Budget wishes: providers highlight remote funding, HCP uptake    

New funding streams to ensure the viability of rural and remote aged care services are among the measures aged and community care providers would like to see in the forthcoming Budget.

In just under two weeks, the Treasurer Joe Hockey will hand down the Federal Budget 2015-16, setting out the government’s priorities and policies.

Last year’s Budget was broadly welcomed by the sector, with the return of $1.5 billion from the axed workforce compact, although there were some unexpected and unwelcome measures, such as the axing of the payroll tax supplement, saving $652 million over four years (an issue which providers continue to lobby over).

This week, Australian Ageing Agenda presents a two-part report looking at what sector stakeholders are hoping to see in this year’s Budget.

Among the issues being raised are improved funding for rural and remote aged care services, greater certainty of funding, and support for the sector to meet its workforce needs.

Today we feature the views of aged and community care providers. On Friday, our concluding report brings you the views of consumer and professional groups.

Viability of rural, remote services

Several aged care providers operating in rural and remote areas said the Budget should provide greater funding to ensure the viability of services in these regions.

Lee-ann Irwin, CEO of the Whiddon Group, which operates across metropolitan, regional, rural and remote NSW, said there was a need for government to partner with providers working in rural and remote areas “to develop sustainable solutions to support services operating in these areas.”

She said this partnership and support was “vital to ensure the continued operation of remote services and equitable access to care for older people, regardless of where they live.”

“As a provider currently operating three services subsidised by Whiddon in some of NSWs most remote regions (Bourke, Condobolin and Walgett), we believe that older people should not be required to leave their community or home to access aged care services and we recognise

that connections and quality of life are often based around living in a familiar community,” Ms Irwin told AAA.

Robyn Batten, executive director of Blue Care, a major provider with services in many remote locations, said her organisation was hoping to see “recognition of the financial challenges of providing services in rural and particularly very remote areas of Australia.”

While Blue Care welcomed the increase in the viability supplement in last year’s budget, it did not go far enough, she said. “The very significant costs of service provision in remote Australia, including to indigenous elders, requires a different funding model to ensure the sustainability of these services,” said Ms Batten.

Ray Glickman, CEO of Amana Living in Western Australia, also said that “greater viability supplement support for rural, regional and remote Australia was urgently needed.”

He said Aged and Community Services WA has initiated a reform helpdesk to assist small and regional members deal with the rapid pace of change. “Specific support for peak bodies, rather than consultants, to help organisations manage change would therefore be money well spent,” Mr Glickman told AAA.

The need for new funding to support rural and remote areas was also highlighted in the budget submission by Aged and Community Services Australia. The peak body called for “alternative funding models that reflect local need to ensure availability and sustainability of services in regional and remote areas.”

The challenges facing rural and remote aged care were also raised directly with MPs and politicians by a group of 20 CEOs during two days of pre-Budget lobbying in March. As AAA reported, the MPs were told about the need for new funding arrangements for these services. “The sooner we begin that dialogue the better, because it is only going to get worse,” ACSA CEO Adjunct Professor John Kelly told AAA at the time.

Uptake of HCP across the levels

Another issue raised by providers is the apparent inconsistent uptake of the new home care packages across the four levels, with many providers reporting vacancies in the lower level packages, Level 1 in particular, while there is reportedly huge demand for the high level packages.

Paul Sadler, chief executive officer, Presbyterian Aged Care NSW & ACT, said the government needed to work with the sector to resolve “some of the difficulties” around the income testing of home care packages, as this has been attributed to the poor uptake.

“There is some emerging evidence of falls in home care package occupancy and up to 40 per cent or more of prospective clients refusing to take up packages when assessed as having to pay an income-tested fee,” Mr Sadler told AAA.

“ACSA and UnitingCare, supported by the National Presbyterian Aged Care Network, have been expressing concern about this since before the fees came in last July, with a particular concern being the steep phase-in for part pensioners. This may have an impact on Federal Budget outcomes, as resolving it could involve reducing the fee take somewhat to improve uptake. In the long term, though, it could reduce financial impact on other parts of the system, such as hospital or residential care admissions,” he said.

Similarly, the uptake of packages was raised by CEOs during the pre-Budget lobbying in March.

Adjunct Professor Kelly said ACSA had been “pretty insistent and consistent with reporting that, and it needs to be looked at.” He said the impact of means testing and co-contribution was “people voting with their feet and we’re seeing vacancies in Levels 1 and 2.”

The concern was that seniors who did receive the care they need would end up in acute care at $1,500 a day. “There are some real consequences that need to be examined.”

On the availability of packages, Mr Glickman said there was an urgent need for the expansion of Level 4 packages in home care.

Still on community care, Mr Sadler also said he hoped the government would wind back the cut to the Commonwealth Home Support Programme growth projections, which was contained in last year’s Budget.

“With unmet need still evident in some parts of the system, cutting this program back to growth only in line with the ageing of the population effectively means some people will continue to miss out on services in perpetuity. Even a modest rise to 4-4.5 per cent growth would be a better outcome than the 3.5 per cent contained in last year’s Budget, compared to around 6 per cent previously,” said Mr Sadler.

Funding certainty through collaboration

More broadly, several stakeholders said they wanted to see greater certainty in long-term funding of aged care, achieved through a constructive approach with government.

The Whiddon Group’s Ms Irwin said: “More than anything, the aged care sector requires a collaborative relationship with the government to ensure a stable funding environment so that providers can make informed and sustainable decisions to meet future demands. This relationship is based around communication and a partnership with the sector to ensure consultation before changes are made that will have a negative impact on the quality of service provision, such as the withdrawal of the payroll tax supplement for private providers.”

Similarly, Patrick Reid, CEO of Leading Age Services Australia, said he hoped for certainty and stability of future funding for the sector “to enable stakeholders the fiscal headroom to undertake and implement meaningful restructuring of the industry in order to meet demand.”

Mr Reid highlighted the “estimated $31 billion of investment needed over next decade to meet growing demand” and said instability in government funding streams presented “a sovereign risk that may minimise opportunities to attract the required levels of investor interest, as we can be sure that investment will not be substantially from government.”

“Only $1.6 billion was estimated for new building, refurbishment and upgrading work in the last 12 months which in real terms will only contribute marginally to the 78,000 places needed in the next eight to 10 years for residential care, let alone what is required for home care infrastructure and delivery,” he said.

Mr Reid also called for a collaborative approach: “LASA has been clear that co-design is key to government and industry realising reforms that will enable future sustainability of the aged care system. In order for co-design to be real there needs to be stability of government funding to allow confidence from the sector, lenders and investors to drive innovation and growth.”

RSL Care acting CEO Luke Greive said his organisation would like to see more flexibility in the separation of funding of residential aged care accommodation. He singled out two areas for reform.

“Firstly, funding to enable delivery of residential aged care into a person’s home such as a co-located care apartment. For example, a supported resident ought to be able to forgo the accommodation supplement in exchange for an equivalent amount of top-up care funding to cover the extra cost of care outside of the ‘walls’ of the residential aged care facility.

“Secondly, third party payments for accommodation in residential aged care. We see cases where family and/or friends wish to ‘top up’ accommodation in the form of RAD payments. The current regulations over RADs and bonds and supported resident funding do not permit this,” said Mr Greive.

Both of these initiatives could proceed at no cost to government and greatly benefit frail, older Australians, he said.

Addressing workforce

Elsewhere, stakeholders want to see Budget initiatives to support the sector in meeting its workforce needs.

ACSA called for government to work with the Aged Care Workforce Advisory Group “in the prompt development and implementation of the Aged Care Workforce Development Strategy.”

Blue Care’s Ms Batten said she would like to see funding for indigenous employment programs in aged care, specifically in rural and remote areas.

“We have excellent permanent jobs for a range of skills – care, administration, maintenance, hospitality – and we need financial support to train, mentor and support indigenous staff. This has the added benefit of enabling us to provide culturally appropriate care,” she said.

What measures to support aged care would you like to see in the Budget? Comment below