if they decide to do so; and (v) is allowed to exercise dignity of risk – i.e. the ability to make decisions that may involve reasonable levels of risk, in order to improve their outcomes. The benefits of Consumer Directed Care is in its infancy, as so few consumers can currently exercise real choice. Almost ¾ of the people we speak to daily have little to no knowledge of CDC, no understanding of individual budgets/funding or their right to make choices. Further, many providers have little incentive to inform their clients of CDC or to provide transparent, easy to understand information to their clients. There are many examples, such as Lynn’s referred to earlier in this submission, and Francene, below. Case Study: Francene Francene was offered a level 4 package for her mother, with the provider informing her that the package “entitled her to 11.5 hours of support per week”. In offering the package, the provider did not mention CDC or individualised funding. Francene was an existing user of Better Caring and had an understanding of individualised funding levels and her mother’s right to develop an individual Page | 5 care plan that reflected her choices. After discussing this with the provider, Francene indicated a willingness to take up the package on the basis she could continue to engage her mother’s existing care workers via the Better Caring platform. This request was initially denied by the provider, on the basis it was not encouraged under home care standards, and that they believed she had adequate options with them. For most consumers, this would be the end of the story. In Francene’s case she was relatively well informed, and in the rare position of being able to challenge these communications. Francene noted that her mum’s provider arrived at 11.5 hours by charging over 40% of the package in administration and case management fees and with the balance of funding, charging services at $48 per hour. Armed with this knowledge, Francene managed to strike a much better deal through another provider – being able to access lower administration and case management on the basis she would do more of the work and having the provider’s support to engage independent care workers of her choice through the Better Caring platform at just $35 an hour. Less than what the provider charges, but more than what a worker might typically earn. The result for her mother was a doubling of the amount of care she could afford each week from the same funding – from 11.5 hours to 22 – directly improving her mother’s quality of life and increasing opportunities for her to remain active and engage with the community. She also able to maintain and build a close working relationship with the care workers she had engaged, who were able to set their own rates and work with a client they had also chosen. “I’ve used agencies before, but I was really impressed with the way Better Caring is set up to look after both the person needing care and the care worker, and I get to choose the care workers and negotiate with them directly. I really like the two care workers I’ve chosen, Alex and Tina. I’ve found them honest and reliable, they work as a team and my mother is always pleased to see them. I am extremely happy to recommend Better Caring (in fact, I do it all the time), as well as Alex and Tina.” – Francene While examples like Francene’s illustrate the significantly improved outcomes that can be achieved when consumers are sufficiently informed to exercise choice, we have many other examples reported to us of knowledgeable consumers being denied choice due to the provider’s internal risk policies related to duty of care and compliance with home care standards, and others who have been unable to achieve better outcomes due to not being informed and/or not being able to access independent or impartial advice. Education key to ensuring consumer choice Based on our direct experience, consumers are currently in the dark regarding consumer directed care. A key indicator of this lack of knowledge comes from our insight into how it compares with knowledge about key government reforms in another sector in which we operate – the NDIS. In our market research (conducted by Pulse of Australia November 2016), 30% of consumers surveyed advised they were informed or somewhat informed about CDC where as 41% were informed or somewhat informed about the NDIS. Tellingly, 57% of the audience surveyed was aged 55+, which one would expect to bias survey results toward awareness of CDC. However, in our experience, even consumers who are somewhat informed have little understanding of individualised budgets and provider charges. If the Government wants to realise the benefits of CDC, it needs to invest further in education and raising awareness, particularly celebrating and sharing consumers’ stories. We note recent campaigns by NSW NDIS to raise awareness of the scheme. (Ref: http://www.smh.com.au/national/how-siobahn-daley- became-the-public-face-of-the-ndis-20161104-gsi2c1.html ) Consumers and providers also need to be educated about consumer protection laws against misleading and deceptive behaviour, which will encourage providers to be increasingly transparent with their sales

Page | 6 pitch and communications. The NSW Department of Fair Trading is actively educating people with a disability in relation to consumer protections for NDIS funding. Defining Duty of Care Further, there needs to be education of consumers and providers around the concept of Duty of Care as a notion that should support people’s rights to choose, reducing the potential for providers to inhibit choice by assuming to always ‘know what’s best for people’ or based on their own risk policies. The aged rights advocacy service defines duty of care as “helping someone achieve their chosen outcome, safely.” This is not necessarily the definition most providers adopt in their home care business. We see consumers being denied reasonable choices on the basis of the providers own risk policies or their risk assessment in relation to duty of care or compliance with home care standards – without considering the consumer’s right to make choices in their life that involve reasonable risk or the notion of the consumers dignity of risk. Creating transparency around costs The issue of a lack of transparency around provider fees is well known and well documented – and is a key barrier to a true consumer driven model based on real (informed) choice. We note that on 14 September 2016, the Hon Andrew Wilkie posed the following question to the Minister for Health and Aged Care: “I have received many complaints from older Australians and their families about the ridiculous cost of home care packages. One example is a client who was effectively being charged $165.00 an hour for assistance with house cleaning and showering when all of the administrative expenses were included. The problem is that there is a cap on fees but no floor on services. This allows overcharging by many service providers on a scale that a reasonable person would characterise as systemic rorting. This is obviously unacceptable both for the consumers who cannot afford the fees and for the taxpayers who are subsidising the packages. What will you do about it?” The response from the Hon Susan Ley was as follows: “It is, I agree, very disappointing to hear about providers who charge such extravagant administration fees and effectively bring a bad name and reputation to so many who do the right thing. It is true that, at the moment, providers of home care packages can charge an administration fee, and we expect them to charge a reasonable fee…. Importantly, from February next year, as part of the reforms being led by this government, we will attach care packages to the consumer, so this situation will not therefore happen. We will give the consumer the power of spending on their own care on their own package in their own home. This will allow them to live exactly the life that they choose, not being dictated to by providers with excessive administration fees but actually recognising that choice in aged care is vital.” Further to this, we have been made aware of an alarming fact; that many providers are rushing to introduce exit fees ahead of the February 27th changes, a move that will surely inhibit consumer choice at a time when government legislation intends to do the opposite. Ensuring, at a minimum, transparency and regulation around these practices is essential to ensuring consumers can exercise real choice after February 27th and their ability to change providers is not restricted. While the February changes are a very important step forward, they will only result in better outcomes if consumers are fully informed about CDC and their right to exercise real choice, and there is a level playing field in terms of consumers being able to be aware of and informed about innovative options as well as more traditional options. Further information regarding our proposals are contained within 2.9 – The effectiveness of arrangements for facilitating access to aged care services.

Page | 7 2.4 The effectiveness of means testing arrangements for aged care services, including an assessment of the alignment of charges across residential care and home care services Refers to Section 4(2)(d) in the Act In this context: • means testing arrangements means the assessment process where: o the capacity of a person to contribute to their care or accommodation is assessed (their assessable income and assets are determined); and o the contribution that they should make to their care or accommodation is decided (their means or income tested care fee, and any accommodation payment or contribution is determined). Response provided: Nil

2.5 The effectiveness of arrangements for regulating prices for aged care accommodation Refers to Section 4(2)(e) in the Act In this context: • regulating prices for aged care accommodation means the legislation that controls how a residential aged care provider advertises their accommodation prices. Response provided: Nil

2.6 The effectiveness of arrangements for protecting equity of access to aged care services for different population groups Refers to Section 4(2)(f) in the Act In this context equity of access means that regardless of cultural or linguistic background, sexuality, life circumstance or location, consumers can access the care and support they need. In this context different population groups could include: • people from Aboriginal and/or Torres Strait Islander communities; • people from culturally and linguistically diverse (CALD) backgrounds; • people who live in rural or remote areas; • people who are financially or socially disadvantaged; • people who are veterans of the Australian Defence Force or an allied defence force including the spouse, widow or widower of a veteran; • people who are homeless, or at risk of becoming homeless; • people who are care leavers (which includes Forgotten Australians, Former Child Migrants and Stolen Generations); • parents separated from their children by forced adoption or removal; and/or

Page | 8 • people from lesbian, gay, bisexual, trans/transgender and intersex (LGBTI) communities. Response provided: Government policies should foster innovation and look beyond traditional care solutions to improve equity of access: Online platforms have the real potential to increase equity of access by transparently connecting people directly in local communities based on criteria important to them, with appropriate safeguards. Criteria can include proximity, languages, culture, interests and attitudes among other things. Better Caring is essentially enabling technology that helps communities to better care for and support people in their own community, irrespective of whether your community is rural or remote, the Aboriginal or Torres Strait Islander communities, a CALD community, or the LGBTI community. And by offering better outcomes, choice and flexibility to workers within these communities, through direct connections, we can attract much needed new workers to the sector. For example, the solution in rural areas is quite likely someone on a nearby farm being willing to flexibly support a neighbour, and earn a non-farm income. They are less likely to do this working for a provider organisation who may or may not in any case be able to sustain service in an area. Technology can transparently and efficiently create and monitor these connections and solutions. These new models challenge the traditional norm of services being delivered through provider organisations and rostered workforces, and as such will likely be resisted, but offer an incredible important solution to consumers, workers and Government. As part of its sector engagement, Government needs to engage with innovators as well as traditional providers. Government also needs to ensure policies and regulation allow for innovative models and that a level playing field exists where consumers are informed and have equal access to innovative or traditional solutions.

Page | 9 2.7 The effectiveness of workforce strategies in aged care services, including strategies for the education, recruitment, retention and funding of aged care workers Refers to Section 4(2)(g) in the Act In this context aged care workers could include: • paid direct-care workers including nurses personal care or community care workers, and allied health professionals such as physiotherapists and occupational therapists; and • paid non-direct care workers including: managers who work in administration or ancillary workers who provide catering, cleaning, laundry, maintenance and gardening. Response provided: Current workforce challenges Workforce challenges in the sector are significant. There remains a shortage of skilled care workers at a time of unprecedented growth in demand, and yet, service providers experience challenges attracting, recruiting, training and retaining workers. Part of the challenge is the historical, hierarchical employment structures and entrenched negative community perceptions around care and support work being a low-skill, poorly-paid profession. Wages remain low, workers often feel undervalued and under- paid, and have little sense of or opportunity to take responsibility. Many workers are attracted to the sector by the personal reward that making a difference to the lives of other people can provide. Unfortunately, the ability for a worker to have a relationship with particular clients is lost or actively discouraged in a centrally rostered workforce model, where rosters are essentially driven by cost efficiency of moving workers across geographic distances, rather than choice. The result: work is task driven rather than relationship driven. As a result, there is a generally low level of morale, despite the fact that care workers are at the coalface of providing crucial human services, and they are often at risk of being lost to other sectors. Demand for services is increasing and innovative solutions can help meet demand The demand for services is increasing while service providers struggle to meet current demand and government funding is finite. In this context, as consumers increasingly exercise their right to choice, they are often seeking workers or services that are different to what has historically been provided to them. This is where solutions like Better Caring can help meet demand. Consumers are now able to make choices about what’s important to them and what they determine to be a ‘quality experience.’ On the Better Caring platform, 55% of people searching for services are not searching for specific services initially – preferring to first search for a worker who they feel they can connect with and trust. When consumers are judging quality, the attitude, motivations and personality of workers is a primary concern, often ahead of the specific experience or even qualifications of the care worker. In fact, consumers have often stated that in their experience the most qualified workers are often not the best workers. Platforms like Better Caring are attracting a new flexible and diverse workforce to the sector: mums or dads while kids are at school, people who are recently retired, people re-entering the workforce or who are under-employed, uni students. Training and competency assessments remain important in models like Better Caring. Workers’ profiles include accumulated experience and qualifications, among other things and workers are motivated to invest in training to improve their ability to delight, retain and build their clients. However, consumers can ultimately choose what’s right for them. Further, the type of services and how services are delivered will shift under consumer choice. Consumers will start accessing a wider range of services and service times that reflect their individuality. We have seen examples of a client engaging an IT teacher, another seeking service at 5.30am, another wanting someone they enjoy community outings with and many cases where an ageing consumer has chosen care workers based on their skill in preparing culturally relevant foods. Many new service requests Page | 10 represent a marked departure from traditional service offerings and will not be easily catered to by traditional rostered service models. Technology and workforce innovations are a necessary response, as is the influx of new workers to the sector offering a range of services that might differ from those traditionally provided. The industry needs to shift from regulating quality and risk to operating with minimum core standards for safeguarding while emphasising real consumer choice. Models like Better Caring work on this basis, similar to concepts supported by Prof Ian Harper in his Competition Policy Paper. Minimum standards include police checks, working with children checks, reference checks, certain qualifications based on the consumer’s needs (e.g. medication assistance) and insurances. On top of operating with minimum core standards, online marketplace models are built on participants earning and maintaining the trust of the community. They are in effect community or consumer-regulated with transparent feedback loops. It provides a very important layer of accountability and celebrates great outcomes. The traditional notion that quality can be regulated by compliance with standards/mandatory training is shifting to one where consumers are seen as best able to judge quality for themselves. How this works in practice needs to be further addressed, particularly as providers are essentially becoming funds holders, but home care standards still hold them responsible for quality of services. This conflict requires resolution. Regulation must support the changing nature of work The nature of work is also changing. CEDA published a paper in 2015 entitled “Australia’s Future Workforce. Section 3.3 “Your future employer: yourself” documents a steady shift globally and across industries toward self-employment. Self-employment is becoming an aspirational goal enabled by technology, as people value flexibility, fulfilment and reward over traditional, rigid employment models. The growth of the freelance or flex economy is well documented. I recently caught an Uber. The driver teaches ballet and works as a DJ, and works as an Uber driver when it suits. She has done 1500 trips over the past year, usually driving in the mornings until she earns $100. There is no reason why this worker couldn't consider offering transport, community access/support, help with shopping and companionship etc. within a similar flexible, multi-job workforce arrangement in the aged care sector. Not long after meeting her we had a family with a young girl with a disability looking for a support worker who was a young female with a passion for ballet. This illustrates the sort of diverse choice people with a disability and people who are ageing will seek. The demand will not just be for traditional care and support workers but reflect the individual things important in people’s lives. Making the aged care sector more attractive as a workplace will be critical to attracting the quality workforce needed to cater to our ageing population. The sector is competing for this Gen X or Gen Y worker – many good care and support workers want the option, flexibility and reward of building their own business, while other workers may prefer to seek the benefits of being a traditional employee. Regulation needs to recognise the shifting behaviours, attitudes and expectations of both consumer and worker. In a 21st century economy. To attract the workforce we need to support those in need, we need to accommodate people who choose to work in different ways. There is currently a potential uncertainty between goals of consumer choice, the preferences of consumers and workers, and current workplace legislation. Under CDC, consumers, as ‘markets of one’, are entitled to make choices based on their specific needs and preferences. Their ability to access care and support workers who can provide flexible, responsive, diverse and affordable care may be inhibited by current workplace legislation. For example, if a consumer directly engages a worker for say five hours per week on an ongoing basis to provide specific domestic or personal services, or companionship, could the consumer potentially be creating an employment relationship even if the intent for both parties is one of a flexible contract arrangement? The multiple factors that determine whether someone is a contractor or employee, can be difficult for consumers and workers to interpret. Currently there is no certainty around this issue for the consumer or the worker. As such, the Government could consider Page | 11 creating more certainty by carving out arrangements where an individual consumer engages a worker for personal and domestic services from sham contracting provisions.

Page | 12 2.8 The effectiveness of arrangements for protecting refundable deposits and accommodation bonds Refers to Section 4(2)(h) in the Act In this context: • arrangements for protecting refundable deposits and accommodation bonds means the operation of the Aged Care Accommodation Bond Guarantee Scheme. Response provided: Nil

2.9 The effectiveness of arrangements for facilitating access to aged care services Refers to Section 4(2)(i) in the Act In this context access to aged care services means: • how aged care information is accessed; and • how consumers access aged care services through the aged care assessment process. Response provided: As referenced earlier in this report, facilitating access to aged care services is about ensuring that consumers are informed about their right to choose and can exercise real choice. We would suggest the Government consider: (i) investing in a campaign informing and educating consumers regarding CDC and changes to Home Care Packages from February 27th, and how to switch providers; (ii) celebrating and sharing stories of consumers making choices and achieving better outcomes, similar to the recent NSW NDIS campaigns; (iii) advising and educating consumers and providers as to whether consumers have the benefit of basic consumer protection laws against misleading and deceptive conduct. The Commonwealth Government, with the assistance of a number of Consumer Affairs, Fair Trading and Consumer Protection organisations is undertaking some great consumer education in the disability sector, informing participants of their rights to access consumer protection laws with their disability funding. This is a key protection on top of home care standards; (iv) ensuring that switching providers is a simple process without significant switching costs. Discourage providers from charging significant exit fees in contracts – particularly until consumers are more fully informed; and (v) creating a level playing field for service offerings – for example, ensuring that My Aged Care includes non-government funded services as this will be a key source of information for most consumers, and ensuring that various government funded (often state government funded) consumer forums and expos don’t preference government funded and non for profit services, over for profit and innovative models. Note: Various forums initiated by government-funded services give priority to government funded services over private services and/or priority to non-for-profits over for-profits. The example email below is typical of this bias e.g. “Dear CHSP and Home Care Service Providers Invitation to hold a Stall at the St. George Aged care Expo

Page | 13 The St. George Aged and Disability Sector Support Officer is pleased to invite the CHSP and Home Care service providers to hold a stall at the St. George Aged Care Expo on Wednesday 24 August 2016 from 9:30am to 1pm. The aim of the Aged Care Expo is to increases awareness and provide information on In Home Aged Care services provided in the St. George Region”, and “Priority will be given to funded CHSP services first, then Home Care Packages and then Private Providers” (vi) providing clarity to providers on the importance of dignity of risk and the meaning of duty of care – i.e. that the definition of duty of care is “helping someone achieve their chosen outcome, as long as they are acting reasonably”; (vii) considering changing the term “approved or registered provider” on the basis that it implies a provider holding CDC funding on behalf of a consumer is in fact the provider of services, when in fact, their primary function is to hold and administer individualised funding at the direction of the consumer. The provider is in effect, first and foremost, a financial intermediary rather than a care services provider, similar to a plan manager under the NDIS or a financial intermediary under various state based disability schemes. This will reinforce individualised funding and the right of consumers to make choices; (viii) revisiting home care standards in the instance where the provider holding funding is not necessarily providing services – to ensure that the funds-holder is not held responsible for quality of services. Choice and judgements of quality should be at discretion of the consumer as long the chosen provider meets minimum core standards for safeguarding; (ix) moving to a model favoured by Ian Harper in his competition policy paper – i.e. people working in the sector must meet core minimum standards for safeguarding but beyond that, the emphasis should be on the consumer’s right to choose and judge quality. The government needs to resist calls to regulate quality. Consumers are very capable of judging quality and voting with their money if they have real choice; (x) as part of its regular sector consultation, Government should consult with disrupters and the consumers and workers accessing innovative solutions, as well as their usual consultation with providers and various peak bodies. This will give them greater insight into how the market could evolve to offer new solutions. (xi) (xi) consider creating clarity around the application of workplace laws where individual consumers and workers are entering into various care and support arrangements for personal and domestic services. The types services will vary significantly under consumer choice.

Page | 14 3. Other comments

Response provided: In general, CDC offers consumers and workers the potential for substantially better outcomes. Informed consumers, accessing real choice, will be key to driving more diverse, higher quality and value for money solutions. Technology and business model innovation will be key to realising the benefits of CDC reforms. Online peer2peer marketplaces have a key role to play in driving real choice and control, efficiency and transparency, improvements in quality and better outcomes for consumers, workers and government. By reducing sector overheads and redistributing the savings to consumer and workers, consumers can afford more hours of care and support (which improves quality of life and importantly shift Government funding toward creating local community jobs, rather than being lost in head office overhead) and workers can earn more. The challenge in community aged care and disability support involves a million and a half people living in homes and local communities all over Australia, seeking support from hundreds of thousands of people also living in those local communities. Technology has a unique ability to create and support these connections efficiently and transparently. If we can more efficiently cater to those people who have the desire and capacity to take more control, we can free up system-wide resources to better support people who are more vulnerable. While the most vulnerable require additional safeguarding, we can’t build the entire system around the most vulnerable as it raises the cost and reduces choice and flexibility for everyone. Government will be well rewarded for money spent educating consumers on CDC and upcoming reforms. Further, Government needs to ensure policy and regulation supports innovative business models, and new ways of working, and resist the temptation to over regulate.

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