The Federal Government is reviewing the design of the Dementia and Severe Behaviours Supplement paid to aged care providers in the wake of an almost ten-fold blowout in projected costs.
Appearing at a senate estimates hearing on Thursday, Assistant Minister for Social Services Mitch Fifield signalled the shake-up of the new dementia supplement following revelations the supplement had already consumed its four-year allocated budget of $52 million in less than 12 months of operation.
Mr Fifield said the previous government had estimated that 2,000 people in residential aged care would be eligible for the supplement but over 25,000 residents were already receiving the additional funding.
The dementia supplement, which was first introduced in August 2013 to help providers meet the additional costs of high-level dementia care, was budgeted at $11.7 million for this financial year, but Senator Fifield said this amount had been spent in January alone.
According to departmental projections, if current claiming patterns continue, in 10 years the $16 per day supplement will cost the government $1.5 billion.
Senator Fifield told senate estimates the policy had been poorly designed by the former Labor government and would need to be “realigned to the funding envelope” set out under the Living Longer, Living Better reforms.
He said he would consult with the Aged Care Sector Committee to discuss options for a change in policy. He said:
“We have been left a ticking policy package with a program blowing out tenfold.”
Senator Fifield said the supplement was an example of a program that did not undergo the necessary “rigorous policy design process” to ensure it kept within budget.
“Ultimately, the responsibility is that of the government of the day to be satisfied that a measure will achieve its objective and do so within the funding envelope that the government of the day has established. I do not think anyone has done this.”
Political football
However, Shadow Minister for Ageing Shayne Neumann accused the government of using aged care residents with dementia as a political football.
He said the Labor government had consulted with the sector and the modelling used to develop and cost the dementia supplement was correct at the time it was implemented by the former Department of Health and Ageing.
“Dementia is not a political football and Senator Fifield should not be using it to score points,” Mr Neumann told Australian Ageing Agenda.
Problems with assessment
Acting Deputy Secretary of the Department of Social Services Carolyn Smith told the senate estimates hearing the prescribed assessment tool was not capturing the intended client group as effectively as had been expected.
“It was expected that one per cent of all residents would qualify for this supplement,” she said. “That was based on consultation with a range of clinical experts in this area. Instead, 15 per cent of residents are claiming it.”
“We have talked to those same clinicians in the last couple of months to understand the patterns of claiming that we are seeing. They do not believe it is a reasonable conclusion that there can be 25,000 residents who have these very extreme behaviours.”
Ms Smith said there appeared to be multiple reasons for the oversubscription including problems with the original design of the supplement and the need for a sufficient compliance regime.
Industry reaction
Leading Age Services Australia CEO Patrick Reid said the peak body would reject any attempt by government to amend the supplement criteria simply as a means to reduce subsidy payments.
He said the number of residents being assessed as displaying behavioural and psychological symptoms of dementia (BPSD) showed the high need for additional dementia services in residential aged care.
Mr Reid said it would also be prudent to understand what planning the department undertook to estimate how many residents would be deemed eligible for the supplement because the department’s planning had not been transparent.
Aged and Community Services Australia (ACSA) CEO Adjunct Professor John Kelly said the previous Labor government had seriously underestimated the number of residents who would be eligible for the supplement and that ACSA had been raising this issue with the Coalition government since September.
CEO of Alzheimer’s Australia Glenn Rees said arriving at an accurate estimate of the prevalence of BPSD in residential aged care was problematic due to a lack of clinical studies. “I think the initial effort by clinicians to design the supplement was always going to be a bit of a test,” he told AAA.
Mr Rees said options to amend the supplement could include introducing greater compliance, changing the criteria for assessment or adding additional eligibility requirements for providers to access the funding such as employing a dementia coordinator, including staff training on psychosocial approaches to dementia and having low levels of chemical or physical restraint.
He said it was the view of Alzheimer’s Australia that the additional funding should only be distributed to providers who could prove they had the capacity to deliver high quality dementia care to residents with severe BPSD.
Whomever the clinical experts were that designed the original proposal and estimates around the number of elderly people who qualify for the dementia supplement obviously have not worked in aged care for a long long time or maybe never. If they had they would know that the supplement is long overdue. We do not use restraint, we have a Dementia Consultant, we have given more than enough training to staff, we use psychologists, chaplains and an holistic approach.What the government needs to understand is that care service employees do not have and will never have the assessment and professional skills that a registered nurse developes throughout their training and through practice. The dementia supplement assists providers to adjust the staffing mix and add more qualified staff to care for residents with comorbidities and very complex psycho-social needs.If it was in a public CADE unit the staffing ratios would include a lot more Registered Nurses, in residential aged care we struggle to provide the level of care that our elderly deserve because the government does not fund services correctly.
Just goes to show how once again governments continually grossly under estimate the cost of Aged Care and again it is the elderly, and those who care for them who are disadvantaged time and time again. The population is aging and the funding is inadequate it is as simple as that. Mr Fifield the reason that this program has gone over budget is because not enough funding was allocated to it in the first place and not as you state above because “it did not undergo the necessary rigorous policy design process to ensure it kept within budget”. If we took away our politicians generous wages and retirement funds and put them at risk of being unable to afford quality Aged Care would they look at the funding models differently?
Have to agree 100%. It is definitely a case of ‘you have to be there’.
I agree completely with the comments already made. The supplement was long over due. Unfortunately the claiming patterns of the supplement were abused in some organisations. This has seen the cost to the Government increase unrealistically. But for those who used the supplement and its claiming criteria, it has proven to be extremely beneficial. There may be a need to modify the claiming criteria and have some level of prudential monitoring of how it is spent, but it should not be removed altogether. I also agree that any reconsideration of the supplement must be based in a reality, not beurocracy.
I’m going to lead with my chin here.
There would be very few providers in the aged care sector with much less than 50% of their residents exhibiting some signs of dementia. Let’s be conservative and say that 25% of all residents then would qualify for the dementia supplement.
With over 180,000 residents in care every night, that 25% equates to 45,000 eligible residents.
The sums aren’t hard. 45,000 x $16 x 365 days equals an obvious estimate of $262.8m per year.
How on earth did the former government come up with an estimate of 2,000 eligible residents?
How could the recent Commission of Audit overlook the impact of new 2013 legislation?
How will providers balance their budgets when they had anticipated receiving the supplement for their significant numbers of residents with dementia?
This is another land-mine that has been overlooked and ignored.
It’s enshrined in legislation.
It’s promised by the former Government.
It’s budgeted by providers.
It’s warranted for residents.
wh is going to do something positive?