To be considered: Grant Thornton on the PC draft report

Above: Grant Thornton Director, Cam Ansell

By Keryn Curtis

The introduction of a star rating system for aged care services and changes to the proposed timeline for implementing the reforms are among recommendations from business consulting firm, Grant Thornton (GT) in response to the Productivity Commission’s draft report into the Care of Older Australians.

Grant Thornton’s ‘Productivity Commission Report: Caring for Older Australians, Issues for Consideration’ recommends the introduction of a star rating system, similar to one used in the UK, that “would enable consumers and their families to compare alternate facility options and prices relative to their accommodation and service offerings.”

The response says the information could be made available through the Australian Seniors Gateway Agency with the standard rating process being undertaken by an independent assessment entity.

Author of the report, Cam Ansell, said he had been consulting with Martin Green, the chief executive of the English Community Care Association (ECCA), the UK’s peak representative body for independent (non-government) care providers.

“I’m suggesting we have a look at the idea. Martin Green says there was a fair bit of resistance initially to the star ratings system introduced in the UK but it has worked out really well,” said Mr Ansell.

 “It’s important however that any ratings system be restricted to accommodation and non-care services and NOT include care services.  We have a strong view that care should be of consistent standard across all facilities,” Mr Ansell said.

Another area needing further consideration for Cam Ansell, and one shared by other commentators on the PC draft report, is the proposed Australian Aged Care Regulation Commission’s (AACRC) responsibility for prudential regulation of accommodation bonds.

“The risk of bond defaults will be greatly increased in a less regulated environment and we have some concern about the capacity and resources of the AACRC.   Prudential regulation needs to be really tight…if there is failure and loss of confidence, that could severely affect the future of the system.”

Speed it up
While the Grant Thornton response is very supportive of the Productivity Commission’s recommendations, other areas of suggested reconsideration include the proposed timeframe for reform.

The GT response says that, given the AACRC and the Australian Seniors Gateway Agency are the two entities that will become responsible for the key roles of assessment, referral and regulation, ‘we believe that the establishment of the entities and comprehensive governance and transition planning should take place as an expedited measure within two years of reform commencement (Stage 1).’

The response says, to do this would require ‘a gradual transfer of responsibilities from the Department of Health & Ageing and other agencies. However, it would signal the support for the reforms by our political leaders and enable the AACRC’s involvement in transition planning and the implementation of reform (rather than relying solely on those entities that will have their responsibilities diminished through the reforms they introduce).’

“A few big sittings of parliament will be needed to get these new entities on the way.  There’s lots of support now from consumers and providers alike and we’d like to see the roles and responsibilities of the regulatory agency set in concrete as soon as possible,” said Mr Ansell.

Another aspect of the timetable questioned by GT is the proposed removal of supply restrictions in residential and community care in the third and final stage of three to five years.

GT recommends that an ‘alternate supply control mechanism be considered for introduction in Stage 1 to enable the sector to adapt and expand in the short and medium terms and that consideration be given to removing supply constraints on residential aged care, at least, during Stage 2.’

Like other commentators, the GT response also expresses concern about the recommendation for the baseline cost for concessional accommodation being specificed as a two-bed room with shared bathroom.

“Most people don’t build two bed rooms.  In reality, most are single.  Most only build double rooms on the understanding that as regulation allows, they will be converted to single rooms,” said Mr Ansell.

Health care vs personal care
Likewise, the GT response notes the difficulty associated with separating personal care and health services to enable the calculation of the universal healthcare subsidy component as separate from the personal care services component for which there is a co-payment.

‘…these are often inter-related services that are provided by the same carers. Few operators capture information on personal and health services separately and it would be expensive and necessarily arbitrary to do so on an ongoing basis,’ the report says.

Ansell says while it is essential to have a difference between public subsidy and what the user pays, “we don’t want a situation where the provider has to separate and work out respective costs.  In the US they can have an RN plus a funding administrator off the floor doing nothing but care plans and claim forms.”

“We recommend extending the public benchmarking study the PC proposes. Currently it would look at aged care costs, establish scheduled prices and set regional quotas for supported residents.

“We need to talk about extending it to include a comprehensive testing and modeling study that looks at the costs of providing care in a range of efficient environments acknowledging that there will be unique costs associated with community care and others with residential care and other settings.” 

The GT response further recommends that the ‘application of these scheduled allocations be determined for individuals by the Australian Seniors Gateway Agency at the assessment stage, and that co-contribution levels should remain constant unless there is a major change to the person’s health condition.”