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Tune recommends wide-ranging changes to further reform


Giving residential aged places directly to consumers, tweaking policies for offline residential care places, and temporarily reallocating unused places to home care packages are among the 38 recommendations in the final report of the five-year review of aged care reform.

Led by David Tune, the Aged Care Legislated Review evaluated the effectiveness of the 2012 Living Longer Living Better aged care reforms and made recommendations for future reform and aged care provision.

The government released the report around 4pm yesterday afternoon, the final day it could table the report in parliament.

The review found the reforms had been successful in moving toward a consumer demand-driven and sustainable system with some improvements significant such as the development of a consumer gateway and investment in the residential sector, but others including those seeking to increase consumer contribution less so.

It recommends further reforms in information, assessment, consumer choice, means testing and access that build on the LLLB and subsequent changes and create an environment where government can look at uncapping supply.

As has already happened in home care, the report recommends abolishing the Aged Care Approvals Round (ACAR) for residential care “as soon as possible” and instead assigning places directly to consumers within existing caps to take effect two years after announced.

Government should review how offline residential care places are managed with a view to implementing changes that maximise availability to consumers, according to the report.

It suggests government allow for the temporary reallocation of unused residential care places to home care packages among several measures to meet the well-known need for more Level 3 and 4 packages.

On this, the review also recommends government increase the proportion of high care packages within the existing home care ratio and introduce a level 5 package to support people with higher care needs.

The report is also calling for an immediate review of existing respite arrangements and another later to ensure equitable supply and access to residential respite after ACAR is abolished.

While the current aged care provision ratio has a target of operational aged care places for every 1,000 people aged 70 years and over, the review recommends changing the cohort to those aged 75 years and over and in doing so, consider whether a change in the mix of places within the new ratio is required.

Also in line with the new ratio it recommends government consider further opportunities for removing supply controls.

However, in the medium term, it recommends government continue to maintain control over the number and mix of residential and home care places.

Initial policy and funding response

When releasing the report, the government announced an additional 6,000 home care packages for older Australians with higher care needs within the existing funding envelope by converting the less popular lower level packages.

It also announced that the new national home care priority queue was available to consumers and released the home care packages program data report, which has shown the extraordinary wait times for home care packages (see more on that here).

Minister for Aged Care Key Wyatt said the government was considering the recommendations, however it has already dismissed two aimed at improving the financially sustainability of the aged care system through increasing user contributions (read that story here).

The government also announced a $20 million investment in the My Aged Care information system to improve public access, particularly in rural, regional and remote areas, and the chair of the workforce taskforce.

It said a detailed aged care workforce strategy will be produced by a multi-stakeholder taskforce chaired by Professor John Pollaers with $2 million committed in the May 2017 Budget.

Fees, and better integration

Elsewhere the Tune Review recommends changes to the basic daily fee in residential care including a requirement for providers to charge a minimum fee while allowing them to charge a higher fee to non-low means residents, with fees in excess of $100 to be approved by the pricing commissioner.

In recommending the role of the Aged Care Pricing Commissioner be retained, the report suggests increasing the trigger for an accommodation payment needing approval from $550,000 to $750,000, linking future maximum accommodation payments and median house prices and also including independent assessment on additional service fees and the uncapped basic daily fee.

The Bond Guarantee Scheme should also remain but reformed to ensure providers make contributions, according to the report, which is in line with ACFA’s advice to the review (read that story here).

The Tune Review made several recommendations to improve access including through enhancements to the My Aged Care platform, information-sharing between government and provider systems and new navigator and outreach services to assist consumers that have difficulty engaging with the gateway through existing channels.

The $20 million boost to My Aged Care announced by government targets improvements for assessors, health professionals and service providers along with clients in rural and remote areas and those with diverse needs.

The review also recommends government integrate the regional assessment service and aged care assessment team workforces, which should be independent of aged care providers and take on residential aged care funding assessment following the review of ACFI.

Elsewhere the report calls for the National Aboriginal and Torres Strait Islander Flexible Aged Care Program to be expanded, federal, state and territory governments and service providers to jointly review the Multi-Purpose Services Program, and government to review further ways of assisting the delivery of improved services to homeless people.

Follow Australian Ageing Agenda over the coming weeks for analysis and responses the review’s findings.

Information and reports from the review available here.

Related coverage

Government dismisses increasing aged care user-pay options

Home care data reveals 90,000 package shortfall

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