In Home Care Evaluation Report
The revised In Home Care (IHC) program was introduced on 2 July 2018, as part of the Child Care Package. This is the final evaluation report for the IHC program, drawing on data collected about IHC up to February 2020.
This revised IHC program replaced the previous IHC program and the Nanny Pilot Programme, with the program's objective being to support families' workforce participation and early childhood education and care requirements where other approved child care services are not available or appropriate. The program is directed at families in geographically isolated areas, working non-standard or variable hours, and those with complex or challenging needs.
The design of the revised IHC program was informed by reviews of previous programs and by feedback from stakeholders, services and families. A significant change with the revised program was the introduction of a new brokerage model, in which five IHC Support Agencies help families find the IHC or other services they need in their jurisdiction(s) (three IHC Support Agencies work across two jurisdictions). One aim of having these IHC Support Agencies is to increase national consistency in the delivery of IHC. Other changes introduced with the revised program included redefined eligibility criteria, a renewed focus on early childhood education and care, minimum qualification requirements for educators, and changes to the allocation of places. The revised IHC program was part of the Child Care Package, which brought in the Child Care Subsidy with its income and activity testing, the introduction of hourly caps and family co-contributions to child care. There is a family hourly rate cap for IHC.
The key data used in the evaluation of IHC were the IHC Program Case study conducted in early 2019, plus follow up interviews with IHC Support Agencies and key stakeholders in early 2020, online surveys with IHC services (two waves), IHC educators (one wave) and IHC families (two waves). Departmental administrative data on Early Childhood Education and Care (ECEC) were also used, along with IHC program data as reported by IHC Support Agencies, and a sample of Family Management Plans. This summary presents key findings from the evaluation.
Overall, the revised IHC program is operating as intended by supporting the three cohorts of families to access ECEC when other forms are ECEC are not appropriate or available. IHC meets an important need, and the families who receive IHC are clear that it is key to their families' and children's wellbeing. But there is a very significant challenge to it being a completely successful program given that IHC cannot be supplied to all who are eligible for it. In particular, there is a bottle neck due to the lack of qualified educators who are available to provide IHC. The supply of educators for IHC needs very significant attention for the program to be delivered effectively. Inability to deliver IHC to families who need it has implications for service viability also, given this impact on the stream of potential income to the service. We note that the financial viability of the IHC service sector continues to be an issue, contributing to vulnerabilities for the IHC program. The introduction of IHC Support Agencies is discussed below, but overall, the findings suggest that these agencies are focusing on supporting families' access to IHC and to other services as needed. It is perhaps too soon to say if the introduction of IHC Support Agencies has made a significant difference to the delivery of a nationally consistent program.
IHC Support Agencies
IHC Support Agencies and the brokerage model
Generally, views seemed to indicate that there are advantages to this brokerage model. In interviews in the IHC Program Study, IHC Support Agencies, key stakeholders and several IHC service directors indicated support for the role of IHC Support Agencies in being able to take a broad view of IHC service use at a state or territory level.
The introduction of this model was somewhat challenging for services, given the IHC Support Agency has taken over a role that had previously been theirs. This has meant less control for services over recruitment of families to their service. This was especially an issue in the period of transition to the new program, with reporting by IHC Support Agencies in early 2020 indicating that this had improved since that time.
While IHC Support Agencies report improvements in the program processes, and communication with services, there is still some uncertainty and confusion about the roles and responsibilities of IHC Support Agencies. In particular, families and educators often seem to misunderstand the differences between IHC Support Agencies and services. This adds to some confusion for families and educators who are seeking additional support to manage their use of, or delivery of, IHC. Overall, it appears that IHC Support Agencies are increasing their involvement in the promotion of national consistency and their capacity to advocate for families is increasing. But these are areas for ongoing attention, improvement and monitoring.
Supporting consistent and high quality IHC
IHC services have responsibility for ensuring quality of ECEC at the service, and IHC Support Agencies have a role in aiming to improve the consistency and, as a result, the quality of IHC provision. In interviews with IHC Support Agencies, discussions about quality often centred on the fairly recent focus they were putting on supporting educators, with a view to improving quality through the establishment of Communities of Practice and training. Different IHC Support Agencies also reported to the Department that their role in relation to quality was also attended to through compliance and monitoring, the FMP set up and review, and through communications with services.
Matching services and educators to family care needs
Developing and implementing processes to match services and educators to family IHC needs has been a significant focus of the IHC Support Agencies. The matching is done by IHC Support Agencies first communicating with families over their IHC eligibility, and (with the family) completion of the Family Management Plan (FMP). There is then a process of determining whether the family can be matched to an IHC service, through knowledge of service characteristics and waiting lists. Since the transition to the revised program (up to 2020) it was reported that improvements to this matching process had been made, but mixed views about the usefulness and completeness of the FMPs remained apparent at the service level. Further, there were still concerns about how these processes contributed to delays in the provision of IHC. There was also still some negativity among some services about the quarterly review of the FMP, particularly if this was experienced as onerous or stressful to families. Family reporting about the quarterly reviews included examples of this process being experienced in this way.
It was generally reported that matching families to IHC supply is working well, to the extent that educators are matched to provide the IHC to meet families' needs. Families using IHC are often quite satisfied with the IHC received, and with the quality of care provided by the educator. They are not always fully satisfied with the hours of IHC received, including with the flexibility of IHC, which to some extent reflects that these families do have needs for quite flexible hours of IHC, or short shifts of IHC, or hours at non-standard times.
As noted above, though, a very significant barrier to effective matching is lack of educator availability. As such, management of waitlists is an important part of the matching process. Particular strains were put on some families who were told by IHC services they have to recruit an educator themselves. For others, no options were presented. Another key role of IHC Support Agencies is therefore to ensure families are adequately supported during the time that the matching process is underway or delayed because of their having to be placed on a waiting list.
Linking children to other support services
An ongoing role of the IHC Support Agencies is to develop links with other services and supports, to enable referrals to be made from those organisations to IHC, and to allow IHC families to be connected to other resources as appropriate. This has become more of a focus for the IHC Support Agencies, now that the transition period has passed, and IHC Support Agencies have more capacity to resource these activities and to further develop their networks. There is certainly evidence that families using IHC often use services other than IHC, but many also report still having a need for services. This is especially so for families with complex and challenging circumstances. As well as having greater levels of need, their particular support needs differ to those in other cohorts.
This will continue to be an important area of development and monitoring, to ensure there is growth in IHC Support Agencies' capacity to link families to support services. This was one of the key areas of concern about the program - about families falling through the gaps if their needs could not be met by IHC. It is therefore critical that this remains a well-resourced role of the IHC Support Agencies. To what extent there may be better models of case management or referrals for families with complex needs may be something that should be explored also.
The revised IHC program was introduced at the same time as the progressive roll out of the National Disability Insurance Scheme (NDIS) across Australia. The roles of IHC versus the NDIS, and how they complement each other, are perhaps not surprising, then. Families as well as IHC services and IHC Support Agencies have found the intersection between NDIS and IHC to be unclear and difficult to navigate. There have been concerns that families are not receiving the level of support they felt they needed through either program. A specific finding was that many support activities which were essential to families were not seen to be covered in either the NDIS concept of 'parental responsibility' or the IHC concept of 'early childhood education and care'.
The extent that IHC Support Agencies have facilitated the links between families and other support services was difficult to ascertain in this evaluation, in part because families were often confused about the roles of different people and different organisations. However, the IHC Support Agencies appeared to be increasingly taking on the role to find information, refer, and connect families to appropriate respite, family support, and disability services.
Is IHC reaching the families that need it?
Application of the IHC eligibility criteria
The eligibility criteria are being used to target IHC to the families in each of the three cohorts. It appears to be easier to apply the criteria to geographically isolated families and families working non-standard hours, with reports of greater consistency of the application of these criteria across the IHC Support Agencies. There is more inconsistency reported in relation to the application of the criteria, and understanding what is in scope, for families with complex and challenging needs. One situation that services report there being inconsistency about, is determination of IHC eligibility for children whose parent(s) has a mental illness. There are still some views by services that IHC Support Agencies do not always apply the criteria consistently, and that sufficient information to make this assessment is not always fully obtained through communications between families and IHC Support Agencies.
The allocation of places
According to the evaluation data collections, the allocation of places across states and services is working and is meeting the needs of families. There being allocations for each jurisdiction is not constraining access to IHC anywhere, with the allocations having been adjusted periodically since July 2018 to take account of the demand for IHC. The process of allocating IHC places from IHC Support Agencies to services is reported to have improved since the transition phase, although some services consider that the record-keeping and reporting about places allocated to their service has added to their administrative workload.
The renewed focus on early childhood education and care (and children falling through the gaps)
The introduction of the revised IHC program saw a renewed focus on the requirement that IHC is for ECEC, and not for other activities. Overall, it was considered that having a focus on ECEC was a positive development, but there were some challenges in operationalising what the boundaries on 'early childhood education and care' were in some circumstances. While there continue to be some families wishing educators could do tasks beyond those covered by the IHC National Guidelines, this appears to largely be handled through educator and service processes.
The focus on ECEC led to concerns about gaps in service provision for children, particularly those children (or families) with additional or complex needs, whose care needs may not currently be met by IHC or the NDIS. The introduction of the revised program certainly did disrupt the services for these families. The IHC Support Agency role included supporting these families, including connecting them to other services as appropriate. This was a significant focus early in the transition. Even in recent evaluation data collections, some families were still accessing IHC because these connections had not been able to be made. They were kept on IHC rather than let them fall through the gaps.
IHC is temporary - IHC and mainstream care
The IHC program is intended to be temporary, which presumes that there will be some change in circumstance that would allow families or children to transition from IHC. This might be a change in child or family circumstances, or the increased availability of a mainstream care option. From the analysis of administrative data, it is apparent that many families using IHC are also using mainstream care, and the time of day patterns suggest that IHC for some children is filling gaps when mainstream care is not available. There is very strong evidence that transitions off IHC do occur for a reasonable number of children combining IHC with mainstream care at a point in time, no doubt indicating that there is a mainstream option that can be used by the family for at least some of the time. However, many children using IHC will not have a suitable mainstream care option, possibly due to remoteness from other services, or due to complex and challenging family circumstances. Families in this situation (and their services) sometimes expressed that having a process in place to facilitate their transition to mainstream care is inappropriate. Certainly, many families indicate that they do not understand the FMP review process that checks in on their continuing IHC needs in relation to potential mainstream options. The IHC Support Agencies have a role in making families aware of alternate mainstream care options where they exist, but there are many families on IHC for whom this will not be relevant.
Families receive quality child care from IHC services
Most families using IHC rate the quality of IHC highly, and they are largely satisfied with their educators. However, some reported a lack of checks and processes by IHC services to ensure educators are supported to deliver high quality care. The families themselves may not be well equipped to assess the quality of an early childhood education and care program, and this is an important role of educators and services if the focus on high quality early childhood education and care is to be maintained.
Affordability, fees and the hourly rate cap
With the changes to the IHC program and the alignment to the Child Care Package, the cost of IHC was expected to change for some families. Changes affecting the cost of care included the introduction of the family co-contribution and the family hourly rate cap. Together, these changes meant families eligible for Child Care Subsidy (CCS) but not Additional Child Care Subsidy (ACCS) were often paying more for IHC than they have paid in the past. The survey data and the administrative data showed clearly that for families using IHC, average costs of IHC increased.
There was, of course, some variation in experiences of affordability and cost. A high proportion of IHC families are on ACCS, and for them, their IHC costs are very low, or nothing for some. Further, some families report satisfaction with the costs of IHC, with some considering it an outlay that is necessary and worth the money. However, there were more often reports of families having reduced their use of IHC because costs were not affordable. Early in the transition to the program, some did not continue with the revised program because it was not affordable.
The family hourly rate cap
Families' IHC costs are determined by the service's charge relative to the family hourly rate cap, the amount of IHC used, and their ACCS eligibility or CCS percentage (as determined by the Income Test). The fee charged relative to the hourly rate cap contributes significantly to affordability, as it determines the amount of family co-contribution. The increase in the rate cap in January 2019 led to a significant reduction in costs to families, with the updated rate cap better aligned to the average fee charged, leaving a lower gap fee.
There continues to be concern over the adequacy of the family hourly rate cap in relation to wages for educators, particularly in relation to the days or times of day that educators often work and associated penalty rates. The rate cap being at the family, rather than child level, was subject to some criticism, as it was felt the family rate cap was unfair to those services providing IHC to large families (as the rate could not be adjusted appropriately to reflect higher care demands in those families, without resulting in significant out of pocket costs). But the analysis indicated that hourly fees were no higher in large families than smaller families, suggesting that having a family rate cap is no more likely to affect large families than smaller ones).
IHC service and educator issues
Educator qualification requirements
Workforce issues are having a significant impact on the delivery of IHC, with data from across the evaluation showing that the key constraint on the program at present is the lack of availability of appropriately qualified educators.
In general, the requirement for educators to be qualified at (or be studying toward) a Certificate III in early childhood education and care at a minimum, has been seen as a positive step for the sector, in terms of helping to address the quality of IHC. Nevertheless, there have been some differing opinions, particularly given the loss to the sector of some educators that families or services have considered to be able to work effectively as IHC educators without such qualifications. In part, this relates to the view that some IHC is provided at times or days that an 'early education' focus is not appropriate, and a pared back approach that does not rely upon educators having these qualifications may be sufficient. Other views related to the potential care provided by educators who are qualified in other fields, where a view has been put forward that a bridging qualification may be more appropriate, to allow them to make use of their other field of expertise without needing to make the financial and time commitment to gain the full early childhood and care qualification.
Other educator workforce issues
Another important workforce issue relates to families now accessing fewer hours of subsidised IHC. This has resulted in, for example, families seeking educators who will work fewer hours and/or split shifts. Such work is not always appealing to educators looking for full-time work, adding to the difficulties for services in terms of being able to supply the IHC needed by families as well as being able to find adequate and desirable work for educators.
There are also issues related to whether services engage educators as contractors or employees. Different services have different models. Contractor models are reported by services to be more financially viable, yet they appear to have more difficulties recruiting educators. Employee models tend to be more expensive for families, such that some families will opt to go on a waiting list for a service with a contractor model to avoid paying the higher fees of those using an employee model.
A significant issue impacting the workforce and the supply of IHC is the means of recruitment of educators. Particularly under the contractor model, services may ask families to find an educator themselves, such that if they are appropriately qualified, they can be signed up to deliver IHC through a service. This poses challenges for families who often do not feel equipped to find or recruit educators, especially if it also involves additional work through a contractor arrangement to set this up.
The potential income for educators is another workforce challenge. There was concern that the rate cap constrains educator payments, although this was alleviated considerably after the increase in the rate cap in January 2019. However, concerns remain for how appropriate the level of the cap is for IHC delivered at non-standard hours, when penalty rates would apply. Perhaps more importantly, though, educator income is an issue for IHC given the strong demand for short shifts of IHC, filling in gaps before or after mainstream care, for example. As such, educators' pay may be quite piecemeal, and is often reported to be insufficient. Many educators work in jobs as well as IHC, such that their availability for IHC work is likely constrained by other employment.
Service financial viability
Finally, a significant workforce issue relates to the services themselves, with service representatives expressing in surveys and interviews doubts about their own financial viability. This indicates the IHC sector is a particularly vulnerable one, such that impacts of any of the above workforce factors may be especially keenly felt. Having access to appropriate levels of support from IHC Support Agencies and IHC Support Agencies' promotion of IHC (to ensure continued demand for IHC) are important to help promote viability of the sector. Some of the issues that may be important to support the IHC services include: access to advice and training regarding workforce practices; help with means of recruiting and retaining educators; access to other forms of funding as appropriate; and consideration of impacts on service administrative workload.
The transition to the revised IHC program
A significant effort was made to transition families and services to the new arrangements through a transition process. But the transition was challenging for services as well as families. For families and services there was uncertainty about the rate of subsidy that could be expected and about how the eligibility criteria would be operationalised. Some families lost access to IHC because their IHC educator did not have the required qualifications. Many families had to reduce hours or drop out of IHC altogether because of the new arrangements. This resulted in significant challenges for some families, many of whom failed to find suitable alternative arrangements. Some of these challenges were inevitable and arose because of the changed structure and eligibility criteria of the IHC program, but others were due to issues within the transition process itself. Many stakeholders felt that the late introduction of IHC Support Agencies caused difficulties for the transition. This was especially apparent in the lengthy delays in determining the eligibility of families to receive IHC and the matching of families to service providers. This had negative impacts for families requiring care but not receiving it, existing families unsure as to whether they would receive ongoing care, and for IHC service providers who required sufficient numbers of clients to be viable.
Australian Institute of Family Studies
Jennifer Baxter, Mikayla Budinski, Megan Carroll, Kelly Hand, Cara Rogers and Jessica Smart
Social Policy Research Centre
Elizabeth Adamson, Megan Bedford, Megan Blaxland, Anna Jones, Paula Jops, Ilan Katz and Jennifer Skattebol
With input from other consortium members
Australian National University
J. Rob Bray and Matthew Gray
The Social Research Centre
This evaluation was commissioned by the Australian Government Department of Education, Skills and Employment (formerly the Department of Education).
The authors would like to acknowledge and thank all of those who participated in or assisted with this In Home Care (IHC) Evaluation. We especially acknowledge the important contribution of the families, educators and services, IHC Support Agencies and other stakeholders who took the time to provide input to the evaluation through interviews or through the completion of surveys.
We also acknowledge the helpful assistance of staff from the Australian Government Department of Education, Skills and Employment, including the In Home Care program team, and also the Evaluation Section team from the Approvals and Relationships Branch for their continuing collaboration, guidance and support.
This report was submitted to the Department of Education, Skills and Employment in October 2020.
Featured image: © GettyImages/PeopleImages
Australian Institute of Family Studies and Social Policy Research Centre. (2020). In Home Care Evaluation Report. (Research Report). Melbourne: Australian Institute of Family Studies.
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