Aged Care Legislated Review – NSW Ministry of Health
Table of Contents
1. Tell us about you 2
1.1 What is your full name? 2
1.2 What stakeholder category do you most identify with? 2
1.3 Are you providing a submission as an individual or on behalf of an organisation? 2
1.4 Do you identify with any special needs groups? 2
1.5 What is your organisation’s name? 2
1.6 Which category does your organisation most identify with? 2
1.7 Do we have your permission to publish parts of your response that are not personally identifiable? 2
2. Response to Criteria in the Legislation 3
2.1 Whether unmet demand for residential and home care places has been reduced 3
2.2 Whether the number and mix of places for residential care and home care should continue to be controlled 4
2.3 Whether further steps could be taken to change key aged care services from a supply driven model to a consumer demand driven model 4
2.4 The effectiveness of means testing arrangements for aged care services, including an assessment of the alignment of charges across residential care and home care services 5
2.5 The effectiveness of arrangements for regulating prices for aged care accommodation 6
2.6 The effectiveness of arrangements for protecting equity of access to aged care services for different population groups 6
2.7 The effectiveness of workforce strategies in aged care services, including strategies for the education, recruitment, retention and funding of aged care workers 7
2.8 The effectiveness of arrangements for protecting refundable deposits and accommodation bonds 8
2.9 The effectiveness of arrangements for facilitating access to aged care services 8
3. Other comments 10
1. Tell us about you
1.1 What is your full name?
-
1.2 What stakeholder category do you most identify with?
State government
1.3 Are you providing a submission as an individual or on behalf of an organisation?
Organisation
1.4 Do you identify with any special needs groups?
Nil
1.5 What is your organisation’s name?
NSW Ministry of Health
1.6 Which category does your organisation most identify with?
Other
1.7 Do 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
2.1 Whether 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 2 package.
Response provided:
Home Care Packages
Substantial unmet demand for level 3-4 packages is being reported across rural, regional and metropolitan areas of NSW. For example, in the Inner West of Sydney home care providers maintain waiting lists that are 12-18 months long and in the Hunter New England area there is a vast under-supply across all geographic areas.
The shortage of level 3-4 packages often results in clients who are approved for level 3-4 packages taking up level 2 packages until higher level packages become available.
The NSW Ministry of Health has identified that there is variable availability of level 2 packages across different parts of NSW. For example in the Illawarra Shoalhaven area, it is reported that there is an adequate supply of level 1 and level 2 home care packages as they are considered to be less value for money compared to Commonwealth Home Support Program (CHSP) service fees. In the Inner West of Sydney, it is reported that package providers do have level 2 packages available at times, often due again for reasons associated with cost.
There is a need to improve the currency and accuracy of the register of available home care packages on My Aged Care. According to one NSW Health service consulted, the register is not always updated or indicative of the actual availability when the provider is contacted.
Residential aged care
The NSW Ministry of Health has identified varying levels of unmet demand for residential aged care. In the mid-North Coast of NSW, for example, residential care places are variable in availability with periods where there are sufficient places and times where there are no available places for some weeks. The trend anecdotally is that places are becoming harder to find. In the Hunter area, NSW Health services note that clients are mostly able to access a residential care vacancy, but this may not be in the facility or location of choice.
Payment of bonds was raised as a barrier to accessing residential aged care due to the limited number of concessional places. According to one NSW Health service, when attempting to secure permanent Residential Aged Care, individuals who are unable to pay large bond on entry, appear to be “unattractive” to care providers, as are individuals with challenging behaviours associated with dementia.
2.2 Whether 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:
Home Care Packages
Within NSW Health there is some support for freeing up restrictions on government control of the number and mix of home care packages. The advantage of this approach is that there may be a possibility that freeing up controls would allow for the development of more flexible and responsive services.
Safeguards however will need to be put in place to ensure equity of access for special needs groups, particularly homeless people and people living in remote areas, as without this, providers will focus on areas that are more profitable.
It is understood that mechanisms to assess unmet demand will be available from February 2017 when home care package waitlists will be managed through My Aged Care and the National Prioritisation Queue for Home Care Packages.
Residential Aged Care
The NSW Ministry of Health considers that it is not necessary to control the overall number of Residential Aged Care places however, as with Home Care Packages, safeguards must be put in place to ensure equity of access of vulnerable client groups, including people living in rural and remote communities and homeless people. This also includes ensuring adequate numbers of concessional places for people who are financially disadvantaged. It is also important to ensure that unintended perverse outcomes are also guarded against, such as all concessional places only be offered in less desirable locations, requiring consumers to relocate large distances. If safeguards are not put in place, over time it is likely that the number of these places would continue to be more limited.
2.3 Whether 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:
NSW Health supports, in principle, a consumer demand driven model for home care packages, however, notes that to be successful, the consumer needs to be well informed and able to advocate for their needs. Currently this is not the case for the majority of consumers. Consumers are still very unclear on what services are available and how to access services. To ensure the success of a consumer driven model, a greater emphasis on education of consumers, families and key referrers such as general practitioners is required.
There are specific concerns about clients who do not have the capacity to make decisions without support, making them more vulnerable. It is necessary to ensure that there are sufficient Commonwealth funded advocacy services to assist vulnerable people access the appropriate level of care.
One of the risks of moving to a consumer demand driven model is maintaining the viability of service providers, particularly in rural and regional areas, which would impact on consumer choice. Calculating and maintaining appropriate staffing levels can be difficult under this model and it may lead to increasing casualisation of staff. There is also the risk of services reducing staffing in case there are fewer clients, therefore reducing the service’s ability to address the need of the consumers. Safeguards therefore need to be put in place to ensure ongoing accessibility of services in remote areas.
Consideration could be given to exploring other models that might suit more remote areas, where there are high service delivery travel costs.
2.4 The 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:
o the capacity of a person to contribute to their care or accommodation is assessed (their assessable income and assets are determined); and
o 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 NSW Ministry of Health supports means testing for residential aged care facilities. However, the process involved in means testing can cause confusion to consumers and delays, including for those moving from hospital into residential care.
The current fee structure for services in the home (CHSP and home care packages) is not balanced or equitable. The fee structure does not provide an incentive for consumers to move through the system from lowest level of support to highest levels of support as their needs increase, contributing to blocks at every level.
For example, CHSP services become full and unavailable because consumers who otherwise would move to a package to meet care needs elect to stay in the CHSP system, as it is usually better value for money and as, for some, a home care package is not affordable. This contributes to newly assessed consumers who would benefit from basic help at home not being able to access services.
As each level of home care package attracts the same fee (17.5% of the single aged pension), this also discourages the consumer from wanting to accept a package at the lower level (Level 1- 2).
Similarly, consumers with a home care package level 4 may be reluctant to access residential care due to the costs involved or their lack of understanding of these costs. This means that there is less movement at the high package level – another block in moving consumers through the system.
A fee structure review as part of Increasing Choices in Home Care may be warranted. It is however essential for any such review to structure fees so that people on lower incomes can afford to access services.
2.5 The 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:
Although residential aged care providers are required to advertise their accommodation prices, the actual cost for an individual consumer is not known until he/she has undergone the means testing process. This creates confusion for consumers.
In relation to the provision of ‘extra services’, there is confusion around what can be included. There is anecdotal feedback of the misuse of this charge. Therefore clarification is required by the Commonwealth Government stipulating what are to be considered “extra services.” Compliance should be monitored through quality assurance processes.
2.6 The 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 context equity 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:
The NSW Ministry of Health considers My Aged Care to be a barrier in some instances to equity of access to aged care services for special needs groups.
In some cases, My Aged Care contact centre staff are unaware that some population groups have specific eligibility arrangements. Examples provided by NSW Health service providers include My Aged Care staff not knowing that Aboriginal people are eligible for aged care supports from the age of 50 and not understanding that Department of Veterans’ Affairs clients are eligible to supports.