The government has raised the prospect of a new national advocacy service for aged care clients, but the existing state-based agencies are being backed by key stakeholders in arguing for the status quo – with some improvements.
The march towards a consumer-led, deregulated aged care market – in which seniors have more control over services, but also pay more of their own money – has prompted a Federal Government review of the publicly-funded services that advocate on seniors’ behalf.
Currently, advocacy services are funded under the Commonwealth Home Support Program and the National Aged Care Advocacy Program (NACAP).
The government has said the review will inform the design of a future advocacy program for all users of residential aged care, home care and home support.
In a discussion paper released in mid-August, the Department of Social Services canvassed the development of a national framework to guide a consistent approach to aged care advocacy, as well as options for a new service structure.
These options included:
- the creation of a single national, centralised aged care advocacy service with jurisdictional offices
- the retention of the existing nine state and territory-based advocacy services (one in each state and the ACT and two in the NT) or
- the creation of smaller, regionally-based providers.
While regionally-based organisations might better respond to local need, it could create a loss of national consistency and possibly higher costs, the department said in the discussion paper.
Push to keep current model
But the nine state-based advocacy agencies that are currently funded under the NACAP argue that the best option for creating a nationally consistent and flexible end-to-end aged care advocacy program is to build on the existing model.
“The current advocacy services have a high level of knowledge and expertise in aged care and CHSP service delivery in each jurisdiction with a detailed understanding and experience in working with the relevant legislation and service standards,” said Marilyn Crabtree, CEO of the Aged Rights Advocacy Service in South Australia.
“Some of these agencies have been funded for 25 years plus, so there is already in place a trained and experienced advocacy workforce seasoned in providing independent, individual advocacy services to older people and their families across Australia,” Ms Crabtree told Australian Ageing Agenda.
Each of the nine agencies had highly developed networks that included consumer organisations, carers organisations, service providers, special needs groups such as CALD and LGBTI, government agencies and statutory authorities like the Aged Care Quality Agency, Ms Crabtree said.
Her counterpart in NSW, Russell Westacott of The Aged Rights Advocacy Service*, said the state agencies welcomed the review, as a means of having the current model improved.
Mr Westacott said the agencies formed their own national entity, the Older Person’s Advocacy Network (OPAN), to solidify their state-based work, provide capacity building and act as a conduit between themselves and the Federal Government.
“We think that with the amount of money we get through the NACAP, the advocacy organisations are pretty nimble and do a very effective job,” Mr Westacott told AAA.
He acknowledged that the services’ reach outside the capital cities could be improved, and believed the government should consider modest but flexible resourcing options, such as allowing agencies to cohabit with existing service providers in key regional areas.
Ms Crabtree argued that the “end-to-end advocacy program” being sought by government was already three quarters built, as seven of the nine OPAN agencies were currently funded to provide both NACAP and CHSP advocacy support.
“It only remains that funding for Victoria and Central Australia needs to be provided along with improved funding for NSW,” she said.
Similar view among stakeholders
The advocacy agencies’ push for the current state-based system has support from several key stakeholder groups, such as carers, seniors and providers.
While most support the government’s move towards a national framework, with clear definitions and guidelines around aged care advocacy, they are against the option of moving to a centralised, national advocacy service.
“Retaining the current structure of separate jurisdiction-based organisations would continue to be the most efficient aged care advocacy service model,” Carers Australia said in its submission to the review.
Similarly, Aged and Community Services Australia (ACSA) concluded that the current model provided national consistency with state-based flexibility.
“Members report that they have respect for the current NACAP services and that the current model works well to support consumers while they maintain a good relationship with providers,” ACSA said in its submission.
National Seniors said that the state-based model allows room for flexibility of services and increased access, while limiting administrative costs.
Additional, tailored funding
While endorsing the current state-based system, almost everyone has views on where it can be improved.
The advocacy agencies said the department needs to appoint a secretariat, which could be established with a “small allocation of additional funding”, to formalise their OPAN network and act as a high-level resource.
Mr Westacott said the secretariat could be compiling and analysing the data periodically sent to the Commonwealth by the nine agencies, thereby gaining an understanding of what’s going on in every state and territory.
The top three aged care advocacy issues in NSW, for example, were the agreement for residential aged care and consumer directed care, financial issues and care fees, he said.
Given the projected increase in demand for aged services, Mr Westacott also argued that the state services should be funded as a percentage of total government spend on aged care. “As aged care grows, in line with the ageing population, there would be increasing demand for advocacy services, putting further pressure on our services,” he said.
He also said the funding provided to each state service needed to better reflect the demographic and geographic realities of that region, given some agencies have more aged care facilities in their jurisdiction than others.
Similarly, there was not a level playing field between states regarding the proportion of special needs groups in each region. Indigenous, CALD and LGBTI communities often take more time and resources to successfully build relationships in, Mr Westacott argued.
One significant area that the review was very quiet on was the issue of elder abuse and advocacy relating to it, according to Greg Mahney, CEO of Advocare, the NACAP service in Western Australia.
“The Federal Government has shown very little interest in funding any elder abuse activity and it’s time they stepped up to the plate to provide more support,” Mr Mahney told AAA.
Mr Mahney argued that it made no sense to exclude elder abuse from the review, considering the overlap between these issues and those likely to arise in aged care.
“Think of the impact on the independence, health and wellbeing of people who are getting aged care services if they’re being abused by their relatives,” he said.
The Federal Government ought to fund the advocacy agencies nationally to deliver a uniform approach to elder abuse, “because currently there’s a range of different approaches, each state has a different level of support,” Mr Mahney said.
Also missing from the review was the issue of systemic advocacy, which several believe is a great oversight. While the NACAP funded agencies provide individual advocacy, there is certainly a need for a formal mechanism to provide information about the trends and systemic issues arising, said Ms Crabtree.
Mr Westacott agreed about the importance of systemic advocacy, but argued it should not be the role of the state advocacy services to lobby government on these issues.
“That should happen through a separate agency. Our role is to provide services, as one-to-one advocacy organisations. I think most of the advocacy organisations around the country are happy to feed into Council on the Ageing and report some of the problems we see,” he said.
*From 24 November TARS will be renamed the Seniors Rights Service
An extended version of this report appears in the current edition of Australian Ageing Agenda magazine (Nov-Dec 2015 issue).
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