AAA has assembled an expert panel of aged care representatives from some of the sector’s provider, consumer and stakeholder groups to offer their opinion on the Productivity Commission’s (PC) final report from its Caring for Older Australians inquiry.
Overall, according to our panel, the PC’s inquiry signified a job well done. Most experts were pleased with the final report; they felt the PC had listened to their concerns during consultations about the draft; and, they said, the document represented a constructive blueprint for future reform.
AAA asked our virtual panel why they thought the final report was such a strong document. Their comments are below.
PC report strengths
“We support the strategic directions of the reforms which focus on increasing choice, providing care in the community and creating a sustainable aged care system. Some of the strengths in the report include a focus on community care packages, flexible options for respite and greater information about the quality of aged care services.
“…The report also includes a recommendation of a trial of flexible options for respite including cashing out. It has always been my view that reform of respite care should be a priority in the first stage of reforms because it is a critical support for family carers who care for a person with dementia at home.
“The lack of appropriate services is one of the reasons that many carers do not use respite despite saying that they need it. Of all the service areas this one is where choice and flexibility hold the key to better carer support. For this reason I believe the implementation of this recommendation again holds promise for immediate benefits to consumers.”
Alzheimer’s Australia CEO, Glen Rees
“From our point of view, the greatest strength is the very definite recognition of Gay Lesbian, Bisexual, Transgender and Intersex (GLBTI) older people and the particularly difficult experiences of discrimination they have endured throughout their lives.
“That the Commission has recognised this and the need to translate this into the development of programs that overcome invisibility and fear on the part of GLBTI consumers and carers is tremendous.
“The Commission’s finding that training and direct services, as well as the development of a national strategic plan, are warranted, is to be commended.”
National LGBTI Health Alliance general manager, Warren Talbot, and alliance member, Dr Jo Harrison
“We are very pleased with the final report. It is good to see more detail in many areas, especially in the proposed implementation plan.
“‘Ageing well’ is fundamental to our approach to older people and we are delighted that this is the Commission’s approach. We strongly support the first sentence of the ‘Overview’, which recognises that ‘older Australians generally want to remain independent and in control of how and where they live; to stay connected to their families and communities; and be able to exercise some measure of choice over their care’. We couldn’t have put it better ourselves!
“Our focus is on supporting older people in their own homes, supporting their carers, and on housing that is affordable, well designed and well located. The recommendations open the way for much greater choice for older Australians in what services they receive, and where and how they receive them.”
General manager (ageing) for the Benevolent Society, Barbara Squires
“We are extremely pleased with the report and its recommendations. We believe it has reinforced the draft report which picked up on the main concerns of the aged care industry and put forward acceptable solutions.
“However the final report has gone a step further and has recommended a number of new initiatives which would be of benefit to service providers and consumers. These include enabling people to move seamlessly between aged care, sub-acute care and disability services, and assisting providers to meet the needs of diverse groups, such as people who are homeless, from culturally and linguistically diverse backgrounds, and Indigenous people.
“We strongly support the continued emphasis in the final report on promoting the independence and wellbeing of older Australians and their contribution to society. In this regard we are very pleased with the focus in community and carers’ support services on social activity and wellness programs.
“…Overall it needs to be emphasised that these reforms are a huge change management process for all stakeholders, and it is pleasing to note that some assistance will be available for small providers.”
CEO of Benetas, Sandra Hills
“I think the final report scores an eight out of ten and given the quantum of the reforms required in this industry, I think this is a good first step in the right direction.
“Concepts of user choice, one-stop shop, reablement, financial packaging the solutions, improved care levels, establishment of the AACC and removal of the arbitrary definitions of care needs are good outcomes if the recommendations are adopted wholesale.
“One of the two most critical elements is the aspect of user choice as it will eliminate the care package brokering that currently exists in the marketplace, which ultimately dilutes both the quality of care and the remuneration received by the care-givers. The second major benefit of these reforms is encouraging our seniors to utilise their family home to care for themselves without fearing the loss of pension.”
Third Age Living@Springwood’s managing director, Chiou see anderson
“The Commission’s report delivered on Catholic Health Australia’s (CHA) three main expectations of providing better access to care, more choice in the type of services available, and financial sustainability to providers of care services.
“The first was that accessing aged care should be made simpler. If government sets up the proposed Australian Seniors Gateway, it will provide support to older Australians to access aged care in their home or in a residential service.
“The second is older Australians need better choice in the type of service they can access. If Government ends current rationing of residential and community care places, and instead makes aged care an entitlement, consumers will be better able to choose the types of services they want, which will often be to stay in their own home instead of entering a residential service.
“Finally, aged care providers who are today under financial pressure will be returned to sustainability if Government sets up the Australian Aged Care Commission with power to independently and transparently determine what services actually cost to deliver. When an independent body publishes an arm’s length assessment of what it costs to deliver care, no Government will be able to get away with funding aged care providers at levels below care cost delivery, which is the cause of financial pressures for many aged care services today.”
CEO of CHA, Martin Laverty
“The report follows on from the first with high-level dialogue that demonstrates a sound approach and is articulated to reflect the diverse views. I think the PC has demonstrated that they were serious in handling the responses to the draft and this is reflected in the fair representation of all stakeholders. I would be very surprised that any one group would commence criticism because I think you have to read it once and then go back again – there is so much to digest.
“It really is comprehensive. I cannot immediately identify any gaps. I read the report through a number of screens – hat one, as an approved provider of nine residential aged care services; the second as a Gen Xer who will be living through the entire process; and thirdly, as a professional.
“As an approved provider, my immediate desire was to go the funding sections and anticipate implications for our older aged care stock that still has a number of multi-bed wards, and also the implications for our new development that has an anticipated construction cost of $35 million. I think at a global level the report recognises both as independent issues…
“As a Gen Xer and consumer, I am greatly relieved the PC has made such a detailed effort and genuinely listened. I am optimistic and, as a citizen, expect reform to occur. Politics aside we must move through a considered but not laboured change process
“As a professional, I consider the sections on workforce and research and know that so much of the future is co-dependant on the passion our people have to see through the reform process and keep older people as the central focus and have an evidence-based pathway for that improvement focus.”
CEO of SummitCare, Cynthia Payne
“For Palliative Care Australia (PCA), the most critical element that has been included is the underlying tenet of ‘dying well’. This was something that was missing from the draft report and the PC listened to what we had to say and included this as a key part of the framework for assessing aged care.
“Up to 50,000 Australians approach death or die in residential aged care each year, so this was something that we felt very strongly about. The inclusion of the concept of dying well will, in our view, provide comfort to all Australians that they can expect to die with their preventable pain and other symptoms well managed, with the people they wish to be present and, wherever possible, in the place of their choice.
“A corollary to this is the recognition that palliative and end of life care should be a basic competency for aged care workers and GPs. We all know the expression – you don’t know what you don’t know – but we need to recognise its truth. If we don’t provide adequate education for all professionals delivering aged care, how can we expect them to know how to recognise need, and to act to provide the best possible end of life experience for those in need? And this is not just about pain and symptom management, although that is clearly a priority, we also need to appropriately address people’s cultural and spiritual needs, and the needs of their family and loved ones.
“Other real strengths of the report are that it is truly comprehensive and addresses the entire sector, that it promotes choice and flexibility, and that it introduces a real opportunity for dialogue between the aged care and health sectors. I also think that the concept of the gateway will be a welcome relief to many who have attempted to navigate the multiple sources of information and entrance points to the aged care system.”
Palliative Care Australia CEO, Dr Yvonne Luxford
“I think the final report rightly places consumer needs at the centre of a reform agenda and seeks a system that provides access and choice to all. The critical success criteria remains the importance of ensuring a sustainable industry where reform is implemented in a planned way, with ‘bite size’ chunks, and in collaboration between industry, government, consumers and key stakeholders.
“Reform is considered in a broad context by putting the consumer at the centre of the PC’s thinking, and then designing an aged care system to meet community needs. The PC has provided a comprehensive package which, with some fine tuning, can form the basis for a reform blueprint.”
Aged & Community Care Victoria’s CEO, Gerard Mansour
“I think the report is a great step forward for the aged care sector as it seems to cover off many issues, in particular the need for flexibility in the care models for the heterogeneous aged care community in Australia.
“It recognises the need for funding changes that take into account that heterogeneity and also provides opportunities for older Australians and their families to play a greater role in making those decisions.
“From my perspective the greatest strength is in the focus on consumer directed arrangements and flexibility, plus the idea of a gateway that informs and empowers individuals and their families to make informed choices.
“Linking the disparate entities that are currently involved in providing services to older Australians in a care co-contribution regime is also a positive. Finally the comments on technology are very promising, as they focus on removing the barriers to its adoption without being prescriptive of what the technologies are, which should allow for innovation.”
Australian general manger of Care Innovations, Dr George Margelis
“Overall Council on the Ageing (COTA) is very pleased with the final report. Its recommendations retain all the basic architecture of the complete system redesign recommended in the draft report; they provide more detail in some key areas; and in many cases they respond positively to suggestions made in submissions and hearings, such as in relation to The Gateway, cashing out of some respite, the equity release line of credit scheme, and a greater focus on end-of-life care.
“The strengths of the report are the outcomes that will be achieved for older Australians if its recommendations are substantially implemented.
“Those key outcomes include:
• We will move from a residential-focused to a community-focused system with most support and care provided in the home
• We will move from a rationed system to one in which people have an entitlement to support and care based on a professional and timely assessment
• Consumers and carers will have more control and choice about the support they receive, when and where; within a system that will continue to have robustly regulated quality standards and controls over support and care, and will focus much more on re-enablement and rehabilitation
• Consumers and carers who have the same means and are entitled to the same levels of support and care will pay the same user contributions and will receive the same levels of government support wherever they are in Australia
• No-one will any longer be forced to either sell their home or pay an accommodation bond, although many people will do both because it suits them, but the bond will likely be lower, its cost will be publicly known and the consumer or their estate will get 100% back
• Pricing of aged support and care will be independently recommended and will include fair and competitive wages for all staff in aged care.”
CEO of COTA, Ian Yates
“The PC report offers a blueprint for reform of the aged sector in Australia. It is a comprehensive and integrated package of initiatives. It addresses the major issues of improving access to services, providing choice for older people, flexibility in funding models and sustainability for the sector. For the first time, the whole sector is united in its support for the proposed reforms.
“There are a number of important elements of the proposed reforms. Firstly, there is the simplified front end to aged care: the Australian Seniors Gateway Agency where consumers can access information, be assessed for their care needs and financial capacity to contribute, receive an entitlement to approved services and be referred to providers.
“Secondly, there is the removal of supply constraints, phasing out the limits on the numbers of residential and care packages, removing the distinctions between high and low care and ordinary and extra services places.
“This will mean more access and greater choice for consumers. It will also provide challenges for providers in terms of developing sustainable business models to meet this competitive environment.
“Thirdly, there is an independent regulator, the Australian Aged Care Commission, that will regulate community and residential places, set and monitor pricing and handle complaints. These three initiatives form the architecture of the new reforms.”
CEO of Aged and Community Services Australia, Patrick McClure AO
“I think it is a monster of a document! Overall I think it does address most issues and am pleased. I might add that most of the consumer findings and wants are issues that we have already moved to address and indeed are getting great response as a result.
“The main strengths are that care suppliers will have to compete and thus improve their offering, while users get to decide who delivers care to them.
At the moment, community care packages are difficult animals to obtain in some parts unless you are one of the larger care groups. I don’t think they will let go easily but do think smaller operators like us will shine if we get a guernsey which we should when/if the customer gets to make the call!
“The most critical element for me is the fact that the report acknowledges that actual seniors should and will get to maintain a lot more independence and control over how they receive care and live their lives. This has been lacking for years and is demeaning and downright disrespectful in my view.
“So these new measures are a step in the right direction.”
Tall Trees director, Phil Usher
“It is pleasing to see the Commission has taken on feedback from services, advocacy groups, unions and older people themselves in developing its final recommendations to government. After decades of reviews, recommendations and neglect we now have a clear direction for comprehensive aged care reform.
“We will examine the report more thoroughly in the days and weeks ahead, however we are pleased our concerns in the draft report about workforce issues, transition arrangements and models of care for people living in rural and remote Australia have been addressed in more detail in the final report.
“The report’s recommendation to shift from a rationed aged care system to a system based on entitlement is one of the many strengths of the final report. Rather than being entitled to be on a waiting list, older Australians will be entitled to aged care services.
“We also welcome the report’s recognition that Indigenous Australians and rural and remote communities require special arrangements to meet their particular needs. There is a strong focus on strengthening community services which we believe are crucial to people remaining as independent as possible.
“More choice and flexibility in the sector is critical so recommendations about uncapping the supply of aged care services and future financing, if implemented, would deliver a robust and diverse aged care system without clawing away the family home or people’s pensions. The report also emphasises reform to care for older people in their community, which is where people prefer to be.”
“The final report is a bold blueprint. The critical success criteria still remains that any reform is implemented in collaboration between industry, Government, consumers and key stakeholders.
“In writing the report, the PC has considered reform in a broad context by putting the consumer at the centre of our thinking, then asking, how do we design an aged care system to meet community needs. The report is a comprehensive package.”
CEO of Aged Care Association Australia (ACAA), Rod Young
“Overall, the report represents a step in the right direction about how we can house and care for older Australians in the future. This is critical given population ageing and long term fiscal challenges we face to fund provision.
“Increasingly, the wellbeing of older Australians depends on choice – not only on their access to the care of their choice, but also the accommodation of their choice.
“As identified by the PC, the ability of the elderly to live where they want, as well as receive the care they prefer, will become increasingly important in maintaining their wellbeing.
“There are great opportunities, for operators of villages that choose the path, to deliver care into villages with fewer barriers than previously existed. In particular, some of the initiatives outlined could greatly assist the long-term operating models for serviced apartments, which can present very positive options for older people seeking more care in an apartment style living context.
“The report delivers some positive outcomes for the sector particularly:
• The Pensioner Savings Account that can enable people to downsize their accommodation and retain their pension
• The opportunity to deliver community care more effectively into retirement villages and
• Consumer directed care that can allow more flexibility in funded service provision which could assist the serviced apartment market in the sector.”
CEO of Retirement Villages Association, Andrew Giles
“I think the final report is great. If these reforms get up it will mean some significant change for the industry but it will also present some very significant opportunities for providers to diversify their client and revenue base.
“After the draft report was published, we held a series of stakeholder forums with PKF and ACCA where we collected feedback on the report. It is fair to say that the PC in its draft report has clarified their position on nearly every issue that was raised.”
Hynes Lawyers partner, Julie McStay
“The PC states clearly that all aged care workers deserve fair and competitive wages. This includes personal carers, community care workers and support workers. The PC agrees with United Voice (UV) that government must ensure that aged care prices are set at a level that allows for payment of fair and competitive wages.
“They agree with UV that increased funding is just the start and that conventional enterprise bargaining has not lifted wages.
“It is promising that the establishment of the Australian Aged Care Commission (ACCC) has been brought forward to the first stage of suggested reform implementation timeframe.
“The ACCC is the mechanism by which scheduled care prices will be set and the PC has made it clear that care prices need to allow for the payment of fair and competitive wages to all aged care workers.
“…The PC states clearly that all aged care workers deserve fair and competitive wages. This includes personal carers, community care workers and support workers. The PC agrees with United Voice that government must ensure that aged care prices are set at a level that allows for payment of fair and competitive wages. They agree with UV that increased funding is just the start and that conventional enterprise bargaining has not lifted wages.”
Assistant national secretary of United Voice, Sue Lines