There’s no question that Australia’s Aged Care sector needs to be overhauled and there is a massive disconnect between what the Australian public expects, and what is being delivered. Attwood Marshall Lawyers Senior Associate and accredited Aged Care Professional, Debbie Sage, reviews the current state of this ever-expanding and often overlooked area of our society.
Australia’s aged care sector, which includes not-for-profit, private, and religious operators, are devising a huge PR campaign to attempt to change the conversation and win-over Australians.
Adam Connolly from Apollo Communications, who was the former Daily Telegraph political reporter and senior media adviser to John Howard, has been given the task of changing the reputation of aged care providers, and in doing so wants to expose the federal government’s shortcomings.
Prior to the COVID-19 outbreak, the aged care industry was already under scrutiny with the Australian Government announcing a Royal Commission into Aged Care on 16 September 2018.
COVID-19 has had a horrific impact on the elderly with a large percentage of fatalities linked to aged care facilities.
The aged care system
In Australia, there are various services available to people as they enter their senior years and look for assistance in order to continue to live independently, or for accommodation to suit their personal and health care needs.
The Aged Care sector is set to expand to meet the needs of the growing older Australian population. This means providing 125 places or packages (in residential care, home care and restorative care) per 1,000 people aged 70 or older in 2021-22. Although most of these places are allocated to the residential care segment, the home care segment is growing rapidly reflecting consumers’ preference to remain at home for as long as possible.
Aged care services available include:
- At Home Care (The Commonwealth Home Support Programme and Home Care Packages)
- Residential Aged Care (also referred to as nursing homes)
- Privately Funded Care (Retirement Villages)
Julie Lockeridge, Principal Adviser and Aged Care Specialist at Lockeridge Financial Advisory, understands the difficulties faced by older people who are changing their living arrangements, and the impact this can also have on adult children and other family members.
“Age is inevitable. It comes to all of us if we are lucky. What distinguishes us is how we plan for it. A key element in the plan is the appropriate aged care. The most important thing to understand is that there is no right or wrong way: it really comes down to what you feel is right for you,” said Ms Lockeridge.
As an experienced accredited financial planner in this complex area, Ms Lockeridge highlights the need to obtain advice from qualified practitioners when considering a transition to care. ‘It is imperative families plan ahead and get good advice before making decisions. It can make a huge difference to the financial bottom line of the people going into care.”
The Royal Commission into Aged Care
The Royal Commission into Aged Care Quality and Safety is expected to provide a final report by February 2021. This investigation will oversee a wide range of issues relating to the quality and safety of aged care services, and the future demand for these services throughout Australia.
Up to July 2020, there were 9,301 public submissions and 6,321 phone calls to the information line providing information and evidence to the Royal Commission, with the most common concern reported being staffing issues, isolation and unmet needs of residents.
Submissions on the impact of COVID-19 and in response to the matters to be examined in the hearing on COVID-19 closed on 4 September 2020. These submissions provide valuable insight and lessons to be learnt in order to better respond to future pandemics, infectious disease outbreaks or other emergencies.
Aged Care funding has historically been a contentious issue
Last week, Health Minister Greg Hunt announced the Federal Government will be boosting aged care funding by $563.4 million to expand on support programs for providers in response to COVID-19. This takes government support for aged care to over $1.5 billion since the pandemic began.
A breakdown of how the additional funding will be allocated
- $101.2 million for aged care preparedness to:
- provide COVID-19 infection control online training
- provide emergency response teams, remote locums and a surge workforce, and reimburse expenses incurred due to COVID-19 cases
- provide access to telehealth consultations
- provide onsite pathology services
- fund the Commission to work with providers on improving infection control.
- $444.6 million to ensure continuity of the aged care workforce including:
- $234.9 million for a quarterly COVID-19 ‘retention bonus’ to be paid to care workers in residential and home care
- temporary increases to residential care subsidies; supplements for rural, remote and homeless service providers; and home care package subsidies
- $70.2 million in emergency COVID-19 grant funding for Commonwealth Home Support Programme (CHSP) providers to fund services such as shopping and meal delivery for people in self-isolation and
- $12.3 million for additional My Aged Care staff to handle COVID-19 enquiries.
- a further $50 million for Meals on Wheels and similar CHSP service providers, and a further $9.3 million for My Aged Care, to help older Australians access food and meals
- $205 million for a one-off COVID-19 payment for residential aged care providers recognising additional costs incurred during the pandemic.
- a one-year extension to the Business Improvement Fund, which gives short-term grants to residential aged care providers at risk of severe financial difficulty.
Funding recommendations from The Aged Care Royal Commission
The Aged Care Royal Commission has recommended that a 1.01% tax increase (or 0.89% increase in the Medicare levy) would fit within the amount Australians have indicated they are willing to pay for high-quality care.
A report released on 07 September 2020 stated the funding would go towards a wide range of reforms including:
- Mandatory four-staff staffing levels in aged care homes
- Mandatory Certificate III training for personal care workers and a national personal care worker register
- Uncapping the number of Home Care Packages
- Improved access to GPs, psychologists, dentists and rehabilitation
The new system would require 30,000 new full-time jobs to be filled plus another 50,000 workers just to meet growing demand.
To attract staff, the report recommends raising pay rates to be equivalent of hospitals with a 5.5% a year increase for nurses and other skilled jobs in aged care.
Mistakes made at a Federal level
The Aged Care Quality and Safety Commission is the national regulator of Australian Government-funded aged care. The Commission approves providers; assesses and monitors services for compliance with the Aged Care Quality Standards; takes action (such as imposing sanctions) to resolve non-compliance; and handles complaints.
Reports show the aged care homes that were hardest hit in Victoria were given a clean bill of health and near perfect compliance ratings by the federal regulator only months before COVID-19 wreaked havoc.
Fifty homes across Melbourne have recorded deaths during the pandemic. The highest death tolls were at St Basil’s in Fawkner where over one third of the facility’s residents died.
Despite compliance from the regulator being granted for most homes, the coronavirus pandemic has exposed significant holes in infection control measures for many facilities.
However, not all facilities were compliant prior to the pandemic, and an ABC analysis also found that one in three of the Victorian nursing homes with clusters of more than 50 cases were found to be non-compliant with at least one quality standard during their most recent audit by the commission.
The standards that were not met included:
- ensuring residents had safe and effective personal and clinical care
- demonstrating effective management of risk
- minimising infection risks
A need for change
Last December, amendments to the aged care legislation amendment (new commissioner functions) bill 2019 were put forward to:
- Improve transparency and accountability around complaints
- Staffing levels
The Coalition voted against all amendments.
If these amendments had gone through, they would have been a game changer for the aged care sector.
It is this information that needs to be carefully considered when people are looking into aged care services and researching facilities. Standard of care should be transparent, with people able to enquire about:
- The number of staff working at the facility
- Qualifications and training of staff
- Historical data on patient incidents including prevalence of pressure sores, weight loss and malnutrition, falls, infection rates and admissions to hospital
- Prior complaints made against the facility
Unfortunately, this information is considered “commercial in confidence”. What this means is this type of disclosure identifies information that if disclosed may result in damage to a party’s interests or trade secrets.
What to be aware of when considering aged care services
Putting the reputation of facilities before the wellbeing of residents needs to change. It is imperative to research and speak to an Accredited Aged Care Professional when you, or a loved one, are transitioning into aged care. Glossy brochures and advertising from aged care providers are not going to tell you everything you need to know when making this important decision.
“Aged Care choices are complex, making the wrong decisions can come at a high price both emotionally and financially. Some of the important financial decisions people are faced with are often highly emotional too. In deciding what is the right choice, you need to consider a range of factors that include the ability to access the care you want, whether or not care will be affordable, the impact on pension entitlements, different aged care costs, potential tax consequences and the effect on estate planning”, said Ms Lockeridge.
When considering what options best suit your health and wellbeing now and into the future, you will want to gain insight and information regarding:
- The aged care industry
- Different choices available in aged care accommodation
- Aged Care Assessment Team (ACAT) and home care
- Centrelink and Veteran’s Affairs
- Residential care fees and what you need to understand when entering a Retirement Village or Aged Care Facility Agreement
It is always recommended to visit facilities you are considering multiple times so that you can see first-hand the type of environment residents are in and the way the staff operate.
Clients and family members should also seek the right advice from experienced professionals in this area when making important decisions about your living arrangements and care requirements prior to signing any agreements. There are complex legal, financial planning, Centrelink, and taxation consequences of the transition to care. Getting the right advice and structuring your affairs properly can make a huge difference to your financial bottom line as well your legal and financial security.
“Getting the right financial advice when planning for a move to aged care can help you understand the cost by identifying the fees and charges that will apply, evaluating the affordability of aged care in the short and long term, calculating your pension entitlement and other benefits. You can be provided with a comprehensive analysis of your options so that you can make informed choices,” said Ms Lockeridge.
Financial arrangements vary widely and need to be considered in light of your own financial circumstances. There is no substitute for quality aged care advice.
Wills and Estates Senior Associate, Debbie Sage, is an Accredited Aged Care Professional having completed the Accredited Aged Care Professional Program through Aged Care Steps. The program provides a platform to develop the skills and confidence needed to create solutions for accessing and funding care plans that best meet the needs of clients.
Attwood Marshall Lawyers supports the elderly and pushes for change
Ms Sage is passionate about the aged care sector and experiences these problems with clients and their families on a daily basis. She believes the federal government should accept full responsibility for the sector and provide appropriate legislative and regulatory frameworks to ensure operators of care facilities have adequate training, resources and funding to deliver a high standard of care to residents. No doubt the findings of the Royal Commission will highlight these issues. The issue will be whether the federal government accepts the recommendations and acts accordingly.
UPDATE! Friday 2 October, 2020
Attwood Marshall Lawyers welcomes the recommendations announced by The Aged Care Royal Commission calling on the federal government to immediately take action as part of the investigation of the response to COVID-19 in aged care.
“These recommendations are a welcome start to changing the landscape of Australia’s aged care sector and to move quickly to address the ongoing impact COVID-19 is having on aged care residents, their families, and professionals working in the aged care industry. We are pleased that the Morrison government accepted all six recommendations yesterday and begin to take responsibility for their role in this crisis. We can only hope the government will continue to address these critical issues and develop an appropriate plan to deal with COVID-19 and future health crisis’ in Australia’s aged care sector,” said Ms Sage.
The six recommendations the Aged Care Royal Commission have made include:
- the Australian Government should report to Parliament by no later than 1 December 2020 on the implementation of these recommendations;
- the Australian Government should immediately fund providers that apply for funding to ensure there are adequate staff available to allow continued visits to people living in residential aged care by their families and friends;
- the Australian Government should urgently create Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to people in aged care during the pandemic. Any barriers, whether real or perceived, to allied health professionals being able to enter residential aged care facilities should be removed unless justified on genuine public health grounds;
- the Australian Government should establish a national aged care plan for COVID-19 through the National Cabinet in consultation with the aged care sector;
- all residential aged care homes should have one or more trained infection control officers as a condition of accreditation. The training requirements for these officers should be set by the aged care advisory body;
- the Australian Government should arrange with the States and Territories to deploy accredited infection prevention and control experts into residential aged care homes to provide training, assist with the preparation of the outbreak management plans and assist with outbreaks.
The Royal Commission have identified a number of lessons to be learned from the experience of the aged care sector’s response to COVID-19 in the first eight months of 2020. These six recommendations are intended to better prepare the aged care sector, its staff and its residents for any future outbreaks of COVID-19. Longer-term reform of the aged care sector will be the subject of the Royal Commission’s final report to be released in February 2021.