Aged Care Legislated Review – Aged Care Matters
Table of Contents
1.Tell us about you
1.1What is your full name?
1.2What stakeholder category do you most identify with?
1.3Are you providing a submission as an individual or on behalf of an organisation?
1.4Do you identify with any special needs groups?
1.5What is your organisation’s name?
1.6Which category does your organisation most identify with?
1.7Do we have your permission to publish parts of your response that are not personally identifiable?
2.Response to Criteria in the Legislation
2.1Whether unmet demand for residential and home care places has been reduced
2.2Whether the number and mix of places for residential care and home care should continue to be controlled
2.3Whether further steps could be taken to change key aged care services from a supply driven model to a consumer demand driven model
2.4The effectiveness of means testing arrangements for aged care services, including an assessment of the alignment of charges across residential care and home care services
2.5The effectiveness of arrangements for regulating prices for aged care accommodation
2.6The effectiveness of arrangements for protecting equity of access to aged care services for different population groups
2.7The effectiveness of workforce strategies in aged care services, including strategies for the education, recruitment, retention and funding of aged care workers
2.8The effectiveness of arrangements for protecting refundable deposits and accommodation bonds
2.9The effectiveness of arrangements for facilitating access to aged care services
3.Other comments
1.Tell us about you
1.1What is your full name?
-
1.2What stakeholder category do you most identify with?
Relative
1.3Are you providing a submission as an individual or on behalf of an organisation?
Organisation
1.4Do you identify with any special needs groups?
Nil
1.5What is your organisation’s name?
Aged Care Matters
1.6Which category does your organisation most identify with?
Relatives and Residents
1.7Do 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
2.Response to Criteria in the Legislation
2.1Whether 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 2package.
Response provided:
Nil
2.2Whether 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
2.3Whether 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:
Nil
2.4The 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:
- the capacity of a person to contribute to their care or accommodation is assessed (their assessable income and assets are determined); and
- 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
2.5The 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
2.6The 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 contextequity 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
•people from lesbian, gay, bisexual, trans/transgender and intersex (LGBTI) communities.
Response provided:
Nil
2.7The 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 contextaged 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:
Nil
2.8The 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
2.9The effectiveness of arrangements for facilitating access to aged care services
Refers to Section 4(2)(i) in the Act
In this contextaccess 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:
Nil
3.Other comments
Response provided:
Our advocacy group,Aged Care Matters,is disappointed that "standards of care" have not been included in the scope of the Aged Care Legislated Review. There have been over 38 federal government enquiries into aged care since 1995. None of these enquiries included standards of care in their terms of reference.
Aged Care Mattersis a voluntary grassroots movement with 150 members (and growing). We are citizens who are deeply concerned about the quality of residential aged care services across Australia. Aged Care Mattersbegan after I publish the following 3 opinion pieces in The Age: (1) The Aged Care Gravy Train[1]; (2) We’re ignoring the needs of our ageing population[2]; and (3) Aged care providers seeking profit instead of residents' wellbeing[3].
The bipartisan ‘Living longer living better’ aged care reforms have decreased regulation and introduced a “consumer-driven market based system”. In aged care homes, the so-called "consumers" are often frail elderly people, many with dementia. How can an elderly person with dementia negotiate with providers let alone "drive" the residential aged care system?
Evidence indicates that the aged care reforms have benefitted providers[4]. However, qualitative data collected by Aged Care Matters indicates the aged care reforms have caused a decline in standard in aged care homes. The decline in standards is due, in part, to the decrease in staff-to-resident ratios. Unlike childcare centres, hospitals and schools, there is currently no federal legislative requirement for aged care homes in Australia to have staff-to-resident ratios or skill prerequisites.
234,931 people live in aged care homes in Australia.Of those, 83% are classified as requiringhigh care. Yetregistered and enrolled nurses now account for less than 27% of the residential aged care workforce, while personal care attendants (PCAs) make up 68%. Much of the hands-on care that registered and enrolled nurses once provided is now being provided by PCAs who aren’t adequately trained for the job.
Managers who are under pressure to meet their profit targets do so by employing cheaper and less-skilled PCAs rather than registered and enrolled nurses. However, the management of older people with complex medical conditions requires the skill of experienced registered nurses, supported by doctors, allied health providers and PCAs.
Some PCAs have as little as 5-weeks training. It is inconceivable that people with fiveweeks training are qualified to provide competent care, particularly when there is no registered nurse on duty to supervise them. Is it any wonder so many people with a relative in an aged care home have contacted Aged Care Matters with stories about inadequate personal care, neglect, and negligence?
Aged Care Matters believes federal legislation is urgently required to ensure that, at a minimum, aged care homes have one registered nurse on site at all times.
Furthermore, the aged care reforms have encouraged private equity firms, new foreign investors, and superannuation and property real estate investment trusts to enter the residential aged care market in large numbers. Aged Care Matters appreciates the importance of this investment into residential aged care. However, these businesses’ primary motivation is profits, not providing high standards of care for older people. In this competitive business environment, Aged Care Matters supports more regulation, not less.
The irony of the move towards a free market system in residential aged care is that private businesses rely on government subsidies for their profits.History shows us that rorting is rife when governments fund the private sector to deliver a public good. With the current arrangements – in which the providers do their own assessments for government subsidies – was anyone in government surprised that one in eight of 20,000 ACFI claimsaudited last year (2014-15) were deemed to be incorrect?
Aged Care Matters is concerned that the current funding model provides a financial incentive to classify residents as requiring a higher level of care. A member of the Executive of Aged Care Matterscomplained when she realised the aged care home had falsely claimed her father had Parkinson’s Disease, and related health deficits, to claim the maximum subsidy. She was told that the appraisers “must be able to trust the word of the health care professionals at the aged care facility”.This is not a “one-off” story. Aged Care Matters has evidence to indicate that it is not uncommon for unscrupulous providers to exaggerate the care needs of residents. It seems some providers classify as ‘’high care’’ as many residents as they think they will get away with.
In addition to those who game the system, providers are not bound to provide more staff or introduce services such as strength training, music or lifestyle programs that would improve residents’ quality of life when the resident has been reassessed as high care. Our evidence indicates that staff levels rarely change nor are extra services provided to the resident. An obvious question to ask is: Where does the money go?
Aged Care Matters supports in principle the introduction of fines to curb a growing trend of false claims for subsidies. However, a fine of $10,800 for providers who repeatedly make false claims is not large enough to discourage unscrupulous providers when the maximum subsidy per resident is $211.40 per day. An aged care home with 60 residents classified as high care receives $12,684 per day from the government. It is doubtful afineof only $10,800 will prove much of a deterrent when such profits are in the offing.
To improve standards of care in aged care homes, Aged Care Matters suggests:
- Mandated staff ratios;
- Better-quality training of PCAs;
- Meaningful accreditation standards;
- Compulsory Quality of Care Indicators;
- A more rigorous Aged Care Funding Instrument; and
- Appropriate government oversight (i.e. regulation)
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[2]
[3]
[4]According to the latest annual survey of aged care homes by Bentleys Chartered Accountants, the average profit before interest and tax increasing from $4497 per resident per annum in 2014 to $6278 in 2015.