Advocating for improved in-home and community care On Monday the 31st of August, Hearing 4 of the Royal Commission into Aged Care Quality and Safety kicked off in Sydney, this time shining a spotlight on Home Care and what can be done to improve the in-home and community care provided to older Australians. Sharyn Broer, Chief Executive Officer (CEO) of Meals on Wheels SA and President of Meals on Wheels Australia, joined a panel of four other home care providers to discuss elements of a future, fit-for-purpose home care system for older Australians. The remaining panel members comprised of Brian Corley - CEO of Community Options ACT Inc, Ahilan St George - Director and Co-Founder of Vitality Club, Jaclyn Attridge - Head of Home and Community Care Operations of Uniting (NSW/ACT) and Fonda Voukelatos - General Manager, Strategy and Business Development of Uniting AgeWell. Mrs Broer described Meals on Wheels to the Commission as three services in one; food, social support and a wellbeing check, before detailing how important the service is to the overall health and wellbeing of its consumers. “We're aiming to deliver about 40 percent of the daily nutrition requirements in the meals that are provided to people's doors. We're also providing speciality meals for people who have therapeutic dietary requirements or who have swallowing difficulties.” “Good nutrition is a preventive health measure for older people. We make sure that we provide variety in the diet and food safety is absolutely essential.” “The social connection that comes part and parcel with the service is critical to supporting the confidence of people to live independently and it's a light-touch way of reducing loneliness and isolation of people within the community.” “Many consumers report that the volunteer and the conversation isare as important to them as the food they receive,” she said. Mrs Broer then went on to describe the other essential element of the Meals on Wheels service; the wellbeing check provided by its dedicated volunteer workforce. “We have volunteers providing peace of mind and follow-up to family members and others by monitoring how that person's going, asking them how they are and reporting back, and most importantly, following up when people are showing signs of medical distress or, indeed, may have had a fall.” Mrs Broer said there is strong evidence supporting that good nutrition and indeed, nutrition delivered through Meals on Wheels programs has been shown to prevent falls. "It's also been shown that Meals on Wheels recipients are less likely to present at hospital emergency departments. If they do, they're less likely to be admitted. If they are admitted, their length of stay will be shorter and their recovery and subsequent outcomes will be better than people that are not well-nourished on admission.” Mrs Broer explained the way Meals on Wheels is funded to the Commission, predominantly through consumer contributions, with secondary funding distributed through the Commonwealth Home Support Programme (CHSP), and indirectly under contract to Home Care Package providers. She then described the benefits of grant funding for meal services. “There is a challenge in what consumers perceive is the value proposition of a delivered meal service. So while there is a proliferation of home delivery services in the community, they're not delivering the full level of care that a delivered meal service is able to, through the grant-funded activities,” Mrs Broer explained. “Grant funding is particularly suitable for Meals on Wheels services, given that we have high fixed and capital costs associated with the service, along with a reliance on volunteer labour, and also that Meals on Wheels is a service that the community expects to be available immediately.” “It's an essential human need to be able to access food and to be able to stand up rapidly [to meet increased service demand] like we [Meals on Wheels] were able to do during the pandemic is one of the benefits of grant funding.” Mrs Broer says the single most important home and community aged care reform issue for Meals on Wheels is recognising that good nutrition is fundamental to healthy ageing at home. “We need to make it as easy and quick as possible for the older people to access the meal and nutrition information support before they become undernourished, ensure that people's contributions for meal services are affordable and improve the interface between primary health and aged care systems.” “We believe that can be achieved by providing older Australians with an entitlement to appropriate food services to support their healthy ageing, direct, rapid and simple service access, and equitable, adequate and sustained investment in evidence-based meal support services, so that consumers pay only the cost of the ingredients, eliminating the financial barriers they're currently experiencing and improving their health outcomes.” Mrs Broer identified two key challenges arising in Counsel’s proposition that meals, transport, respite and social support services are delivered solely by the CHSP until home care programs are integrated. She said that there needs to be an increase in the capacity forof the CHSP to respond to the 100,000 people awaiting a home care package at their assessed level of need, as well as evening out the inequitable Government contribution between both the CHSP and HCP. “Within the Commonwealth Home Support Programme, the level of Government investment is much lower and it's quite variable within the CHSP within and across jurisdictions. “So, again, in South Australia, our Meals on Wheels service delivered through the CHSP requires a consumer contribution of $9.75.” “So it's the exact same service but the consumer is paying $5 more to get that service through the CHSP than through the Home Care Package.” Mrs Broer says Meals on Wheels is encouraged to see these matters largely addressed in the draft propositions put forward by the Commission and looks forward to positive steps brought about by the inquiry.