Aged Care Legislated Review – Office of the Public Guardian - Queensland
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?
State Government
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?
Office of the Public Guardian - Queensland
1.6Which category does your organisation most identify with?
Other
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:
The Office of the Public Guardian (Qld) has not seen a reduction in unmet demand for residential aged care. There is ongoing unmet demand especially for adults with complex needs (such as complex health issues - HIV or dual diagnosis, or adults with behavioural issues). In a number of cases, it has taken months to find an aged care placement for an adult with complex needs. Many nursing homes continue to refuse residents on the grounds that the ‘adult would not be a good fit for the facility’ resulting in the adult remaining in hospital for over three months. The Office of the Public Guardian also continues to see waitlists for available home care packages, in particular level 4 packages. This impacts on the ability for an adult to return home from hospital and for some clients this can mean the difference between an adult returning home, or being forced to prematurely enter into aged care.
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:
If further steps are taken to change aged care to a consumer driven model, there needs to be consideration as to how adults with cognitive impairment will be supported to access services. This issue is acknowledged in the recently released Australian Law Reform Commission’s (ALRC) discussion paper, Elder Abuse at page 196 (paragraph 11.23). At present, aged care services in Queensland require a formal guardian to be appointed for adults with cognitive impairment, which is extremely restrictive and intrusive on the adult’s life and the Public Guardian should only be appointed as a substitute decision maker of last resort. Instead, most adults with cognitive impairment can be adequately supported with the use of informal support and networks, including advocacy agencies and these avenues should be promoted. Again, this is discussed at page 244 of the ALRC’s discussion paper, Elder Abuse. The Office of the Public Guardian (Qld) supports the ALRC’s proposal at 11-8 which states that aged care legislation should provide that agreements entered into between an approve provider and a care recipient cannot require that the care recipient has appointed a decision maker for lifestyle, personal or financial matters. Consideration also needs to be given to creating specific safeguards and quality assurances to ensure those adults with cognitive impairment are receiving the services they are paying for.
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:
The Office of the Public Guardian (Qld) raises the following in relation to the effectiveness of arrangements for protecting equity of access to aged care services for different population groups:
- Adults who are financially disadvantaged continue to experience less choice in aged care placements and are often required to share rooms due to their inability to pay for their own, private room.
- There is limited choice of culturally appropriate aged care facilities for Aboriginal and/or Torres Strait Islanders or for culturally and linguistically diverse people, with very few appropriate aged care facilities in South East Queensland.
- There are issues with equity of access to aged care services in rural or remote areas. As there are fewer aged care placements in rural or remote areas, adults can be left in their home with an inadequate level of home care package. Alternatively, the adult has to move far away to enter into an aged care facility. This is inappropriate as it impacts upon a families’ ability to maintain a regular connection with the adult.
- Aged couples also face problems with both being able to access appropriate placements in the same aged care facility so they can remain together.
- Aged adults currently in incarceration or on forensic orders (or under the Dangerous Prisoners (Sexual Offenders) or legislative equivalents) experience problems with access to aged care services and placements. The Office of the Public Guardian has a number of clients that are able to leave prison accommodation, mental health facilities, or Queensland Health facilities and require placement in an aged care facility. However, as they cannot obtain an aged care placement due to their complex medical and/or behavioural needs, this cohort of the population must inappropriately remain in the prison or health institutional setting.
- As outlined above, there are issues with equity of access to aged care services for adults with cognitive impairments as many aged care facilities will not accept the adult unless a formally appointed substitute decision-maker is appointed (for example the Public Guardian). At present, aged care services in Queensland require a formal guardian to be appointed for adults with cognitive impairment to accept the offer of an aged care placement. Appointment of a formal guardian is extremely restrictive and intrusive on the adult’s life and the Public Guardian should only be appointed as a substitute decision maker of last resort. Instead, most adults with cognitive impairment can be adequately supported to express their views and wishes about accepting a placement, with the use of informal support and networks, including advocacy agencies and these avenues should be promoted and accepted by aged care providers.
This issue is discussed in further detail at page 244 of the ALRC’s discussion paper, Elder Abuse. The Office of the Public Guardian (Qld) notes the ALRC’s relevant proposal at 11-8 which states that aged care legislation should provide that agreements entered into between an approve provider and a care recipient cannot require that the care recipient has appointed a decision maker for lifestyle, personal or financial matters.
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:
The Office of the Public Guardian does not have any comment on the effectiveness of arrangements for protecting refundable deposits and accommodation bonds. However, it is important to raise that the requirement for these to be paid means that some adults are being prevented from entering into aged care at the appropriate time, when service providers determine that home based care is no longer adequate. For example, some family members and/or powers of attorney will not sell the family home (either because they reside in it, derive an income from it, or do not want to sell what might have been their future inheritance) to pay the deposit or bond. Family and attorneys consider the deposit/bond a burden that forces the family home to be sold and consider that such a sale is not in line with the wishes of the adult.
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:
The My Aged Care portal is not user friendly and is time consuming. The Office of the Public Guardian has attempted to contact My Aged Care to make referrals, but is redirected to go through the portal. The portal does not have sufficient options to choose the right relationship with the adult. Upon making a referral, it can then take many days to receive a return call where the same information provided in the portal is then then repeated in the phone call. In one instance, despite speaking with a representative from My Aged Care and requesting notifications to be put on the file due to the adult’s cognitive disability, an ACAT assessment went through without consultation with the Office of the Public Guardian (formally appointed as substitute decision maker for the adult). The Office of the Public Guardian discovered the ACAT assessment more than two months after it had occurred, despite being the primary contact for the adult with cognitive impairments. Additionally, because of these access issues, some adults with more mild impairments are forced to seek formal assistance which could result in a formal guardian being appointed. This is an inappropriate response to dealing with access and usability issues.
3.Other comments
Response provided:
The Office of the Public Guardian (Qld) is aware of a number of young clients with cognitive impairment that are forced to reside in aged care facilities as there is no age appropriate care or housing placements. The Office of the Public Guardian strongly urges the Commonwealth Government to provide adequate funding to provide practical, dignified alternatives to aged care for young people.
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