Episode 19 - Navigating In-Home Aged Care Reform

In this episode, Scott Lynch (Managing Director of Community Therapy) speaks with Lorraine Poulos (Managing Director of Lorraine Poulos and Associates).

Together they discuss all things in-home aged care reform. It’s a sector undergoing constant change and review, and many providers feel overwhelmed and uncertain of what the future may look like.

In this episode, Scott and Lorraine discuss the reform pathways and explore strategies providers can utilise to best navigate the opportunities and risks that are likely to arise as the sector evolves.

We hope you find this conversation useful and informative!

Resources
LPA & Associates Website
Lorraine’s LinkedIn

Community Therapy Website
YouTube
Facebook
LinkedIn
Scott's LinkedIn

Takeaways

• The in-home aged care sector is undergoing constant change and reform, which presents challenges for providers.
• Seeking help and support from experts can provide valuable guidance and insights for navigating the complexities of the aged care landscape.
• Despite the challenges, opportunities for innovation and in the sector will arise as reforms are implemented.

Timestamps
(0:00) Introduction
(1:10) Summary of In-Home Aged Care Reform
(5:21) The Challenge of Uncertainty for Providers
(11:48) Opportunities and Risks for Providers
(18:44) Importance of Care Management
(24:58) How Funding Models are Evolving
(37:15) Getting Answers and Future Readiness
(42:02) Stages of Choice, Resilience and Seeking Help

Transcript

0:01

Welcome to the Community Therapy podcast where we talk all things community healthcare. I'm your host, Scott Lynch. Today we're chatting to Lorraine Poulos about the Support at Home Reform Pathway. Lorraine is the Managing Director of LPA, Australia's largest home care consultancy and training organization. Lorraine is an experienced healthcare executive having worked in the health, aged and community sectors for over 35 years. She is a member of two not -for -profit boards and a former health minister nominee on the New South Wales Medical Council for over 10 years. Lorraine and her team have been supporting the sector for over 15 years in aged care with a particular focus on home care. Lorraine brings a passionate, practical approach to everything she does. Welcome, Lorraine. Great, thanks Scott, so nice to be with you again and well done on the great work that you do. No, thank you. You're buttering me up for a lovely podcast. Thank you. I'm really excited for today's podcast. In -home aged care is experiencing constant change under the reform pathway from the Department of Health and Aging. Many of these reform pathways started after the Royal Commission, but there seems to be constant reviews and commissioned reviews. providers are dealing with this change during peak macro and economic pressures at present, inflation, etc. And they're navigating arguably the most significant industry reforms that many may experience in their careers. And I can speak to that as myself as still I think I can claim somewhat young in my career, but I have been nearly 15 years in aged care now as well but and have navigated some industry change, especially in residential aged care of ENAC to ACFEE. So within in -home aged care, single assessment workforce, support at home merger of home care and STRC, quality indicators coming, so much more. What's the general sentiment and readiness to change for the providers that you're supporting? that have great questions got. So what we're seeing at LPA is that there was a lot of energy, lots of work being done in the previous 18 months. And then when the department announced that the delay of the Supported Home Program to 2025 for home care packages and short -term restorative care program. and then a further delay to 2027 for the CHSP services. That sort of gave people, I guess, two, how we see it, two sort of sentiments. One was, oh, well, when is it going to change? And the unknowns, so that, I guess, that anxiety around the unknowns. And then as, whereas for other providers who have been proactively looking at the models, I'm starting to see that the profits that they were making previously has started to shrink. So it's given them a bit of an opportunity to take stock and have a look and see where they're going in the future. So it's sort of two schools of thought and action. What we're doing is encouraging providers to keep that momentum going because the lights just won't go off in June 2020. five and June 2027, all throughout that period, there are reforms and changes. And I think what you said is so true, that change fatigue. We would argue that in most businesses, you have to change and adapt. And whilst it's hard sometimes for providers that have been reliant predominantly on government funding and one source of government funding. to adapt those models into a more of a business type approach. And I think that's probably why the Commonwealth Home Support Services have been delayed because, you know, there's approximately 900 ,000 to a million people on that program. And that's a lot of people to transition into the support at home. And also for... those Commonwealth Home Support providers to be able to decide whether they're going to be in home care or out of home care. Many of them are local government providers. We've seen a big exit from local councils in who are providing those CHSP programs because they're no longer getting a grant. So there's no, I guess, guarantee that they're going to get that income because it's funded. and it's already moved towards that activity -based funding model. So lots of change and, yeah, as you said, change fatigue. Yeah, so what would be the biggest challenge that you're finding in general? Each provider, each type of provider, council, for -profit, not -for -profit, large organizations, small, franchised component. We've got lots of different, I guess, types of providers now in the market. But what's a general or really common challenge that's permeating all of those types of providers as they're gearing up and trying to navigate change, irrespective of where they are in their change journey. Yeah, for me, I think it is uncertainty, not knowing. Someone said recently in a consultation with part of the support at home reform consultations, can you just make a decision, either rip the bandaid off, because it's very hard for us to be planning our businesses. We're worried about the future role, for instance, of our... care managers and coordinators, they're starting to get a little bit unsettled. We're worried about when, particularly in home care packages, when will the package management subsidy or ability to charge that, when will that stop? We know that that package management charge is going to be rolled in to the hourly rate. But if you're not selling any widgets, Scott, then you're not going to get that 10 to 15 % of package management. And in care management, there are many people in home care packages who don't really access much care management. They're fairly low level. So we've seen some promising feedback from government that they will continue to fund. They understand care management. whether it's low or low care management or complex care management. So we think that's a really positive sign. Also, I think that there will be a much greater opportunity for new entrants into the market. Now, we know from the Royal Commission into both aged care and disability services that that poses a risk as well. Hmm. in the reforms there is anticipated to be provider obligations or rules we're hearing about. And that is a concern to some current providers. Will they be able to meet those obligations and rules? So they're already looking at their governance structures. But I guess it's the unknown. So we've got enough information. And for me, I have this analogy, it looks like a fish, smells like a fish, it's going to be a fish. So get yourself ready for it. You don't know if it's salmon or barramundi, but it's fish. Whereas other people, they actually want the black and white. And they say, why would we do all this work, Lorraine, if we don't know? Government could change their mind. So uncertainty, I think, is it. Yeah, I agree. As like community therapy providing allied health services, we're not an approved aged care provider, but we partner with countless approved aged care providers and we can sense that from our partner organizations. And most of my role day to day is stakeholder meetings, meetings with executive teams across home care, STRCC, HSP, and you can sense that change management fatigue. It's, it's trying to adapt to constant change from the department, but then also trying to then roll out that change management internally. And as a leader, you're then supporting and trying to have smooth change management for your team. So there's that sense of, you know, balancing, I guess, that psychosocial, psychological safety as a leader of how do you manage your change management fatigue, but at the same time, you're trying to ensure great change management processes for everyone that you're supporting across an organization and, and also consumers as well. So the, it's so challenging to navigate the aged care system as it is. And we're then going to see even further change. And at times consumers are starting to be aware of that. upcoming changes and they ask providers and as providers we don't have all the answers yet so you sort of have change questions coming left right and centre which is quite challenging but I think you put it really well of you can't always know all the answers but we know there is a reform process that is continually marching forward so I think smooth change management is always about what things Do you know for certain that you're going to have to change? Is this efficiencies across your system, your care management system? Does it need to be more flexible? Does it need to be more mobile friendly? What sort of things are you doing across staff retention, staff culture? Really map out those things across the strategic and operational plan that are going to make it easier for dealing with. new change that is just going to come that you may not be certain of what it is, but you know it's coming. So you might as well get rid of the certain things now. Exactly. And look, I think for many of us that have worked in the health and aged care sector for many years, there's always change and there will always be change and we have adapted. I think the planned changes over the next two to three years are quite, they're huge. There's a new aged care act. Now the aged care act is meant to be passed by July this year. Now of course we're hearing that maybe it won't. What does that mean? So that means that a lot of the legislative changes, including the aged care standards, will they be able to be put into practice? Will we be assessed against those aged care standards? So it's that sort of uncertainty as well. But I think, you know, I was reflecting yesterday, there was a beautiful document. I mean, I thought it was a beautiful document, but then I don't have a liar. So, my husband's watching football and I'm reading Corinne's cases. So yeah, I don't, I think. a lot to that. My wife, Alexis, is always like, oh, what are you looking at? I'm like, I'm reading the aged care newsletter that just come out from the department. all right. I mean, I do swim and I do sing, so I do have another life. And there was a document called the HK Roadmap, and some of your listeners would have seen that document. And a lot of what was planned and talked about... in that document, which had bipartisan approach, it had approval from the peaks in general. A lot of that is coming to fruition now. Deregulation of the market, that would then, that contestability would perhaps drive quality. We're starting to see new models of aged care where providers are getting ready to build, just build aged care facilities that maybe... won't have the constraints of the current model. And we can see in the plans for the registration categories that those low risk service types such as domestic assistance, social support will not have that intensive requirement around meeting the standards, which I think is a good thing. However, for providers, there will still be those rules and obligations to protect the public. You know, we're accepting government funding. You've got to agree to those rules is sort of an easy, for me, a simple way of describing to providers why they've got to do that. And I think that is an opportunity for current providers to expand their current service type. But it's also a risk for current providers, for example, common law home support providers, because as that market opens up, we saw what happened in NDIS. Huge number of providers and some of the challenges that came with that. So the traditional model of not looking at your billable hours, relying on grant funding, unfortunately that has gone. And I say unfortunately, because for me there's this amazing social capital that happens with those small local community, neighbourhood type services. I'm not saying that, private for -profits don't also have that model. I do, I've seen really good efficient models and providers like you and I that have come out of provider land and have set up businesses because they want to make a difference. So I think it's a myth to assume that all private providers are not doing the right thing, they are doing the right thing and they innovate and they want to grow their business. But I do think on the flip side, that's social capital where someone can walk into a neighbourhood centre, maybe get some advice, or the CHSP coordinator might spend a couple of hours, for which they're not funded, doing care management. So I think there's two in the future we're thinking about opportunities. And I know for many CHSP providers who are providing service types such as personal care. community nursing, they're actually doing unfunded care management with some very complex clients, Scott, because those clients do sometimes they're self -funded retirees and if they go into a home care package they have to have their income tested amount charged which can be up to$29, $30 a day. Mm -hmm. And for a level one too, they're not going to be that much better off, number one. And then the second part of it is that those CHSP clients, really the provider should be funded for that care management. So we're encouraging providers to keep a note of that additional care management, so long as it's legitimate according to what we understand case management or care management is. around assessing, evaluating, monitoring, transitioning, those beautiful concepts of case management. Keep an eye on that because once the supported home program merges, so CHSP and home care packages, there is, I think, an opportunity for providers to maybe gain funding for services which they haven't been claiming. The other area I think which is of great interest to me is that providers could start to be thinking about what innovations they can do now if they've got reserves and start thinking about a social support program based on the short -term restorative care model. So that therapy model start now so that when deregulation happens or the opening up of the market happens, you've got an attractive product. And the other thing in the reforms which I think is an optimistic one is that the prices will be set very similar to NDIS and we don't know what those prices are but if we look for instance in aged care at the veterans home care and veterans community nursing funding, it's quite generous compared to what some package providers are charging their clients. And we know with the quality assurance reviews that the Commonwealth has undertaken with providers, getting them to justify their pricing, making sure that the care management for which they're charging is actually being provided and they've got evidence that they have provided that. I think that has tightened up. and may provide us more aware of their obligations and has stopped some of that potential overcharging. And we've had lots of advocacy from the advocacy groups like COTA and OPAN and others around, well, why is this a reasonable charge in a package? So in summary, there are some positives. The pricing might be better for individuals. for providers and it's a bit of a more of a level playing field. So you might find that providers will exit because they maybe have been charging too much. We'll all have to become a lot more efficient. And then the other little area of interest for me is that around care management, case management. So many of you will know that that's been an area of passion of mine for a very long time. And I rolled out the Case Management Society of Australia's certification program across the country. Now, the case management society has been very quiet. There's, you know, we don't hear from them anymore. I think they've missed an opportunity to advocate for the sector around those beautiful skills that we see care managers or case managers exhibiting every day. But that care management is a separate service type. So in the model, individuals can choose a separate care manager. We would hope they would stay with one provider but I think that will be an opportunity for new players to come in and or current providers need to be aware of that, need to be conscious that it's not a given that the current service types and care management that you're providing will be what potential clients want. I think I've gone around the shop there. I've taken notes as we've went. You've covered so many wonderful things. One thing, I'll summarise a couple of my thoughts there. I think you've drawn attention to over this, let's just call it at least a decade, there's a significant rise in acuity and complexity of care in the community. I can reflect back on my first days of residential aged care over a decade ago and half of the car parts. would be full with residence car parks and residence cars. And now consumers that we support in the community every day, many of the most complex consumers that I would have seen over a decade ago in residential aged care. We know length of stay in residential aged care is quite short now, more trending towards that six month mark for new entrants into residential aged care. So. The complexity of care in community is rising and will only continue to rise. And it's a real need to continue to recognise and advocate for the importance and value and necessity of care management and really good care management. As allied health professionals, like community therapy team out in the field every day, we rely on really good care managers. We need them to be contactable. and we need them to be really aware of their consumers needs and that's only growing over time that need. So I think you pressed that point nicely. been getting a lot of requests and we do a lot of health skills for care managers because health literacy is something that all of us can understand. And I think the traditional social work, psychosocial or welfare model that we have had in home care has changed dramatically and so it should. And some care managers are frightened about And we just reassure them that if you have a really good model with a clinical lead and you've got very strong pathways for referrals, you've got a very clear understanding of what your scope of practice is and the importance, Scott, of that beautiful multidisciplinary team. I can't overestimate how important having an OT, a recreational... officer or therapist, you know, an exercise physiologist, trying to build your team so that you're ready for the future opportunities is something that I would really encourage. And for providers to start doing the work around the clinical education. We've got a nurse practitioner and a team of clinicians who we provide clinical packages. So we will... chair the clinical governance committee, provide support. If there's a very sticky situation in the community, they can reach out to the nurse, the nurse can then go to a nurse practitioner. Just to, because of workforce, that's a big issue in the future, is having a workforce that's skilled enough to be able to provide quality care. And one of the initiatives that, or one of the, I guess, discussions that we're hearing a lot in the reforms is around conducting check-ins. So clinical and non -clinical check -ins on people and the importance of doing that so that we can recognise that early deterioration. That's only good if you've got someone within the team or some resource like your organisation or ours that you can say, well Scott, we've got this client and we're seeing AV and see what do you think? And some providers don't have a clinician. So part of the strengthening governance around the quality advisory bodies and also just the governance in general came out in both royal commissions, the lack of clinicians on boards, the lack of clinical input. And I think the commissioners in both of those inquiries were quite surprised that you're providing a know, a clinical care model and yet you don't have clinicians. It's a bit like, well, we're doing food, but we don't have anyone on the board that's ever worked in manufacturing of food. So, you know, when you think of it objectively, that's quite a reasonable observation. However, my argument is that, well, of course we didn't because in particularly home care, because it was a social model. There weren't people being looked after at home. And as we move into that more user pays model and people wanting people, baby boomers thinking about reverse mortgages and how they might fund their care. Just to give you a personal example, a friend of mine's husband's not well and she was really confused about what she should do. So I just sat down with her and wrote down some options and said, well, look, if you were to have your... husband looked after at home for the next year or so, put aside $350 ,000. And I said, but if you look at your wealth, both capital and your investments, that's nothing in terms of having a good life. The flip side is, you are managing like a little business and you won't always find the staff that you need. But... that that is an option. And I think that model will really start to come. And we've seen that already where in wealthy areas, people do have 24 hour care. And the proposal that there will be end of life packages, I was part of that consultation recently within the reforms. It was a very interesting discussion about, you know, when someone's nearing the end of life and that it's being diagnosed by a nurse practitioner or... adopter that end of life is close, that they can access the highest level of funding equivalent to residential. So that's a very positive thing. I'm going off track again aren't I? no, that's no, this is the type of conversation I was looking for because our listeners are across a range of areas, but our listeners wanted to hear, you know, all aspects of the complexity and we're all used to this as well. So it's nice, you know, listening and sometimes for me listening to conversations like this is validating. because you're just continuing to hear all of the thoughts that are in your own mind said by others and the complexity. But some of the other things that drew to my attention from what you've been saying is there's always pros and cons of different funding models. So there's CHSP has its pros, it has its cons. Support at home will have its pros and has its cons. ACVI and residential aged care, same thing versus ENAC. So I think it's always about recognizing the pros and taking advantage of those opportunities to drive good clinical care and outcomes and experience for consumers and then, and for your team. But you have to then really recognise and identify those constraints and okay, what is the barrier here from this model? And how do we identify some opportunities there as well? Often the frictions in the model do present those opportunities and you identified. one of those correctly of support at home. CHSP eventually coming into that in and around 2027. See if the timeline stays to that this time. But that social model, social prescribing, social groups may fall away a little bit and we go very one to one. Well, there's then a big opportunity and a big yearning for that from consumers and the public. So if you can... get on the front foot now and start embedding those types of models and you'll be well prepared through to then. I think around pricing, what came to mind for me of at least seeing iHackers work across ENAC. So if you're not aware of iHackers, the Independent Health and Aged Care Pricing Authority, I've been quite impressed. by their work so far, at least in residential aged care. I feel that they are, they did an increase in the rate probably beyond what the industry were expecting, which was refreshing and was more representative of what the true cost of care is. Many would argue it needs to go further, but at least went probably further than most thought it would initially. And... that will, sorry to interrupt, Scott, but I think that will happen. I was presenting at the National Aqua Conference last year and they presented after me in the same session and they indicated that the pricing, their goal was to have the prices determined by the end of this year. So I think that's really... exciting for us. We can then plan a bit more if they stick to the timeline. And the other interesting point that we're still fairly silent on and for providers they're watching this closely is what will the contribution be from consumers or people. Now I think we have to take our provider hat off for a minute and think about fiscal responsibility. There's a whole, we've got children and there's a whole group of young people in this society, this wonderful country of ours. And should they be responsible for paying for our aged care? There's so many baby boomers and of course government wants us to be healthy. So how will that come to play? We still haven't got anything concrete and of course it'll be an election issue. I remember when John Howard said, nobody will ever have to sell their home to go into aged care. Well, very slowly over a period of time, it's a given now that everyone has to contribute. It wasn't realistic. So that's for me a bit interesting too, because once that gets announced, what the contribution rate will be, it is potentially a political hot potato or... They could just do what has happened in the common home support where you have a consumer, a fee contribution policy. It has to be up on your website. People have to be asked to contribute and you might pay $15 for your personal care and $10 for your social support. So maybe that's how it will come into play and it won't be income tested. Certainly at the moment, my understanding is that there's no, there's no suggestion that. be means tested but income tested and I sort of think that's a fair thing. Others would argue that people, older people may not want to pay for their care they will forego that and we have seen that. That I guess is a concern so if you're going to not allow someone to enter because they can't afford to pay or they don't want to pay, not can't afford to pay sorry want to pay, might be an issue. But also I think what we saw in home care packages, so in the very beginning of home care packages and now the provider I worked for, we ran the very first home care package program. And you were expected to pay and everyone was charged a daily fee, different to the income tested amount for daily fee. Then what happened with the deregulation into consumer directed care in 2015 and then the opening up of the market in 2017, we saw that two things. One, individuals, consumers said, why would I contribute to my care when I've got unspent funds? And then the second one was new providers wanting to grow their business and said, we're just not going to charge a daily fee because the time and effort and pain that it takes to collect that day fee. it's not worth it and we'd rather get the package management and the care management income. Now that's where we've landed and we've got all these two billion plus unspent funds. So getting back to my original comment, I think we've got a fiscal responsibility as a society to make sure that the money that's being allocated by government is spent where it needs to be spent so that it gets given to more people. that need it. Whether that's going to be palatable to the community, I don't know. I know what your thoughts are on that. Yeah, I think, you know, I've seen that in and around residential aged care comments as well of, you know, re -looking at this and see that at a government level, it's kind of, you know, the inquiry results are sort of just continuing to be pushed back week by week and month by month. So I agree that it is a big political. item. Aged care is and always will be and will continue to rise with the in, you know, the baby boomer aged care wave, you know, coming towards us. So, but at the same time, I think across providers, but also consumers, and our new older adult consumers coming like I can speak to my grandparents and my my mom that they have a sense of fiscal responsibility as well as an average consumer, more broadly of, you know, really wanting to make sure that at a broad level, you know, government programs are fit for purpose and giving a return on investment. And I think the NDIS has brought that conversation front and center as well. And we're seeing that starting to permeate most health components of the sector. We want our private health insurance being fit for purpose. We want our public health systems being fit for purpose. And there's this general sense of the health landscape, the aged care burden, changing all aspects of that care. And it's not just the aged care system that is adapting to that. We're seeing public health, primary health networks really up their focus on. How do we support the aging consumer? Just at the time of recording, just last night I was at an event which was a innovation challenge purposely for mental health for older adults on the Central Coast. And that was commissioned by a primary health network, Central Coast Local Health District and the uni, the I2N network. So it sort of draws this attention to age care is... becoming on the, well, is on the radar of all areas of health and department. So I don't feel that it's hard. It's always hard as government. You're a politician and you can be very siloed and get your blinkers on there. And but for our politicians, if you're listening, I think they need to be brave and just continue to move forward with their agenda and be careful of who they're listening to here. And remember that most of society do want to see good stewardship of resources. And that's what we trust our politicians to move forward with. So I don't think they need to be fearful of, you know, putting a line in the sand and saying, this is what's needed for the next 20 years. So let's move forward with it. So hopefully they have the Hopefully they're brave enough to do that before an election and not having to wait to after an election result where they do that. That would be my two cents on it. I do think you touch nicely on that providers should feel optimistic that through this year they will get most of the answers that they kind of need to some of the uncertain areas. What is that quarterly budget going to look like? What's the care management going to look like? What sort of caps may be on quarterly budget to quarterly budget and what's the pricing schedule and they can really start to plan things out. You touched on a couple of opportunities, but I think I'd pose a similar question that I did with the challenge question. across all different types of providers, profit, non -for -profit, franchise, big, small. What do you think their general biggest opportunity is that they're not really looking at at present? Is it something like group programs or is it more that their care management systems are old and not ready for the future? Where's their opportunity that in general they're not taking advantage of? Well, that's a difficult question because we see providers that are quite naive in their business models and we help them invigorate that and either meet standards or get ready for the future. So that's a bit difficult. They might still be using spreadsheets. So then we would be saying you need to get a really good CRM, one that's going to interface with government. So I think in the digital space, However, the cohort of consumers, older people are not necessarily ready for it and that will take a bit of time. So I think for me it's that they are maybe burying their head in the sand about the implications of activity -based funding. And rather than saying I've got 400 clients, or 400 packages, we try and get them to think about, I've got, we sell 400 hours of service every week in this particular category, understanding what are the service types and doing some scenario planning around, well, if we've got X number of personal care hours and they pay us Y, this is what it might look like. That plus the care management really understanding who's got high acuity levels, who are they on your clinical risk register, do you have a clinical meeting where you discuss those, all of that costs money and all of that costs infrastructure and knowledge and systems and processes for good quality care. So not recognising that. Where we've got... providers that may have got residential care, independent living units and home care. Where those providers have historically treated those businesses as sustainable businesses in their own right and funded and resourced those businesses well, they seem to be doing okay. But the ones that perhaps haven't, and residential has been the most important part of their business, we're seeing those providers struggling. And now the boards are asking questions. Why are we in this Commonwealth Home Support Program? Not meeting their targets, governments now saying, right, tell us why you should continue to get this funding. Give us a business case scenario for that. So that's where we're still seeing that they're either burying their head in the sand or they're very worried about it. And then it's like, well, I think maybe we should exit. And that's a choice. might be a choice. Let others do that really well and let's specialise. Yeah. provider's found themselves in their journey. but I do think there's lots of opportunities and that will take innovation and energy. And look, Scott, as you and I know, that often comes down to leadership and individuals at that leadership level that are prepared to take that risk or prepared to invest. And I think it's a shame that, you know, we've just come out of COVID, so that was really difficult for providers. So that put the brakes on innovation a lot. However, the flip side is that it allowed us to do things a little bit differently, but not that differently, I don't think. I think for me, you know, I really love Stephen Covey's stages of choice. You know, I read the seven habits of highly effective people. I don't think I'll get any of those habits. He wrote another beautiful book about the eighth habit. And in that he talks about those stages of choice. And I refer to them a lot, which is... You know, we can rebel or quit against all these changes. And then when you go up the ladder of those stages of choice, the top one is creatively excited. And some of us are creatively excited. Some of us are just happy, cheerfully cooperative. They're happy to go along. Others are willingly complying. Let's just go with it. We're dependent on government funding. And some people might... we would hope not choose to go into that maliciously obeying. Well, we'll do it, it's not gonna work. It won't work, it hasn't worked before. They change their mind all the time. I would hope we could probably get to that creatively excited. But there are some people that have just said, this is too much. And remember when we first introduced consumer directed care and budgets. And I remember running around the country and it was like. Heh. is Monday, I must be in Melbourne. Oh no, it's Tuesday, so I'm in Brisbane. Doing the CDC budgeting training for the peaks all around the country. People, I said, you can't come to the training without a laptop. That was huge for people because they had to practice doing a spreadsheet. And I remember one day this person said, that's it, I'm out. I did not join, I did not become a social worker to be plugging figures in. And I think that's... To me that encapsulates how some people would be feeling. This is all too hard and that's a choice. Yeah, but I would hope that they don't make that choice. Yeah, I think like the one of the last things I would finish on today and then I'll ask for like one, you know, summary thing from you as well. But I'm just going to piggyback on what you've said there around, you know, stages of choices with change management, depending on where you are personally, where you are professionally, where you are with all aspects of life, your resilience to that change can change day to day. Something could happen. You could get a phone call from a family member. and then tomorrow the department releases the thing and it breaks you. You don't have that resilience. So I think no matter where you are in that choice, whether today's the day that you're feeling ready and excited or, and you've stayed like that forever or you're swapping and changing, for anyone, it's just get help. So you need to reach out to someone like yourself and your group at LPA or... going, okay, I don't need to make this harder than it already is. Let me pay for some level of support, at least have a bit of an introduction to and an exploration of like, okay, am I on the right track? Do we have the capability with our current organization and structure to continue to take this on? Or are there areas and opportunities that sometimes may be more efficient? And I think you... drew onto a nice one for providers of being able to outsource some of their clinical governance. So that can be really hard for an organization to build, especially if they're coming from a history of predominantly domestic assistance and social support and transport and groups, et cetera. That's going to take a lot of time and energy and capital to build that out, both in recruitment and training and then... If you don't have those governance models, you're going to build them out and you've already got a lot of other things. So sometimes depending on what your capabilities are, you are better outsourcing that and getting that help. So that would be my number one tip of after this session today, if you've been good enough to listen all the way to this stage, you should sit down and just write down, okay, where are we with these things? How comfortable do I feel with? leading my organization through to support at home and beyond. And if you can honestly say to yourself there and be honest of going, actually, I'm a bit worried. I'm more worried than I think I should be. You should pick up the phone, send an email to LPA, give the shout out here and get some support. That would be my tip. Look, thanks for that plug, Scott. That's not necessary, but thank you. I guess my final messages would be, you know, I wrote down before resilience, and that's a word that gets bandied around a lot. What does that mean? That means that as leaders, things are hard. And that's why we are leaders. We solve one problem and we think, yeah, and then another one comes. And what happens, we learn from those that problem solving, well that worked this time. So having that resilience, being open, I think debate is healthy, but debate that is not looking for the big picture solution is just a waste of time. It's just a talk fest. We need to have solutions. So if you've got, and during the consultations with the department, I think, you know, there has been some really good. solutions put forward and I think government has listened and that's a good thing and those consultations continue. So I would say slow down, be ready but realise that as leaders our jobs are hard and if we're standing still in the stagnant then nothing will change and that change will be forced upon us so we're much better off being part of it. But thank you I just really enjoyed. It's been lovely. And I hope it's just one or two things. In all the work that we do, we say to our clients that we work with, or our customers, is well, you know your solution. Sometimes you just need a little bit of guidance, or you need to be able to say, I'm thinking this is the right decision. What do you think? And give us the evidence that sits behind us. But I don't think it's all the sky's falling. I there's lots of opportunities and the demographics of older people is only getting larger. So I think it gives room for optimism and innovation. I like that. That's a lovely way to finish. It's been a real pleasure chatting to you and I hope our listeners are walking away with a list of ideas to review and action to improve their readiness for change. Maybe their stage of change as well. But make yourself a coffee or tea, get pen and paper out and just take some notes. Sometimes it's about holding space for yourself to give yourself that 15 minutes, 30 minutes in your day as a leader to... reflect on a session like this to then think about what changes you may need to put in place. Everyone will find show notes and links in this episode on our website, communitytherapy .com .au slash podcast. Thank you for listening once again, and I look forward to chatting to you in the next episode. Thanks so much, Lorraine. Thanks, Scott.