Aged Care Legislated Review – Community Vision
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?
Service provider
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?
People who are financially or socially disadvantaged
1.5What is your organisation’s name?
Community Vision
1.6Which category does your organisation most identify with?
Aged Care Provider
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:
In WA there continues to be a number of people who need to access higher support aged care packages and therefore, the oversupply of Level 1/2 packages still remains an issue and will continue to remain an issue while there is no bilateral agreement on the movement to CHSP. That said, generally people will be willing to accept a lower level of package while waiting for a high needs package to become available, but the costs now are prohibitive meaning that often paying for services is more cost effective than going through means testing in order to accept a higher level of payment for what is considered to be an inferior product in the consumers eyes. The degree to which people will accept a package when they are financially disadvantaged will be borne out by the higher numbers of referrals for high care packages and the backlog of people wishing to enter assisted places in residential care as high needs. We will also see an increase in social isolation particularly in regional and remote areas as people shy away from losing pension and making additional contributions to have minimal service deliver due to the increasing cost burden on providers to pay staff and travel costs.
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:
Understanding that there is a finite amount of funding available, the ability to be able to access a care package will be determined by the ability or want of a person to pay the care contributions deemed essential a part of the process. It is therefore, unnecessary in my opinion to continue to cap the number and availability of home care places, as people will self- select based on their ability to pay and the availability of a package. In residential care, for those who do not have the means, there will need to be an increase in the number of government assisted places available, as the number who will select away from paying a co-contribution and being means tested, will mean that they will present with co morbidity issues at the ED and will subsequently need residential care places. The mix of residential will need to be adjusted to reflect the need for an increased number of high care places. Making home care packages more affordable will give the ability for providers and consumers to work better together to allow people to remain home for longer.
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:
The consumer demand model is more effective in controlling the funding. As indicated previously, albeit consumers will be assessed as needing care, they will self-select based on their ability to meet the co-contributions required and the ability to live without the additional 17.5% of their pension. Albeit they can apply for hardship, this may detract from the attractiveness of the package and therefore, as a result they will choose to go with the cheapest option and not necessarily the best option for their needs. The supply driven model gives government the control over the number of places and funding it uses and in controlling the budget would make more sense. However, as indicated above, the ability to pay is likely to regulate the market for them.
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:
The means testing arrangement is currently flawed! The number of incorrect assessments a person gets, the conflicting information around what is and is not included and the overall ability of someone to pay the fees determined, will essential mean that many will not access necessary services, which in turn will mean that people will be homeless and without security presenting at local hospitals with costs which will exceed those that would have been paid had the means testing accurately reflected a person’s capacity to pay. The means testing disadvantages those who have no means to make a payment or contribution and have higher care needs, but capacity to live in the community. Having clear concise guidelines which allow for greater clarity and understanding and clear communication to the people who are being assessed is essential. Some dispensation for those who are financially disadvantaged is also a component which needs to be reviewed as many will not be able to afford to meet their needs for daily living. Already in the City of Joondalup and Wanneroo we are seeing an increase in the number of homeless people as a result of insufficient funding and many are presenting at our health campus with significant issues, which increases the pressure on the health system to deliver cost effective services. For those whose only access to services is via Centrelink supports, there needs to be a different approach taken.
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:
Not being in residential care I can only comment from the comments which have been made to me. Effectively residential care will become the domain of those with cash and those with high care needs. Those who sit in the middle will not have access to residential care, as their capacity to meet the costs will be prohibitive. This is already evidenced in the number choosing to remain at home and requesting higher services. This demand will become an unmet need and subsequently will impact mainstream hospital services.
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:
I am not seeing any preference for services from those in the local community from diverse backgrounds other than through organisations linked to the community. That said, I do believe that all providers are aware of the need to provide services to these groups and that there is a general willingness to assist people to access services particularly in community supports. More could be done to help more access services and to understand what this means and what is available.
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:
There is a huge demand for skilled workers in the community and this is not going to reduce. This industry is not seen as “sexy” from a career perspective and many stumble into the industry through lack of affinity with their present employment or as a result of having children. The bias is still towards older females and the alignment of the funding with the costs of services creates a disconnect, with the role being paid at the bottom of the wage scales. With CDC many will opt to run their own private enterprise and contract services back, which will create a free market for labour and increase costs as a result to employers to retain. The cost of administration for CDC is more onerous with those costs needing to be incorporated into the unitised costs of services. Management is now being scaled back to reduce the costs, which leads to accountability issues when there are problems and more self-service type models are becoming the future. With many in remote areas and those financially disadvantaged not having access to the internet or to computers, this prohibits their ability to become a care worker or if a consumer, ability to access a service. Some incentive is required which will reward and recognise people who work in this area for their services through education programs which allow them to up-skill or through strategies for recruitment and retention aligned to performance mechanisms of the overall organisation are essential for retention of key workers. The rate that the private market will pay those available through the modern awards creates a divide for those who can pay and those who can’t.
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:
N/A
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:
With the advent of the My Aged Care Gateway, much of the communication to community has fallen to providers. Many providers do little in this space to communicate with consumers about their ability to access services and many don’t have internet access. The changes which have occurred for the main part in WA have had little airplay and many are not aware that they need to be ACAT assessed or what this means. The first time they generally hear the term is when in hospital. ACATS also are at different levels and will often provide conflicting information and generally do not have a great understanding of the implications for the consumer, leaving much to the providers. They often provide misleading information to consumers as a result. Much more needs to be done in WA to educate the ACAT teams on how to communicate effectively with consumers and also to ensure that they are not bias towards any particular organisation when releasing their referrals. More education is also required for consumers so that they are aware of the means testing, how to access, the process etc., and where to go. It is only those who are educated or who have been part of the system through families that generally have an understanding of what it means and how to go through the process.
3.Other comments
Response provided:
While we are in agreement that CDC is the way forward and that generally people should be in control of their own wellbeing and funding, there is a large education component which is still not evident. Many people will self-select away from support through financial disadvantage and this will ultimately lead to an increase in hospital ED presentations later in life. As a result people will be staying in hospital for longer. It is preferable to start some earlier interventions which will enable many to remain home for longer with minimal supports in place and this gap is an unmet need. We are of the opinion, that through early education and early access to lower level support, consumers can begin to understand the system better and begin that preparation for what is needed later in life. By early education, we can help eliminate some of the concerns and prepare people for the means testing approach and also the interventions which will be available to them. Overall we feel we are on the right track with CDC, but there is some tweaking still required for us to be able to make this work efficiently and to benefit those who are at a financial disadvantage.
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