Reform and the benefit of hindsight
It was a case of ‘don’t hold back’ for many at the ACSA National Conference on the Gold Coast this week.
Above: Dr Norman Swan faciliating the debate at the ACSA National Conference on the Gold Coast on Tuesday. Panel members included, L – R: Cam Ansell (Grant Thornton – not visible), Sue Macri (RSM Bird Cameron), Ian Yates (COTA), Sue Lines (United Voice), Ray Glickman (ACSA Board/Amana Living), Robyn Batten (Blue Care) and John Kelly (ACSA)
“As long as we continue with ACAR (Aged Care Approvals Rounds) rounds, we will continue to have unmet need. There is no reason there couldn’t be an entitlement based system run through Medicare to ensure all Australians get the care they need.” Sue Macri
By Keryn Curtis, who attended the three day ACSA national conference on the Gold Coast this week.
MORE than four months after its release, delegates at the Aged and Community Services Australia (ACSA) national conference were enthusiastic to tell us what they really think about the government’s Living Longer. Living Better aged care reform package; but there was diversity in the passionately held views.
A panel session held on the Tuesday, with representatives of aged care providers, consumers, unions, ACSA and a financial commentator, prompted lively debate indeed, at least partly fuelled by the accomplished and challenging style of facilitator and broadcaster, Dr Norman Swan.
Reform and sustainability were understandably hot topics across the three days but the panel session on Tuesday provided an outstanding forum for the broad spectrum of opinion across all the key stakeholder groups.
Former Assistant Commissioner for the Productivity Commission’s(PC) inquiry into Caring for Older Australians (the report to which the government’s reform announcement responded to), Sue Macri, presented her views for the first time since completing her role with the Commission. Ms Macri said she felt that enough time had elapsed since the end of her tenure last year for her to speak publically about her views on Living Longer. Living Better (LLLB).
Ms Macri said she was disappointed that the government had cherry- picked the recommendations of the PC report but that it was up to the aged care sector to decide how to view the government’s response.
“It’s up to us to make sure that this is just the beginning of the journey, not a missed opportunity,” she told delegates.
Ms Macri spoke about three broad areas of disappointment with the government’s LLLB reform package – reforms to the regulatory environment; reforms around the interrelationship between the acute care sector and aged care; and the workforce initiatives.
She was critical of the governance arrangements implicit in the reforms, saying that in not clearly separating policy regulation and compliance and appeals, it created an inherent conflict of interest within the Department of Health and Ageing (DoHA).
She was also critical of the failure of the reforms to create an entitlement based system.
“As long as we continue with ACAR (Aged Care Approvals Rounds) rounds, we will continue to have unmet need. There is no reason there couldn’t be an entitlement based system run through Medicare to ensure all Australians get the care they need,” she said.
Ms Macri said that aged care should have access to proper Medicare rebates to provide frail residents with access to higher level care without having to be admitted to hospital. She described the ‘workforce compact’ as a bandaid approach and too ‘city-centric’, saying much more can be done to improve access to high quality education and well-articulated career paths in the sector and more to encourage people into jobs in regional and rural areas.
“However, this is not just a government problem […]; providers also need to do more,” said Ms Macri, who urged delegates to take an optimistic view, to try to see the current reform package as just a beginning and to maintain the focus on achieving long term reform.
Positives and negatives
Grant Thornton partner, Cam Ansell identified three elements of the reform package that he described as having negative impacts for aged care providers, and three which were ‘opportunities’. The negatives included the ‘recalibration’ of the Aged Care Funding Instrument (ACFI), the ’continuation of the managed bed policy’ and the ‘capping of bonds and charges’.
On the other hand, he said that high care accommodation payments and the option of a periodic payment or bond; and the means testing and uncapping of aspects of service and accommodation charges were positive on balance, as was the introduction of the increased accommodation supplement for new facilities.
Mr Ansell said aged care providers should be focusing on evaluating their services and financial sustainability; looking at new service models; and preparing for future developments including wage negotiations, finding staff efficiencies and modelling for the user pays evolution.
CEO of COTA Australia, Ian Yates, was also having a bet both ways. While welcoming the LLLB package, Mr Yates said he was concerned it did not go far enough. He confirmed that, while full ‘gateway’ functionality was one element that had not been delivered in the reforms, he had received confirmation at the meeting of the National Aged Care Alliance (NACA) last week that it had not been ruled out.
He was critical of the recent political campaigning on the part of aged care providers around the changes to the ACFI, saying the government was correct in saying the adjustments to the instrument were announced in November last year and were not part of the LLLB package.
“I don’t agree with the political strategy of the providers on this. But I do know something about political strategy which is all about the art of the possible,” said Mr Yates.
“We need to focus on the 2013 budget now, keep up the pressure with ACFA [the new Aged Care Financing Authority] and take the opportunity to work with all three parties. The sector will have to make sure aged care is an election issue,” he said.
Plain speaking
The ensuing questions and discussion drew some honest and animated responses, spearheaded by some observations from doctor and broadcaster, Norman Swan, who challenged providers about why they weren’t out there doing more for themselves instead of asking to sup at the table of government. He said finding efficiencies and delivering innovation had long been the norm in the wider health system.
One delegate boldly told the audience that she believed there were huge differences between aged care providers which were largely a function of different levels of management competency and leadership. She said she had worked for four different aged care providers and said the comparisons were sharp.
Having worked in government and non-government roles in the aged care sector over a twenty year period I have seen many iterations of the ‘not enough funding’argument. I have put the case more than once myself to several Howard Govt. and Rudd (more than Gillard) Govt. Ministers. I have been a significant part of the push that resulted in two major reviews – Hogan and the Productivity Commission. Having now moved on from aged care, I have a real sense of ‘Here we go again’ in much of the current debate. ‘Look for the game changers’ would be my advice and I agree with Sue Macri’s, Ian Yates’, Norman Swan’s and not least the anonymous delegate’s comments. They are on the money
I have yet to see any discussion about the Government’s removal of the Accommodation Bond Guarantee. When Bonds are applied to high level care, over time there will be in excess of 130,000 with bonded beds. With average bonds now heading to $300,000, even a 1% insurance premium will add $390m to aged care providers who will simply pass it on to the residents.
All this when only $25m has been paid out since the introduction of the Guarantee.
It is hard not to think that significant fundraising effort and effective donor management provides some of the answer to what is, which ever way you look at it, a significant erosion of Government funding to resi. That doesn’t look like reversing given calls on funding for disability and to a lesser extent education.
C’mon aged care get with the program. Think outside the box and look for the talent that is available to challenge the NORM and build a new model or two. We are only limited by our imagination and current evidence that can validate the provision of care to the elderly in a safe and careing way.
Out with the old and in with the new.
I am in agreement with Drew Dwyer, there is indded opportunity for a new approach to aged care in this nation, however for us to progress this, the Federal Government has to deregulate our top heavy industry to enable consumers to access the type of care they need and are prepared to pay for over and above the Medicare entitlement for each older Australian. Our industry is over regulated and this compliance effort consumes valuable resources that could really be better used on the delivery of care which includes improved wages for deserving staff. Apply your medical school scapel Drew and cut out all the horse feathers imposed by a bulging and obese inefficient bureacracy. Unfortunately, the LLBL seems to be adding even more layers of red tape