The new cabin class system coming for Australia’s aged care
The newly introduced Higher Everyday Living Fee may unintentionally see aged care drift towards a two-class system, writes St Basil’s NSW/ACT CEO Diana Horvatovic.
There’s a quiet divide about to unfold in aged care homes across Australia – and it looks a lot like boarding a plane.
Some residents will move to the pointy end, getting the first-class experience of higher quality meals, more enriched lifestyle programs, better furnished rooms and greater dignity in daily living. Others, most likely those on pensions or with limited savings, will sit further back, excluded from the added extras because they can’t afford to pay.
The newly introduced Higher Everyday Living Fee (HELF) means providers can now charge aged care residents for bundled services that go beyond the minimum care standard – things like better food, more frequent cleaning or extra lifestyle activities.
Whilst the change is designed to ensure more transparency and give families more choice, it runs the risk of aged care drifting towards a two-class system where access to comfort and choice depends on what’s in your wallet.
At least on a plane when you’re squeezed into economy for a few hours you can take some comfort knowing your destination is the same. But for those in aged care we’re talking about a living experience which could be many months or years long that could be profoundly shaped by the class of ticket.
Access to outside excursions or music therapy shouldn’t be reserved for those who can afford to pay more. They’re essential components of wellbeing, mental health and dignity later in life.
They also put a huge burden on providers to explain and navigate the changes in an already shifting environment.
The HELF model sees residents with add-ons living alongside those without – each experiencing starkly different daily experiences under the same roof. How do we explain to a resident with dementia that they can’t attend a music activity because they haven’t paid for it? It also presents family members with a difficult choice for their loved ones who may feel guilted into choosing higher-cost packages to avoid a perceived stigma of second-class care.
For aged care providers, we’re also still trying to navigate changes to the care minutes which is the minimum amount of time our staff must spend with residents each day. One of the most frustrating realities of the requirement is that exceeding the minimum offers no financial recognition.
We may be delivering 230 or even 250 minutes of direct care per resident per day to meet the residents’ needs but our funding is capped at the government’s baseline. There’s no mechanism to reimburse the actual cost of delivering more than the mandated minimum. In effect, the more care we give, the more we lose financially. That’s a perverse outcome for a reform that’s meant to raise standards, as it penalises providers who go above and beyond.
Government policy must do better than this. It must do more than allow optional comfort. It should protect residents from structural and financial inequality and ensure all residents receive a meaningful quality of life, not just the lucky or wealthy ones.
The question remains as to whether this class system will genuinely enhance the lives of the residents in our care. Should the quality of life of our older Australians be dictated by their ability to pay for it?
Growing old shouldn’t mean slipping into irrelevance while others glide by with a better seat and a glass of wine.
If we truly value older Australians, then dignity, comfort and inclusion must be non-negotiable, not just available to those who can afford the upgrade.
Diana Horvatovic is the chief executive officer of St Basil’s NSW/ACT
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And how does this differ in concept with the current Additional Services regime.
I liked the author’s analogy to classes of travel in older Australians’ experience of tiered service levels in residential aged care, depending on capacity to pay. I think differences may be more visible in residential than in community.
The same comparison about affordability could also be made to community aged care (CHSP/SAH) although the tiers of fees could also be described as a penalty i.e. the more income you have, the higher the cost for one’s care at home.
The comparisons are helpful but also undeservingly penalise some groups of older people especially women (single, unpartnered) who simply wanted a better life and landed up in the part-pension, self-funded category.