Maria Tomasic - The Royal Australian and New Zealand College of Psychiatrists

Ms Kerrie Westcott
Director, Legislation Section
Transition Branch Ageing and Aged Care Division
MDP 550
GPO Box 9848
CANBERRA ACT 2601

By email to:

Dear Ms Westcott,

Re: Proposed amendments to the Aged Care Act 1997

The Royal Australian and New Zealand College of Psychiatrist (RANZCP) welcomes the opportunity to provide a submission to the proposed amendments to the Aged Care Act 1997. The RANZCP congratulates the Commonwealth Government’s commitment to improve aged care facilities and the ten year aged care reform program, which includes increased funding. The RANZCP is committed to improving health outcomes of older Australians, and would like the Department to refer to the RANZCP Position Statement Priority must be given to investment that improves the mental health of older Australia (which can be found here: http://www.ranzcp.org/Policy-and-advocacy/Aged-Care.aspx).

The RANZCP supports the principle of increased flexibility in care and supports the establishment of a Quality Council providing it is created in a manner that makes it effective. The RANZCP is a leader amongst Australasian medical colleges in developing partnerships with consumers, family and other carers in respect to excellence of service provision. The RANZCP supports the principle of consumer directed care. However, in regards to aged care, the Department should ensure that sufficient safeguards are put in place for people with a mental illness. This should not be limited to those with dementia but also people who have a mental illness during periods when their capacity is impaired. It will be essential to ensure that evaluation of this strategy includes this vulnerable group.

The RANZCP has reviewed the proposed amendments and congratulates the Department on the proposed amendments in terms of patient outcomes. However, it should be acknowledged that some care recipients will be further out of pocket and that some residential aged care facilities (RACF) are likely to suffer from decreased funding. The RANZCP supports the removal of distinctions between HLC and LLC approvals. This should allow aged care assessment services (ACAS) to be more efficient and speed up patient transfers.

There are serious concerns that Australia may have already left action too late to prevent a decline in mental health care for older people [1]. The RANZCP is deeply concerned that the ambiguities regarding responsibility for psychological support or mental health treatment in residential aged care continues to prevent appropriate planning by either aged care or mental health services. The depth and range of the RANZCP’s concerns can be found in the Position Statement.

In reviewing the proposed amendments, although the Act appears to state that people may require Aged Care support due to psychological needs, associated materials do not appear to support this in practice. In particular, the following appear to discriminate against people with mental illness. The Aged Care Funding Instrument (ACFI) data shows that approx 50% of people have a diagnosed mental illness on entry to a RACF [2].

In reference to Section 41.3, residential care does not provide care in a psychiatric facility and appears to be interpreted as if long term psychiatric hospitals are a modern modality of mental health care. The National Mental Health Strategy, supported by Commonwealth and state and territory governments, has clearly identified that this not the case, with the possible exception of a very small number of highly disabled individuals. Mental health care should be provided in the person’s home, including an aged care facility, if this is required. The results of this dichotomous thinking have been highlighted and condemned by the recent New South Wales (NSW) Ombudsman's report [3].

The updated guidance regarding assessment of mental illness was a welcome improvement upon the previous guidance, but it still emphasises that the person must have primarily an aged care related disability [4]. Not only does this appear to contradict the inclusion of psychological need as a reason for requiring residential care in the Act, it would also appear to contribute to RACF providers' lack of preparation to meet these needs. In the context of the Aged Care Act, reference to psychological need, and ACFI data showing up to 50% of people entering RACF having mental illness, this appears discriminatory and detrimental to the well being of older people [2]. This is compounded further by, reportedly due to the reference to meeting psychological needs in the Aged Care Act related documents, the apparent exclusion of people either with dementia, or living in RACF, from access to Medicare funded psychological services other than those provided by psychiatrists and GPs. The cost of an appropriate course of such treatment makes funding from within the residential aged care subsidies impossible.

Recommendations

·  People with mental illness should be recognised as a special needs group in residential aged care

·  There is a need for urgent joint reform involving Commonwealth and state departments responsible for aged care and Mental Health to ensure that the older person's needs for appropriate housing and support are met, whether they have mental illness or not.

·  People living in residential aged care, as well as those living with dementia, have unimpeded access to Medicare funded mental health care.

The RANZCP believes these concerns must be addressed by the Department to ensure that the Aged Care Act satisfactorily delivers better aged care policies and programs.

If you would like to discuss any of the issues in regard to this letter, or would like any further information, please contact Dr Anne Ellison, via or by phone on (03) 9601 4918.

Yours sincerely

Dr Maria Tomasic
President

cc: Mr Andrew Peters, CEO, RANZCP.

References

1.  National Health and Hospitals Reform Commission, A Healthier Future for All Australians Final Report, 2009: Canberra.

2.  Department of Health and Ageing. Aged Care Fundings Instrument Reports. 2012 5 December 2012]; Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acfi-march-2012#04.

3.  NSW Ombudsman, Denial of rights: the need to improve accommodation and support for people with psychiatric disability A Special Report to Parliament under s.31 of the Ombudsman Act 1974, 2012: Sydney.

4.  Department of Health and Ageing, Assessment and approval of people with mental illness, Australian Government, Editor 2010: Canberra.

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