A golden opportunity for change?

The ACCV Congress Q&A panel (L2R): Matthew Flinton; Bill Forwood;  Bill Appleby; Ben Feather; Prof Tracey McDonald

By Yasmin Noone

Just over two months ago, the sector hailed the release of the Living Longer. Living Better aged care reform package. A united front of aged care organisations and advocacy groups sung the federal government’s praises as if reading from the one songsheet, as press releases welcoming the golden opportunity for change flowed in fast.

But, it seems, a few of the tables are turning. With more time to do a few calculations and consider the fine print in the reform package, some aged care advocates are now questioning their initial reaction to the 20 April announcement. Others, meanwhile, are shouting discontent from conference rooftops.

Last week, AAA attended the Aged and Community Care Victoria (ACCV) State Congress in Melbourne. One of the most interesting conference sessions was the Q&A panel on day one (Thursday 21 June), where six industry experts presented their thoughts on aged care reform. Panel commentary varied from positive to negative and debated whether the aged care reform package received really is an “opportunity for change”. Here is just a taste of what was said.

Bill Appleby, CEO, Jewishcare:

Mr Appleby provided the first comment of the panel session by saying that the popular phrase about reform, “opportunity for change”, omits a word: “missed”. It should be “missed opportunity for change”, he told delegates.
 
He said the reform package should also be called “Living Longer. Scratching to survive”.

“On 20 April, all the sector stood united by the announcement. The volume of press releases received [all spoke of] ‘amazing’, ‘courageous reform’.

“We thought, how fantastic is that?…And then we get down and have a look at the detail. There are not a lot of details and what detail there is – that we’ll get $500 billion over five years – that is a drop in the ocean. It’s not a lot given the ageing demographics.

“There are more negatives in the package than positives.

“…From my point of view, the changes are dire.”

Mr Appleby specifically spoke of the ‘clawback’ of the Aged Care Funding Instrument and the impact it will have on capital arrangements. He said those providers which are now at breaking point will break and those who are doing well could be pushed close to having to refinance.

“My concern is that in nine days time [July 1], we will have changes forced upon us, as policy on the run.

“…In my view, nothing has changed. Supply is actually controlled, demand is controlled and prices are still controlled.

“This reform package represents nothing more than what we’ve already got…so if we want real structural reform we’ll have to move to a new market.”

Tracey McDonald, Professor of Ageing, Australian Catholic University:

Prof McDonald said the impact of the reform package “is much greater than we anticipated”. But conceded that it was designed “to be tweaked and will change as it needs to be changed”.

However, she said, recent government talk about providers price gouging and rorting the system via the ACFI was unfair. 

“If the [ACFI] tool was faulty and there were loopholes, then we’d use it,” she said. “I don’t think that is gouging. That’s just using the system to get what you need to do, done.”

She referred to the importance of a cost of care study as without one, there is no way of knowing what it really costs to care for older people.

However, Prof McDonald added, structural reform is wider than just the aged care sector. Health reform has been ongoing however better integration between the aged and health care sectors is needed.

Prof McDonald mentioned the federal Opposition’s “worrying” silent reaction to the reforms, and asked that the government (current and future) makes “considered moves rather than political ones”.

She winded up her comments with a final say on the future shift towards community care. Prof McDonald said she warns against returning to a time, like in the 70s, where care for people in their own homes was relatively “hidden, unpaid, unsafe and unacknowledged”. She therefore requested that the sector starts discussing specifics about the move to community care, so as to avoid a similar fate in future.

“It’s something we need to do now. We need to start the ball rolling on the debate on this.”

Bill Forwood, strategic counsel at CPR Communications, and former member of the Victorian Legislative Council

Referred to as the ‘glass-is-half-full’ panel spokesperson, Mr Forwood said the reform package does present an opportunity for sector-wide improvement.

“We’ve come a long way in the last five years,” Forwood reminded the audience.

Firstly, he said, the ageing portfolio is now a cabinet position. And as far as the Minister for Mental Health and Ageing, Mark Butler, is concerned, “we’ve never before had an articulate advocate in the cabinet…A least he is out there pitching”.

The fact is that that “never in Australia has there been a report implemented completely once handed down”. So the government was never going to fully implement the recommendations of the Productivity Commission’s Caring for Older Australians in the form of Living Longer. Living Better.

“We are starting a process…Sure it’s not perfect and sure, things need to be changed. But never think the public sector understands you. And bureaucrats understand you even less than politicians do…”

Mr Forwood recommended that the sector continue to advocate their needs, with one voice, and articulate the case for further reform to bureaucrats and politicans of all political persuasions.

It’s a matter of …”getting the message right, the evidence right and articulating the position, flat out now”.

“No government wants aged care to fall apart. No Opposition wants to come into government …and [inherit] a system that is falling apart.”

Ben Feather, director of policy and senior legal advisor, Bupa Care Services:

“There are some positives out of the reforms,” Mr Feather said.

“The funding for dementia is welcomed. The focus on community care is welcomed…The changes to low and high care bonds is a good thing. And opening up extra services and amenities to the consumer is a positive.”

But, Mr Feather said, there are also negatives with the package which should be seen as “unintended consequences”.
 
Regarding ACFI: “The modelling we’ve done is different to the modelling the department has done. And they are not sharing the assumptions of their model.”

Mr Feather therefore urged the sector to, once again, “come together as one voice” to advocate for further details and reform.

Brian Haratsis, managing director, Macroplan:

In a presentation made earlier in the conference, Mr Haratsis said the reform package received was “an insult for an outcome”.

“You’ve got problems already…These problems are going to compound.

“The sector is experiencing major wage pressures…the cost base is going to increase and the government is not going to give you any more money.”

While on the panel, Mr Haratsis said “instead of arguing over a few millions,” the sector should be arguing for “an industry restructure”.

“The big issue is industry restructure. [The sector should argue] that the funding is not good enough and demand that new structures be put in place.”
 
And, he concluded, a restructured system should include a scheme which allows people to “pay forward” for their care – like health insurance, they would pay for their aged care while they are well, earning an income and able to afford the expense.

Matthew Flinton, director of Legal and Policy, BUPA Care Services (UK)

Mr Flinton said similar demographic changes are happening in ageing populations across the world.

“Challenges in aged care are international,” he said.

“It doesn’t make any difference if you’re Australian, British or Spanish.”

But, Mr Flinton conceded, Australia’s current system is “better than ours as it drives a public understanding of how aged care should work”.