One quarter of all aged care facilities claimed the now axed Dementia and Severe Behaviours Supplement for more than 20 per cent of their residents, including a very small number of services that made claims for their entire resident population, internal government documents reveal.
Some 6 per cent of facilities claimed the supplement for 50 per cent or more of their residents.
The figures, which have never been publicly released, were obtained by Australian Ageing Agenda under a Freedom of Information Act request.
Claims for large proportions of residents were most common in the private sector, where nearly 50 per cent of for-profit facilities made claims for more than 10 per cent of their residents. This compared to 36 per cent among not-for-profit facilities and 28 per cent among government services, as at January 2014.
The $16-per-day dementia supplement was intended to support the small group of residents with very severe or extreme behaviours associated with dementia not already covered within the ACFI, which the department estimated to be approximately 2.2 per cent of residents.
The ministerial briefings and minutes obtained by AAA show:
- The Department of Social Services undertook a review into the over-subscription in February 2014 but did not report back to the minister until almost four months later, in late May.
- DSS acknowledged multiple factors contributed to the 12-fold blowout in eligible residents including a lack of training and that inappropriate claiming may have been a factor in the overspend.
- The department acknowledged a new funding mechanism would be years in the making and recommended the minister introduce an interim measure while a new payment was being developed.
In early February 2014, six months into the operation of the supplement, the department informed the Assistant Minister for Social Services Mitch Fifield of the over-subscription and commenced a review of a small number of sample claims and supporting documentation.
Before commencing the investigation into the cause of the over-subscription, the department said it would write to aged care peak bodies informing them of the review.
The Opposition has consistently criticised the government for failing to initiate a review or to provide any warning to providers prior to terminating the supplement.
While the size of the review is unknown, the department did not report back to Senator Fifield until late May when it concluded, based on the advice of expert clinicians, there were likely to be multiple reasons for the significant increase in claims, including:
- a lack of training for nurses to assess eligibility,
- misunderstanding of the target population, possibly exacerbated by the name of the supplement which did not refer to ‘very severe or extreme’,
- and the eligibility assessment tools which were failing to distinguish the right group.
The department also acknowledged that inappropriate claiming could also have been a factor.
In the minute to Senator Fifield in late May, the department also admitted that failures in the design of the supplement meant DSS had “no way of knowing” what impact the supplement was having on care recipients.
There was no requirement on providers to outline the particular behaviours of the residents, the additional care being provided or to report on clinical outcomes, DSS said.
Given the over-expenditure, the department advised the minister to “move quickly to communicate the degree of financial overrun” and cease the supplement on 31 July, when the 12-month claims lapsed. If the government did not terminate the supplement, the department said budget estimates for 2014-15 would need to be increased by $150 million.
Supplement redesign
The documents cast doubt on the feasibility of calls from the Opposition and some parts of the industry to redesign the supplement, which the department said would take “several years.”
“A new assessment tool which is capable of targeting the right group of residents would need to be developed and trialled, and training delivered on how to use the new tool,” DSS said in late May.
Considering this, the department said the government could fund interim projects while a new payment was being developed, and that these options could be pursued with the Aged Care Sector Committee.
On 30 May, in a letter to DSS secretary Finn Pratt, Senator Fifield confirmed that he had agreed to terminate the supplement and to develop both “an interim and ongoing measure that was appropriately targeted” to support residents with severe behaviours.
Prime Minister Tony Abbott agreed to the cessation of the supplement on 23 June, three days before it was announced in Parliament by Senator Mitch Fifield.
In his letter to Minister for Social Services Kevin Andrews, Mr Abbott noted the proposal to develop more “targeted arrangements” and said any arrangement should be developed within the existing funding envelope for future years.
Slow to communicate
Despite the government having agreed to put in place future arrangements that were targeted and within current expenditure, it now appears to have been slow in communicating this to the sector.
For example, when Senator Fifield announced the removal of the supplement on 26 June, the only assurance he offered regarding the future was a commitment to “work with aged care providers and consumers in the support of people with severe behavioural and psychological symptoms of dementia.”
Immediately following the supplement’s axing many industry stakeholders questioned the government’s ongoing commitment to a replacement.
Ahead of the Ministerial Dementia Forum earlier this month, the department advised the minister that sensitivities would be high and the announcement of an annual dementia forum would help allay sector concerns.
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