Funding Cuts: You Decide!

I gathered these thoughts together the day the Royal Commission into Aged Care Quality and Safety was announced – Sunday 16 September 2018 if my memory serves me well.

This information gathering was in response to the first question of the Prime Minister when making the announcement. The question was around the alleged $1.2 billion cuts to aged care.

Folks, I get it – there have been many cuts from both major sides of our Australian Government over a number of years. And there has been continuing growth in aged care funding based on population related indices etc. But what is galling around these discussions is that the major political parties and the bureaucrats seem unwilling to give simple, transparent responses to questions about these matters.

The recent Federal Senate Community Affairs Committee Hansard from 24 October 2018 make for mind numbing obfuscation around this very issue, with Opposition asking relevant questions, and Government, and Officers, all putting in their opinions, without any direct answer to what should be a simple question. This of course happens regularly at such Committees and is not confined to Aged Care. But this Australian is over it!

Why cannot our elected leaders and paid Officers answer simple questions and be held accountable for the policy and funding interventions they create into valued human service provision? We are projecting tens of thousands shortfall of residential aged care places by 2025 (ref 1) and now some 121,000 not provided with an appropriate level of community care packages short for older Australians already assessed by Government as needing community delivered aged care services. (ref 2).

Of that number, almost 57,000 had no package allocated. A discussion around the residential care funding issues can be found below. Parliamentarians prefer to support their side of the debate, but the Department of Health and Federal Parliamentary Library advice really does paint a helpful and insightful picture into this matter of “funding cuts”.

I shall leave it to you to decide. But if you were to ask me, a return to the residential aged care sector of the $1.2 billion in ACFI funding cuts, along with a requirement for providers to sign off on their direct care staff ratios, would provide, on average, an immediate return to a ratio of 3.2 Hours per Resident per Day (“HRPD”), and begin a move to the 4.3 (or from my research, 4.2) HRPD as soon as possible.

Recent changes:

ACFI subsidy expenditure has been growing more quickly than expected. The Australian Government believes the unexpected growth in claims cannot be explained by an increase in the frailty of residents, although many in the industry disagree. In order to rein in expenditure, around $1.7 billion in savings over four years were included in the Mid-Year Economic and Fiscal Outlook 2015–16 (MYEFO) and the 2016–17 Budget, to be achieved through changes to ACFI scoring and subsidy indexation. Despite these savings, residential aged care expenditure was still forecast to grow at around 5.1 per cent per annum.” A summary of the impact of these two difficult measures can be found below – https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Librar y/pubs/rp/BudgetReview201617/AgedCare 

“Rein in expenditure.” Is that not just a euphemism for a cut to funding?

You decide. Nice chatting!

References:

Ref 1- Aged Care Financing Authority, ‘Sixth report on the Funding and Financing of the Aged Care Sector’ (Aged Care Financing Authority, 2018), 36.

Ref 2 – Department of Health, ‘HOME CARE PACKAGES PROGRAM Data Report 4th Quarter 2017 – 18’ (Department of Health, 2018), Table 7, 11.

Image: Courtesy Business News.

Shaky Foundation: Where is residential care today? 

I have been tracking various residential aged care data and some interesting comparison figures for two decades now since the Aged Care Act came into being in 1997.Please allow me to say right upfront – collecting relevant and appropriate data from indices can be difficult and not always truly comparable.

The data represented below is purely to make us think, and perhaps identify for providers at least, why it seems to have become so much more difficult to maintain a high quality residential aged care service today to people with more pressing multiple morbidities than ever before.

Clearly, by comparison, our funding foundation has worsened over the past twenty or so years.

Residential Aged Care Comparators:

Some description of the various indices follows:

Continue reading “Shaky Foundation: Where is residential care today? “

Report and Recommendations – Joint Select Committee on End of Life Choices

I have been working back in the aged care sector since August 2016, and as many of you know I have been the Chief Executive Officer of Braemar since March 2017.  A few weeks back I did seek comment from colleagues and visitors to my blog about these “end of life choice” matters.  Thank you to those who have pondered, commented, and otherwise contributed on these things.

Pain, suffering, and distress are existential.  The desire to end one’s own life is based on existential circumstances with perhaps the view that there is little hope for any future improvement in life’s outlook.  The majority Christian view still is that Christ offers hope for an end to all suffering, but that happens at the natural end of this life – not a life brought to early closure.  The endurance of pain and suffering can seem intolerable, and the grasp of hope seemingly so far away.  We must develop ways in which we can assist to bridge the perceived gap between the existential pain and future hope by how we manage our pain, symptoms, and suffering and sense of loss; yet contemporaneously offer support to others afflicted by such suffering, grief and loss.

Continue reading “Report and Recommendations – Joint Select Committee on End of Life Choices”

Your Thoughts Wanted

Hi folks,

Two quite important matters are being discussed by parliamentary committees here in Western Australia over the next twelve months or so, and I seek your advice, attitudes, and thoughts on these matters.

The first matter, and also being discussed by the New South Wales and Victorian Parliaments respectively, is around “end of life choices”.

I seek your advice, attitudes, and thoughts about this important matter.

Continue reading “Your Thoughts Wanted”

Unfair Expectations?

I recently chaired an afternoon session for a “Law in Aged Care” seminar in Perth.  It was a very useful day’s focus on the myriad of interaction that aged care providers have with the law daily.  There can be matters associated with town planning, local government, occupational health and safety, fair work, accreditation and liability issues, and that might be just before morning tea …

In October 2017, the residential aged care sector reaches twenty years since the enactment of the Aged Care Act 1997 (Cth).  As I recall, for Western Australians it started on Monday 1 October being a public holiday Monday.  The then new Act was a mighty and useful change from the Aged and Disabled Persons Homes Act and the Health Act.  Whilst it has not all been plain sailing the Act pertaining specifically to aged care has, in my view, served Australia well.

Continue reading “Unfair Expectations?”

Nothing Changes?

This piece was published as ‘The Bones are Bare’ on Australian Ageing Agenda

I have been back working in the aged care sector for almost twelve months now – first on an interim basis with Baptistcare here in Perth, and for the past four months or so as Chief Executive with Braemar Presbyterian Care in WA.

One of the most common questions on my return to the sector is about the amount of change there has been in “aged care” since I left the sector back at the end of 2010.

One could say that the change has been enormous, with refundable accommodation deposits now part of residential aged care, and significant changes having been made to funding around client centred care in the community aged care sector.

On the other hand, one could quite calmly suggest that no great change has happened. After all, since I first entered the aged care sector back in 1982, we have had at least some fifteen (perhaps closer to twenty) Australian Government Ministers with responsibility for aged care services over the past thirty years. In that same period, we have had at least three major changes to the funding regimes that providers live with daily.

Continue reading “Nothing Changes?”