Enough ACFI anger

The leaders of the two peak aged care provider associations are urging their members to direct their energy to practical efforts and to help move real reforms forward.

By Keryn Curtis

The leaders of Australia’s two peak aged care provider associations are calling on their members to focus on practical steps forward in the wake of an angry response to the July 1 changes to the Aged Care Funding Instrument (ACFI), the tool used to calculate the funding available to residential aged care providers to provide care for each resident. 

In the last fortnight, aged care providers, consumers and advocates Australia-wide have unleashed a torrent of anger and frustration aimed at the federal government and Minister for Health and Ageing, Mark Butler over changes to funding for aged care providers.

A satirical-style opinion piece written by Ray Glickman, the CEO of the WA aged care provider, Amana Living, and published on this website [Op-ed: Butler’s stroke of ACFI genius, 3 July 2012], proved something of a turning point.  It became an independent public forum for providers and consumers and other commentators to ventilate their points of view.

The Minister has formally responded to the opinion piece with his own op-ed, published yesterday by Australian Ageing Agenda. There has been extensive commentary to this article already.

CEO of Aged and Community Services (ACSA), Adjunct Professor John Kelly, said the huge response in terms of commentary to the opinion piece, reflected the real degree of concern and angst among those people working at the coalface. However, he said it was time to progress with the reform process in a sensible and productive way.

“It is important that people can have the opportunity to ventilate their concerns, and express their emotions but now we have to look at how can we progress things forward, sensibly.

“I feel comfortable that most of our members want to keep to the path and stay part of a progressive reform process as long as there is a sense that we will be genuinely listened to,” said Prof Kelly.

Professor Kelly reiterated that his members’ support was predicated on the belief that there will be genuine engagement from the Government and the department.

“We will continue to work constructively with NACA to support the broader reform messages. We’ve got to get on with business but our members are close to the real world and they need to feel that their concerns are recognised and not just being perceived as bleating.”  

“There is a lot of hard work going on out there at a local level. We have told the minister we don’t agree with what’s been done.  Now we are going to collect the data – between now and the end of the year – so we will be able to present it back to the government and the department to show what we are seeing as the real impact.

“I see that as being constructive.  There will always be two sides and there’s no use continuing to have this argument about the assumptions.  We now need to look at the impacts it will have,” Prof Kelly said.

CEO of Leading Age Services Australia (LASA), Gerard Mansour, said the sentiment among LASA members was likewise one of disappointment.

“People are very disappointed. The starting point for the government was that ACFI funding levels were a problem and needed to be reduced whereas for the sector, ACFI was actually a huge improvement on the previous system in that it was getting much closer to meeting the actual costs of care.”

“The fundamental driver of aged care providers is provision of quality care, so when you do anything that puts that at risk, you get angst.  So it’s not surprising,” said Mr Mansour.

“But now we need to go into ‘doing mode’ and the focus needs to be on how to resolve this situation. We need to come up with some wide-ranging and innovative ideas that can make a genuine impact.”

Mr Mansour said it was clear that the changes will affect different providers in different ways, depending on the service model and factors such as the mix of high and low care services offered.  Like ACSA, LASA has worked with a benchmarking software vendor to make available a software tool enabling members to calculate the actual impact of the changes at the individual facility level.   

“There is enormous difference of opinion about how it will affect providers and we need to get the data,” Mr Mansour said.

Short term measures

Both ACSA and LASA are seeking short term measures from the government to ameliorate the impact of the changes on providers’ income.  These include options such as bringing forward the start date for charging bonds for high care residents to July 2013, rather than 2014; offering extra protections for regional and smaller providers and an alternative solution for insuring bonds that removes any need to use the commercial insurance market.

ACSA’s John Kelly describes these measures as low cost and low risk and believes the government will be receptive to these. 

Gerard Mansour says other helpful measures could include simplified reporting of accounts, a review of some of the proposed time frames, as well as the broadening of the eligibility criteria for the new fee for the accommodation payment. 

“Every compliance requirement has a cost so if we can genuinely remove and address some of those things, that will all help.  

“We need to remind ourselves, we don’t have to just accept all the terms of the Living Longer Living Better package. The government has suggested a whole lot of things and a series of timetables that they thought would be appropriate but we are working on it right now and we need to give them some ideas about how these things will affect us and what would work better for us,” Mr Mansour said. 

He said the second thing for providers to remember was to look at what else could be done, ‘outside the square’. 

“The Productivity Commission and others have suggested some really clever ideas – things that could contribute at least in small part, to a solution. But at some point we need to recognise that there is going to be a gap and we are going to need more funding.  

“We don’t think residential aged care was overfunded. Our view was that ACFI was getting closer to delivering the real cost.  At heart, we don’t think this an issue about claiming.  It’s an issue about long term projections not accurately reflecting real costs,” Mr Mansour said.

Tags: acfi-anger, acfi-reform, gerard-mansour, john-kelly,

5 thoughts on “Enough ACFI anger

  1. The Associations and Peak Bodies and others involved in the discussions leading up to the latest reforms appear to have done a deal with the Minister. I would not be surprised if the Minister proposed: ‘show support for the reform of the ACFI and I will ensure that the better reforms of the Living Longer Living Better package will get support’
    A nice little deal from an excellent salesperson and the ACFI reforms got up.
    Notice that all the CEO’s of the Peak Bodies, showed general support for the reforms on their release.
    Now that members have had a chance to consider they see that the dirty has been done.

  2. We have been sensible and we have continued to be productive in the face of complete disregard for our plight. Now is the time to stand up and yell! The squeeky wheel gets the oil. For far to long we have attempted to politely inform and educate those in government about our plight and what we need. We have thanked previous governments for funds that do not cover the cost of care. We have jumped through legislative hoops hoping that if we are a good child we will be treated better. None of this has worked and I for one am tired of being nice. It is time to yell from the tree tops and get the mainstream media involved before we start seeing precious aged care facilities close and elderly people who require 24 hour care taking up hospital beds. We are making a noise in our little world whilst the wider community are completely unaware of our plight. Our peak bodies need to stop playing nice it doesn’t work!

  3. The whole issue around the ACFI changes has created not only angst but mistrust between the industry, DH&A and Government. The Minister can quote the
    $ 310m extra in the budget until the cows come home but it won’t alter the reality that
    1. Whatever the number how can the Minister or anyone in Government assure the Australian community that it is enough to do what is expected by Government. The simple honest truth is that the Minister not only will not but cannot as Treasury decides what it wants to spend and the cake is sliced and diced accordingly. There is no consideration by Government of what it costs to provide the service and support to older Australians Minister so let’s stop pretending there is.
    2. In relation to the increase in accommodation supplements in two years time – the new level will be ~ $20 a day lower than the required costs reported by Grant Thornton in 2011. Exactly how is this going to increase the availability of quality buildings for residential care.
    3. The reallocation of $ 1.2bn of ACFI funds into the compact is recognised as a positive intent, however it simply reduces the amount of hours carers and others can spend with our elders. Same dollars – higher average rate – fewer hours. The Government would have some credibility if it actually put the $ 1.2bn on the table with the same strings attached – then it could validly claim it has done something to help aged care workers. Instead the scheme will reduce employment and place further strain on an already stretched workforce.

    Perhaps Ray was a little playful in his interpretation but it does seem that LLLB is steeped within a principle of “loaves and fishes” as a biblical theme. Given that our Australian Government, in spite of billions of dollars of extra income being generated through our “mining boom” can’t generate a surplus, one would have thought that they of all people would understand the same principle applies to aged care provision.

    Yes we need to work together to get some sensible outcome and of course as we always have, this industry will bend over backwards to help. The time for that was late 2011 with honest good faith conversation and true consultation – not two months after the budget event and three after LLLB. For the sake of those for whom we provide care, we have to work this out quickly.

  4. The expressed outrage and frustration with both a Government and a process that has taken so long to provide any relief to a sressed industry is just the tip of the coming fire storm Like our elderly clients, providers have just taken what’s on offer and what’s imposed by the Dept of Health & Ageing. We cannot afford to do this otherwise it shall be to our absolute ruin. NACA, like the UN has been perceived to be a lame duck with members all in the tent so to speak, like frogs placed in a pot of water and placed on the stove top to bring to a slow boil rendering the participants dull and weak, unware that they have been conned following a compromised road. As peak body leaders, you have witnessed the angst expressed by your members and you need to negotiate much harder and stand firm so that older Australians can indeed be cared for by providers, in spite of this uncaring government. Who indeed is holding the Minister to account in the sense that decisions to alter ACFI have been made in haste, effective from 1st July, yet we still do not have the new business rules etc, neither have the IT companies had time to alter their programs. Clearly there are some people in the tent that are in the Minister’s pocket.

  5. Well we have had growth in ACFI income in line with those described by the Minister, and well above CPI and the increased frailty levels, over the last 5 years. We have used these increases to provide an additional range of health, positive ageing, teaching and quality initiatives. And so have many providers I have spoken to. We will have to reduce some of these initiatives and prioritise them, but I get that the current rate of ACFI income increase was not sustainable. The one off reduction is pretty tough viewed over one year, but not over the last 5. It would be pretty tough going forward, if we didnt have the compensating income and capital raising contained in LLLB. The introduction of these and the monthly monitoring, offered by Government to safeguard against unintended consequences will be critical to achieving the successes embodied in LLLB. This Government offered us pretty good reform at a time when most of us thought it wasn’t possible. So, in this current environment, what can we do to make it happen? Sure, we are caring but we are also talented, innovative, independently minded operators. The time is ripe for us to be more entrepreneurial, less contractor, and in this mindset to back serious sector leadership to work with Government and others. Older Australians deserve it.

Leave a Reply

Your email address will not be published. Required fields are marked *