Author
-
John Dicer
Expert Advisor
Published
21/02/2023
When The Royal Commission into Aged Care Quality and Safety was founded in 2018 it galvanised unprecedented attention on Aged Care and the systemic issues contributing to substandard care for some of the most vulnerable in our community.
It brought into sharp focus the fundamental flaws in a critical yet failing sector at a time when increasing demand for its services was coming under extreme pressure—driven by an aging population, declining standards of care and strain on funding as well as the weight of a skills shortage.
In my role as the then Aged Care Pricing Commissioner and Government Representative on the Aged Care Financing Authority, I watched with keen interest as the hearings and submissions played out over the subsequent years before the Final Report.
The Royal Commission into Aged Care Quality and Safety handed down its Final Report in February 2021, containing 148 Recommendations.
Since then, the previous Government responded in the Budget in May 2021 with a $17.7 billion package of reforms to be introduced over 5 years through what are known as the 5 Pillars (page 6). Additionally, legislative reform has also started and has continued under the current Government.
And while these initiatives demonstrate steady progress to the reforms stemming from the Royal Commission, the changes are broad ranging and may take up to 10 years to completely transform the Aged Care system.
As Prime Minister, Anthony Albanese has stated on the passing of the most recent legislative reforms, “The Final Report of the Aged Care Royal Commission was titled ‘Care, Dignity and Respect’. Those three little words are the least we can provide our older Australians who built this country. With today’s passage of the Royal Commission Response Bill the Government has taken a significant step to ensure older Australians receive the care, dignity and respect they deserve.”
But this is just the start of the journey to reform, as noted by the Minister for Aged Care, Anika Wells, “The task to reform aged care will take years but this bill (The Aged Care and Other Legislation Amendment (Royal Commission Response) Act 2022) passing is a critical first step.”
But real, incremental progress is being made. Major reform initiatives essential to ensure the Aged Care system and its change agenda must be seen as innovative, technologically adept, financially sustainable and that provides a workforce environment for people to work in and remain in for the long term.
These first major changes include:
AN-ACC: this new residential funding model commenced on 1 October 2022 and replaces the Aged Care Funding Instrument. The Australian National—Aged Care Classification (AN-ACC) will initially be administered by the Department of Health and Age Care and will be taken over from 1 July 2023 by the Independent Health and Aged Care Pricing Authority (IHACPA). IHACPA will also take over the costing for home care in the next couple of years. The costs are determined through an activity-based funding model are designed to capture the true costs of providing care.
Care Minutes: as part of the costing studies each aged care resident must be provided with 200 minutes of care which time includes the time of a Registered Nurse (RN). The time can be provided by RNs, Enrolled Nurses, and Personal Care Workers (PCWs). The time must be direct care. This may challenge some Providers who do not adopt a RN model but rely heavily on PCWs to deliver the care, particularly in dementia specific care environments. The issue here is that the measure is a quantitative one and not a measure of quality.
Star Ratings & Quality Indicators: the residential Star Ratings system is designed to support consumers make informed choices about their care needs. The Star Ratings will be based on 4 categories which comprise:
- Consumer Experience;
- Service Compliance and Accreditation;
- Care Minutes; and
- Quality Indicator Program
The Star Rating System commenced in December 2022 and will be an interesting experience for residential providers as they face a new world of on-line comparisons and ratings. One issue is to ensure that the system compares like with like and not homes that are distinctly different; for example, some home specialise in dementia others do not. The system will require refinement over the next few years with a similar rating system to be introduced for Home Care.
New Aged Care Act: the new Aged Care Act will be drafted to “underpin the fundamental and generational reform across aged care.” The new Act will legislate the 5 Pillars; establish mechanisms for eligibility for care, funding arrangements and regulation; support greater choice and transparency; and set out a system of governance and accountability and standards. The aim is to have an aged care system founded on needs, dignity, care, and respect. The Act is due to commence on 1 July 2023 and will be underpinned by a new Regulatory regime.
National Aged Care Advisory Council (NACAC) and Council of Elders (CofE): NACAC provides expert advice to Government on the implementation of the reforms and that the needs and expectations of senior Australians, their families and carers are met. The CofE provides advice from senior Australians to Government on a range of matters including quality and safety; needs of senior Australians and their right to be treated with dignity and respect. Further governance measures recently announced in the October 2022 Budget are the appointment of an Inspector General of Aged Care as well as a new and independent Aged Care Complaints Commissioner.
Workforce & pay: the most crucial issue facing the sector is workforce and pay/conditions. There is a commitment by the Government to fully fund any pay increase handed down by the Fair Work Commission. The workforce is under enormous strain through COVID pressures and workers are leaving the sector for better paid jobs elsewhere. The supply of labour right across the spectrum from domestic entrants to foreign workers must be expanded otherwise issues with quality and safety will continue to occur. The cost to Government of funding any pay increase is estimated at $4b. This issue and others raise the serious question of future funding and sector sustainability and the vexed subject of user contributions which are always a hard political sell.
What we are striving to create is an Aged Care system that is built on care and safety, is truly consumer directed and promotes a wellness and reablement philosophy.
In my own close experience in the sector and appreciation for what needs to change, I have a view that as a country, we need to paint a picture of what we want our Aged Care sector to look like—what will it be like for my grand-parents, parents and even myself when we reach that stage of life when we need some help from the Aged Care system.
We need to constantly have that picture in mind, but equally importantly be clear as to how we will get there, what are the policy and program decisions that we need to make, how will the system be funded and financed and how do we have a workforce and governance structure that is vibrant and sustainable. In short as the Prime Minister has said—a sector built on the values of Care, Dignity and Respect!
The 5 Pillars are:
- Home Care: supporting senior Australians who choose to remain in their home;
- Residential Aged Care Services and Sustainability: improving and simplifying residential aged care services and access;
- Residential Aged Care Quality and Safety: improving residential aged care quality and safety;
- Workforce: supporting a growing and better skilled workforce; and
- Governance: new legislation and stronger governance underpinned by a new consumer focussed Aged Care Act.
