Pros and cons: expert PC panel

AAA’s expert panel discuss the strengths and weaknesses of the Productivity Commission’s draft report from its inquiry into aged care.

When the Productivity Commission announced that it would conduct an inquiry into aged care in 2010, most industry advocates bravely pinned their hopes of reform and sector-wide change to the release of its report this year.

With the Commission’s draft report now in the public domain, the details are being debated.

AAA has assembled an expert panel of aged care representatives from some of the sector’s provider, consumer and stakeholder groups to talk about the draft report. The panel comments on the document’s strengths and weakness below.

 Draft report strengths

“I think that this report can be classified as the most fundamental review of the industry undertaken since the mid-1990’s. It is a report that makes recommendations that can’t afford to be ignored!

“We strongly support the recommendation that sees the regulation of retirement villages remaining the domain of the state and territory government, and that this regulation should continue to not be aligned with the regulation of aged care. To have recommended otherwise would have seriously impacted the continued supply of this important housing option for seniors.”
Doug Strain, CEO, Masonic Homes

“I’m delighted to see that the voices of individuals telling of their experiences have not been lost among the myriad of submissions [received] from large organisations, and that the focus [of the report] is so clearly is on listening to what older Australians have been telling us for years – that they want to stay as independent as possible, connected to their communities and have real choices of the support and care that they may need.”
Barbara Squires, General Manager- Ageing, Benevolent Society

“I like the focus on independence and wellness.”
Greg Mundy, Aged Care Commentator

“Greater transparency and equitable access for older people; improvement in user pays model and [the fact that] control is with the consumer. The ‘gateway’ concept is innovative and will hopefully replace a fragmented system with a much more responsive one.

“[The report] provides for a future that is less reliant on residential care. It recognises the benefits of community capacity building and that health care should follow the person and be provided in-house…”
Dale Cleaver, CEO, Royal District Nursing Service SA

“In writing the report, the PC thought through a whole system rather than pieces of it. It’s a total package. [The new bond system] gives people the opportunity to access their assets without being penalised. The PC also cleverly worked out a way to protect someone who is not a home owner as non-home owners are currently penalised. [The new system] is a clever way to find equity for all older people.”
Gerard Mansour, CEO, Aged and Community Care Victoria

“The report gives consumers the choice of where they receive their care and who provides it; retains the safety net provisions, a hallmark of the current aged care system; recognises that carers are also consumers of aged care services; and it builds the aged care system on a wellness and restorative approach, and backs this up with funding mechanisms that actually gives people the opportunity to leave care where this is appropriate.

“It also removes the artificial distinctions between high and low care, and between residential and community care, replacing this with a continuum that ranges from basic support through to personal care and highly specialised health and nursing care.

“The report addresses the equity issues in aged care with a fair, simpler and progressive approach to financing aged care that appropriately balances the role and responsibility of government and consumers to provide for their accommodation and care.

“The Commission has recommended that quality, pricing, standards and complaints are undertaken by a separate independent agency to be called the Australian Aged Care Regulation Commission (AACRC). It fixes the governance issues, addressing how aged care is regulated between the Department of Health and Ageing, the Aged Care Standards and Accreditation agency and the Complaints Investigation Scheme.”
Gillian McFee, Director, UnitingCare Ageing

“The key elements of the recommendations from a consumer perspective include- greatly expanded access to services based on an assessed entitlement to services; greater emphasis on community care; better access to information for consumers; and models of care that empower older people and their family carers to decide when, where and how the services they need will be delivered.”
Glen Rees, CEO, Alzheimer’s Australia

“We have always said that the sector needs reform and that includes financial changes. We support addressing issues around finance but do not support the user pay model suggested.”
Lee Thomas, Federal Secretary, Australian Nursing Federation

“We are pleased to see the inclusion of LGBTI older people so significantly in this report.  For too long the needs of our community elders have been ignored. The Alliance stands ready to work with government, our members and the aged care sector to improve services for LGBTI seniors and provide quality care and support for those in need.”
Paul Martin, Chair, National LGBTI Health Alliance

“The report confronts funding options, which will help focus the debate. The recognition of consumer choice [in the report is also] an encouraging start.”
Michael O’Neill, CEO, National Seniors

“It puts forward constructive, innovative and practical recommendations, which provide a solution to the key concerns facing aged care. The report has taken notice of the issues which have been raised over a number of years and taken bold steps to fully address them.

“A particularly pleasing point is that the report puts the focus on consumers and service users and how services should operate to meet their needs, not how users have to fit into rigid service systems. This can be seen in its recommended model of care where there is to be one flexible range of services to meet individual needs, which would replace the current fixed service levels.

“The establishment of a single Gateway and Regulatory Body will greatly assist in overcoming current duplications, such as dual-gatekeeping and a myriad of overlapping regulations as [there is a] lack of communication and co-ordination between DOHA, Accreditation and Standards Agency and CIS.”
Sandra Hills, CEO, Benetas

“I am delighted to read of the recognition for wages parity within the health sector, and the strong acknowledgement that the aged care industry is caring for more complex needs and therefore requires appropriately skilled and qualified staff. The deregulation of both community care and residential is pleasing.”
Sharon Davis, Regional Manager NT, Frontier Services

“The Liquor, Hospitality and Miscellaneous Union (LHMU) is impressed with the recommendation to set up the Australian Aged Care Regulation Commission. The indexation of subsidies has been a key stumbling block in attempting to lift aged care worker wages above poverty levels. Allowing an independent body to publicly and transparently price the cost of care is a significant step forward for the industry and one which will be welcomed by workers, consumers and providers.
Sue Lines, Assistant National Secretary, LHMU

“I have been involved in the movement to establish a United Nations Convention on the Rights of Older Persons and therefore the recommendation to move from a needs-based to a rights-based approach for the planning of care for older Australians is most heartening.

“The current approach of rationalising services, according to the identified needs estimated on population distribution, does little to assist people in accessing appropriate and timely services that could help them to remain independent and at home. The approach recommended in the report acknowledges the rights of people to have such access.”
Professor Tracey Macdonald, RSL LifeCare Chair of Ageing (Faculty of Health Sciences), Australian Catholic University

“I am primarily impressed that the PC Report has reinforced that any new system-wide aged care model is going to be based around the care needs of the older Australian. From a provider’s perspective we must always remember that we exist to meet the needs of the client. The client never exists to meet our needs. Providers are not perfect but if they can grasp this premise then one hopes that continual improvement will shape their service delivery.

“The commentary on the regulatory and governance framework, capital and service utilisation payment arrangements is extensive throughout the report. In addition, there is a good matching of report recommendations to previous hospitals and health reports, suggesting that an integration of high dependency aged care provision and palliative care and end of life care matching hospital levels of acuity are not far away in terms of structural reform.”
Wayne Belcher, Former CEO, The Bethanie Group

“The inquiry report captures the past, grounds the aged care sector in the present and proposes reforms for the future.

“It is comprehensive and coordinated, and targets the aged care framework, system and sector. The report is a timely stocktake of the current situation and suggests recommendations and reforms which can improve the provision and delivery of aged care services, so that older people can better access services of their choice.

“Navigating aged care has been a nightmare and this report puts much into perspective: access; information; consumer-centred care; carers; workforce; costs; affordability…and recommends practical, targeted reforms.

“It is also encouraging to note that non-English speaking background/cultural and linguistically diverse aged and community care issues are canvassed as integrated elements for the sector- and not just mentioned as exotica or an afterthought.”
Rosa Colanero, CEO, Multicultural Aged Care

“The focus of the report is on creating a stronger ‘user pays’ system for those care recipients with the ability to pay more for the care and services they receive. It is also positive to see that diversity and the special needs groups are considered, although many recommendations are such that should be/are already in place.

“Bonds are to be implemented across all levels of residential aged care for those who can afford to pay- that is, persons in ‘general’ high care places who are not exempt from paying bonds if they have the necessary assets…The report aims to provide a system that is easier for the aged and their families to negotiate.” 
James Underwood, Director, James Underwood & Associates

Draft report weaknesses

“Technology and its importance is referred to but it is less well-developed than other concepts. I am not sure if the impact of dementia is not a bit underplayed. There will be debate about setting a two-bed room as the base standard for residential care- this is a question of what the government is prepared to pay for.”
Greg Mundy, Aged Care Commentator

“The details of what the proposed changes would mean, especially in the first two years, will hopefully be clearer in the final report.”
Barbara Squires, General Manager- Ageing, Benevolent Society

“What has been left out is the detail regarding how the model for improved access to community based care and support will work (in comparison to RAC). The report has a predominant focus on financial modelling but there is not enough focus on how to attract or retain workforce.”
Dale Cleaver, CEO, Royal District Nursing Service SA

“The only exception appears to be the failure to recommend an immediate increase in the provision of community-based aged care packages. Masonic Homes remains firmly of the view that the unlocking of the limits placed on the availability of community-based aged care should be immediately lifted and we will be firmly reinforcing this in the response we will make to this draft report.

“We can not afford to let the implementation process be protracted. Hence, we are of the view that whilst the five-year rollout for changes to bed licensing arrangements is acceptable- as the timing of beds is protracted anyway due to the planning and building process- such is not so for community-based aged care. An increase in the availability of community-based aged care must be effected immediately!

“The principal deficiency we identify in the report – and one that wasn’t really addressed through the Terms of Reference – is the whole issue of seniors housing and accommodating an ageing population. It remains our position that the most critical challenge for the Australian community is to ensure we are all appropriately housed – and this needs to extend beyond just the layout of the built form. We need to address the whole functioning of the community including matters such as transport.”
Doug Strain, CEO, Masonic Homes

“The biggest weakness is that the PC hasn’t demonstrated that a move to a more significant free market model will work in all settings for everyone. This will be our litmus test. Will it work as well in the western suburbs, as well as in the eastern (middle class) suburbs? Will a provider have as much incentive to provide services, care and accommodation everywhere (like rural and remote areas)?

“Secondly, will this freer market model work equally for people in special needs groups such as the homeless, those of a non-English speaking background and people from rural Victoria? That is fundamentally the biggest challenge of this architecture.”
Gerard Mansour, CEO, Aged and Community Care Victoria

“It is to be expected that in a report of this kind, where it is essentially re-designing Australia’s aged care system, that there will be areas where detail is lacking. However, from our perspective, this is mostly around execution. It will be very important that in the execution phase of these reforms, there are opportunities for consumers, providers and Government regulators to sit down together and make sure what is implemented can actually work in practice.

“There are plenty of examples where large change management programs flounder. The reasons for this are usually because of poor implementation. We will need to make sure that this good report, which appropriately charts the imperative for change and the high level architecture of a contemporary aged care system, does not also flounder in the execution phase.”
Gillian McFee, Director, UnitingCare Ageing

“The detailed nature of the report provides stakeholders with many opportunities to focus on specific aspects of the recommendations that they may disagree with. This type of criticism may have the potential to take the focus away from the need for reform and the main principles that should govern reform.”
Glen Rees, CEO, Alzheimer’s Australia

“The report lacked recommendations or meaningful discussion about how Australia would deal with skills shortages, skills mix, care hours and transparency in aged care. Ignoring these vital issues means that these significant issues will continue into the future.”
Lee Thomas, Federal Secretary, Australian Nursing Federation

“There is too tight an emphasis on the economic value of the family home and no understanding of its emotional value. Wages for staff has been placed in the ‘too hard basket’ and the transition arrangements are inadequate.”
Michael O’Neill, CEO, National Seniors

“There are very few weaknesses…however it is a pity that the report did not mention the issue of ageism in our society and the need to develop a range of initiatives to educate the public on the positive aspects of an ageing society and the benefits older people bring to our way of life.

“Also…it does not mention the need for affordable housing for older people on low incomes. This group finds it extremely difficult to obtain suitable housing and the development of a strategic policy framework on housing for older people needs to highlight the plight of this group of older people, and the need to develop strategies to meet their accommodation needs.”
Sandra Hills, CEO, Benetas

“Personally, I would have preferred more detail and stronger recommendations in three main areas of concern in remote and regional Australia – staff housing, recruitment costs and the impact of mandatory criminal history checks.”
Sharon Davis, Regional Manager NT, Frontier Services

“The report recognises the low pay and difficult working conditions of aged care staff but fails to propose real solutions to these problems.

“In terms of working conditions, the report categorically rejected the introduction of staff to patient ratios. Yet the alternatives it proposed – increased assistive technologies, IT solutions, increased training and a reduction in regulations – will do little to help personal carers and support staff on the aged care frontline. As it is, many aged care workers have to provide more care to more patients with less time, and we would have liked the report to focus on more substantive suggestions.”
Sue Lines, Assistant National Secretary, LHMU

“Much of the report pertains to the delivery of residential care to older people with health issues despite the inclusion of community based care for those which health needs.

“Proposed changes to the financial arrangements around residential aged care services are laudable, however the upheaval that such an overhaul may have within that industry could result in fragmentation and reduced access to high care services so needed by vulnerable members of the older Australian cohort.

“Much will depend on the processes that would operationalise any transition to a new model.  We will have to wait to see what the options are and whether alternative systems of allocating subsidies and ensuring accountability are better or worse.”
Professor Tracey Macdonald, RSL LifeCare Chair of Ageing (Faculty of Health Sciences), Australian Catholic University

“The issue of recommendations about recurrent funding levels has at least been left in abeyance, if not omitted.

“The question about which first to liberalise – quantity or price – is in fact highlighted in the PC Report (Box 14.2 on page 454) suggests that by leaving such a distortion in price mechanisms in place, the impact of removing caps on quantity of service provision might not be encouraging.”
Wayne Belcher, Former CEO, Bethanie Aged Care

“There is lack of clarity and overlap with some aspects of disability, health, HACC and carers. Significantly, costings for most suggested reforms are ‘in principle’ and ball park figures rather than specific and formulaic. It is understandable but costings can provide a valued rationale for escape clauses for governments and others. And costings can be an unsurmountable challenge for consumers. Costings will be the devil in the detail.

“For older people from diverse cultural and linguistic backgrounds, the report canvasses several priority issues but does not address them as specific reforms. For example: How will the report and information about the reforms be provided to older people from diverse cultural and linguistic backgrounds? How will they provide feedback and responses? How will they access the Gateway? Will the objectives and outcomes to be achieved by the Gateway identify and aim to address the special and specific information needs of older people from diverse cultural and linguistic backgrounds? Will the Gateway be able to refer Dutch older people to Dutch speaking service providers?”
Rosa Colanero, CEO, Multicultural Aged Care

“[There is a weakness in the] recommendation that bonds be “capped”. In reality, the cost of providing accommodation will vary at least as widely as it does now for all the multiplicity of reasons that peoples’ home come at different costs.

“There appears little rationale for the recommendation [that calls for] the abolition of retentions from bonds. The report recommends the option of paying accommodation costs via periodic payments, lump sums or a combination of the two – this option is already in place in the legislation.

“Policy direction to meet demand for Service Integrated Housing – the third aged care sector –  is not addressed in light of abolishing limits on the number of community care places and allowing retirement villages to continue on the ‘self-regulation road’ separate from aged care regulation.
James Underwood, Director, James Underwood & Associates

Written submissions on the draft report must be sent to the Productivity Commission by Monday, 21 March 2011. Email feedback to agedcare@pc.gov.au
 

Tags: aged-care, caring-for-older-australians, community-care, draft-report, policy, producticity-commission,

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