Session 1: Provider challenges

Support expectations

Discussion points

When you receive DSS residential care funding, is there a clear understanding of the quality and quantity of care you are expected to provide for disabled people for that funding?

Overarching themes from the engagement sessions

All groups emphasised the need for greater clarity about service expectations from the centre. Providers specifically highlighted that:

• Group 2 (Large Providers) and Group 3 (Small Providers): There is a lack of clarity and consistency in residential support expectations across funders, NASC assessments, and service specifications. This makes delivering services difficult to plan for and can contribute to a misalignment between the price that DSS pays and the providers’ financial ability to deliver services.
• Group 1 (Medium Providers): Providing whole of life, responsive care does not align with the services specification. Funding needs to be able to be flexed and reevaluated to care for disabled people when their needs change. 
• Group 4 (Aged Residential Care Providers): DSS funding doesn’t cover the level of care providers feel is required for some disabled people, which providers consider results in under provision of some services.

Additional provider comments

• Providers often receive unclear or incomplete client information from whānau when receiving care applications which makes it difficult to define and understand care requirements and expectations.
• There is a difference between the actual residential care services provided and funder (DSS) service expectations. While funds are somewhat sufficient to support a care model, they do not support disabled people to live full lives, in accordance with EGL principles.
• The current pricing model does not support the provision of increasingly individualised care services.

Regional consistency

Discussion points

Do you feel that residential care pricing and funding is allowing there to be consistency of provision of care within your region? What about nationally? What is driving the variation if there is any?

Overarching themes from the engagement sessions

All groups expressed a need for greater transparency across -- and justification for differences in -- pricing and funding and expressed concern that there was unwarranted variation across regions. Relatively, providers were less concerned about the existence of variation, and more concerned about the lack of a transparent rationale for variation that exists. Providers also highlighted that:

• Group 1, 2 and 3 (Medium, Large and Aged Residential Care providers): There is a need for transparent and consistent residential care pricing and funding across regions to address the variations in regional budgets, NASC assessments, guidelines, cultural competency and funders to enable equitable access to services and funding.

Additional provider comments

• There is disparity in cultural competency between staff and funders.
• Not all service types are available across all regions, limiting care options.
• Contracted rates need to be consistent. The funding should then be negotiated and allocated on an individual needs basis.
• The level of funding provided is dependent on the NASC assessment. These assessments are inconsistent across regions.

Cost drivers

Discussion points

How have your cost drivers changed in the last 5 years? What are the main drivers of cost changes from your perspective? Consider operational, staffing, client needs/services, estates and maintenance.

Overarching themes from the engagement sessions

All groups highlighted similar experiences with the current pricing and funding approach. There was consensus that pricing inconsistency and underfunding was a key challenge that needed to be addressed to move towards a more stable, predictable, and consistent pricing model. Providers also highlighted that:

• All groups: Residential care costs/prices are outpacing funding due to a combination of environmental and situational factors. These increased cost drivers include:
  • Cost of living (e.g. rent).
  • Workforce (e.g. pay equity).
  • Operation and compliance (e.g. health and safety).
  • Individualised care and behavioural support (e.g. need for separate homes).
  • Care support expectations (e.g. from the Government and whānau).
  • Economy (e.g. inflation)
• These cost pressures are further compounded by a funding model that is occupancy based and which do not fully account for fixed costs and vacancies, leading to a gap between price levels and the actual cost of providing residential care for individuals.

Additional provider comments

• There is an increasing need to provide 1:1 support during a resident "crisis period“. However, often services are limited during these times, therefore providers end up absorbing the costs.
• Some costs are heavily individualised such as preferences in hobbies and interests.

Funding Consistency

Discussion points

Do you feel that rates are set fairly and consistently? Is pricing transparent or can it be improved? Is a simplified uniform model (that accounts for regional and client variation) desirable?

Overarching themes from the engagement sessions

All groups noted a lack of consistency and fairness in the current funding approach. Providers also highlighted that:

• All Groups: Provider funding is inconsistent across regions, impacting the consistency and quality of support provided for individuals with similar needs. Inconsistent funding means that financial risk is placed on providers, impacting the sustainability of residential care service provision. There is a significant gap between service expectations, NASC assessments, and funding levels.

Additional comments

• There is a need for an objective assessment of the level of need to support a greater consistency of funding.
• Pricing and funding is not consistent for residential care recipients with the same care and support needs.
• The care disabled people receive is contractually defined, which may not reflect their needs and particularly how these needs may change over time.
• There is a misunderstanding that once funding is in place it can be decreased, however this may result in an increase in future funding to meet the expected (and required) level of care.

Funding Relationship

Discussion points

What is the relationship between the provider (you), the needs assessor (NASC), and funder (MSD/DSS)) relationship like? Consider commissioning, negotiations, transparency and communication.

Overarching themes from the engagement sessions

Each engagement session focused on different points relating to the challenges faced with funding relationships. Providers also highlighted that:

• Group 1 and 3 (Medium and Small Providers): There is a lack of clarity around the relationships (and a lack of ‘partnership’) between providers, funders and NASCs, with uncertainty about key contacts, decision-makers, and contractual expectations not aligning with the level of flexible care needed for disabled people.
• Group 2 (Large Providers): Inconsistent expectations, capability, and NASC pricing undermines the relationship and trust between NASCs and providers.
• Group 4 (Aged Residential Care Providers): The relationship between ARC providers and funders is unclear meaning there can be multiple funding streams for individual residents, making it unclear who the primary / responsible funder is.

Additional comments

• Providers have relationships with many different agencies and people meaning there is no clear point of contact for funding decisions or escalation of provider issues. A provider even felt there was a lack of clarity around required payment terms.
• Bureaucracy drives the provider to funder relationship, which results in an overly risk adverse approach.
• Various funding/funder actors have different perspectives.

Other

Discussion points

Are there any other issues/concerns you would like to raise in relation to pricing and funding challenges?

Additional provider comments

• There is a need to make sure that disabled people are not continually marginalised because of national funding pressures.
• Third party expectations do not align with the needs of our residents and limit the individual choice and control available to them, placing them at significant risk of harm.
• A service can quickly become unsustainable and not support the level of care needed for a person if individual needs change or house capacity changes.
• The current funding freeze has created a significant risk of harm to those in care. We are placing those individuals with exceptional needs at risk because of our limited budget.
• Providers are flexible and creative in their provision of care; however, contracts tend to be too rigid to allow for innovation.
• The workforce is such a critical part in being able to deliver care services and needs to be closely monitored and managed to enable the appropriate level of care to be able to be provided.
• Available (interagency) support varies significantly, impacting service delivery and the level of care able to be provided.