Aged Care Legislated Review – Ethnic Communities’
Council of NSW
Table of Contents
1.Tell us about you
1.1What is your full name?
1.2What stakeholder category do you most identify with?
1.3Are you providing a submission as an individual or on behalf of an organisation?
1.4Do you identify with any special needs groups?
1.5What is your organisation’s name?
1.6Which category does your organisation most identify with?
1.7Do we have your permission to publish parts of your response that are not personally identifiable?
2.Response to Criteria in the Legislation
2.1Whether unmet demand for residential and home care places has been reduced
2.2Whether the number and mix of places for residential care and home care should continue to be controlled
2.3Whether further steps could be taken to change key aged care services from a supply driven model to a consumer demand driven model
2.4The effectiveness of means testing arrangements for aged care services, including an assessment of the alignment of charges across residential care and home care services
2.5The effectiveness of arrangements for regulating prices for aged care accommodation
2.6The effectiveness of arrangements for protecting equity of access to aged care services for different population groups
2.7The effectiveness of workforce strategies in aged care services, including strategies for the education, recruitment, retention and funding of aged care workers
2.8The effectiveness of arrangements for protecting refundable deposits and accommodation bonds
2.9The effectiveness of arrangements for facilitating access to aged care services
3.Other comments
1.Tell us about you
1.1What is your full name?
-
1.2What stakeholder category do you most identify with?
Peak body - provider
1.3Are you providing a submission as an individual or on behalf of an organisation?
Organisation
1.4Do you identify with any special needs groups?
People from culturally and linguistically diverse (CALD) backgrounds
1.5What is your organisation’s name?
Ethnic Communities’ Council of NSW
1.6Which category does your organisation most identify with?
Aged Care Provider Peak Body
1.7Do we have your permission to publish parts of your response that are not personally identifiable?
Yes, publish all parts of my response except my name and email address
2.Response to Criteria in the Legislation
2.1Whether unmet demand for residential and home care places has been reduced
Refers to Section 4(2)(a) in the Act
In this context, unmet demand means:
•a person who needs aged care services is unable to access the service they are eligible for
e.g. a person with an Aged Care Assessment Team / Service (ACAT or ACAS ) approval for residential care is unable to find an available place; or
•a person who needs home care services is able to access care, but not the level of care they need
e.g. the person is eligible for a level 4 package but can only access a level 2package.
Response provided:
CHSP networks and services have continued to report a significant demand for a greater number of Level 3 and Level 4 HCP’s to meet the high needs of our ageing population, however current availability is limited. As a result, consumers are redirected to access lower level packages until package level 3 & 4 become available. This has created a number of issues in the sector. Firstly, from the onset of the assessment and service, the clients do not receive the appropriate level of care resulting in unmet care needs until more appropriate packages become available. The second concern being that lower level packages are designated to high needs clients resulting in less Level 1 & 2 packages available for consumers with entry level and low care needs. As a result, the clients are placed on waiting lists until a package becomes available and thus at risk of becoming high risk clients without early intervention or immediate care support.
CHSP services are experiencing demands for services and pressure to meet higher care needs of people who should be on packages but are not transitioned, identified or do not take packages due to the additional costs and fees. More resources and support is required to assist CHSP to identify and assist to transition clients to appropriate levels of care, however this is only possible if the appropriate number of packages are released and are available otherwise the customers will remain in the CHSP system.
Benchmark uptake of CALD clients- We raise concerns for the future CDC package allocation system that does not designate minimum Aboriginal or CALD specific packages rather promotes generalist packages for all clients entering the system. In theory, the new CDC package system allocation seems like an equitable and consumer driven approach, however in practice CALD services and agencies have identified limitations and access issues with the new open market process. Currently, CALD packages are allocated to meet minimum benchmark requirements and ensure CALD consumers are supported to enter the system. We are aware of the multiple complex cultural and language issues which affect access for CALD consumers and result in less uptake of CALD consumers in the aged care arena. To address this, the service provides actively sought to have the packages filled when there were vacancies. CHSP and aged care services were actively engaged and informed of vacancies and actively sought to identify and transition clients into packages. Quite often these clients were eligible for higher care need but were not identified by the assessment system earlier. As of February 2017, the “active pursuit to engage CALD consumers through vacancies will not occur as benchmark or minimum CALD packages or monitoring of CALD uptake will not be possible by the sector. Strategies and mechanisms need to be put in place to assist the sector to monitor CALD uptake of packages and ensure CALD consumers do not become a minority in the CDC system.
Appropriate residential places available for CALD Clients – The ECCNSW and its members are raising concerns regarding the number of CALD clients who are unable to secure appropriate residential care places appropriate to their cultural, spiritual and language needs. CALD specific and multicultural residential care places are limited and vacancies are filled immediately due to demand. Mainstream services are not the preferred choice of CALD consumers. Appropriate CALD residential places are essential for those with complex needs, victims of torture and trauma, language difficulties or reverting back to their language due to the onset of dementia. We strongly advise the continuation of funding for CALD specific residential care facilities places which are the CALD consumers preferred choice of care in later stage of life.
2.2Whether the number and mix of places for residential care and home care should continue to be controlled
Refers to Section 4(2)(b) in the Act
In this context:
•the number and mix of packages and places refers to the number and location of residential aged care places and the number and level of home care packages allocated by Government; and
•controlled means the process by which the government sets the number of residential care places or home care packages available.
Response provided:
Controlled allocation and distribution is important however we question the current method of allocation used by the Commonwealth to determine package number and mix. To date the number of packages released does not accurately reflect the current demand rather it seems to reflect demographic or local planning statistics. Utilising the expertise of ACAT, RAS’s and CHSP service data would be able to provide data more reflective of the demand and needs on the ground. The CHSP and Sector Support and Development Programs would also be able to identify trends, changes and shifts in client needs as they arise assisting the Commonwealth to be more timely and responsive. For this to be effective, CHSP and service providers need to be trained and linked into the monitoring process, report demand and needs on a regular basis and feed directly into the Commonwealths planning processes.
There is also significant concern regarding the number of service providers who have the capacity to adequately provide high package care and competency with CDC, wellness and restorative approaches. More investment and time is required to build and train a skilled, responsive and adaptive service system with service providers that can provide various levels of packaged care in both metropolitan and regional areas. Regional areas are reporting limited mix of high level packages as service providers in their area are not able to deliver high care needs due to unskilled staff, lack of resources and organisational limitations. This is forcing older consumers to accept lower care packages or relocate to other areas to be able to receive appropriate services. The Commonwealth may need to consider a mapping study to scope the distribution of level 1, 2 3 and 4 packages across NSW and regional areas and to invest training, resources and support to regions who need to develop the infrastructure, service models and skilled staff to begin to service their region appropriately. Accessible and equitable services are currently not an option or choice for consumers in these areas due to lack of availability.
2.3Whether further steps could be taken to change key aged care services from a supply driven model to a consumer demand driven model
Refers to Section 4(2)(c) in the Act
In this context:
•a supply driven model refers to the current system where the government controls the number, funding level and location of residential aged care places and the number and level of home care packages;
•a consumer demand driven model refers to a model where once a consumer is assessed as needing care, they will receive appropriate funding, and can choose services from a provider of their choice and also choose how, where and what services will be delivered.
Response provided:
A consumer demand driven model is valuable when consumers are well informed, supported and resourced to make empowered decisions about their aged care needs and actively seek the services they require. In many cases, older people entering the aged care system are reporting they are overwhelmed, confused and are challenged with navigating the current aged care system. When it comes to CDC, often their choices and preferences are unable to be provided as they transition from CHSP to package support. For many moving to a HCP means withdrawing from the CHSP service they have received and developed a rapport and trust with. For many CALD consumers, their current CHSP with their CALD services provide them with entry level care with the support of appropriate bilingual support systems in place which allows them to stay at home longer and safer and remain out of long term residential care. Moving to HCP means they must withdraw from these trusted services and move to new arrangements which often cost more, are with new service providers that do not have culturally trained or responsive workforce and are more complex to manage and understand.
This is experienced more so by CALD consumers. It is with the help of skilled and trained bilingual and bicultural aged care workforce that consumers are supported and directed to receive the right support services that they need and are available. Without the active navigation and support of CHSP and aged care workers, the consumers would not be able to identify services to effectively drive the market or influence demand. Comparatively, a market driven purely from supply allocation driven by the Commonwealth and based on demographical/ regional data will also not provide an adequate allocation of funding or numbers to effectively meet and respond to the growing and emerging needs of our ageing population. The demography does not reflect emerging needs, minority groups, consumer preferences, diversity of services available, underrepresented special needs groups etc. It is recommended that direct allocation driven is supported by sector feedback and consumer consultation which would collectively be required to provide more effective allocation figures.
Concerns are also raised about the capacity of My Aged Care call centre staff that may play a role in documenting and reporting on consumer demand and needs. The SSD and MAPS officers continue to receive complaints that call staff are unable to adequately accept and correctly categorise aged care needs of consumers who call the contact centre. This is particularly the case for special needs groups and CALD consumers. Call centre staff in many instances are unable to facilitate discussions which direct the callers to the right services or assessments. Often the RAS and ACAT assessors are given incorrect information about the client’s personal details, requests or aged care needs. To reduce the errors and loss of time providing services, the My Aged Care call centre staff need to be provided with extensive aged care and cultural competency training to be able to facilitate effective discussions at the initial point of entry so that accurate data and information can be collected and provided to assessors, and service providers.
2.4The effectiveness of means testing arrangements for aged care services, including an assessment of the alignment of charges across residential care and home care services
Refers to Section 4(2)(d) in the Act
In this context:
•means testing arrangements means the assessment process where:
- the capacity of a person to contribute to their care or accommodation is assessed (their assessable income and assets are determined); and
- the contribution that they should make to their care or accommodation is decided (their means or income tested care fee, and any accommodation payment or contribution is determined).
Response provided:
To provide an equitable and accessible aged care system, fair means testing needs to consider consumers who are experiencing hardship, temporary challenges, cost of living in metropolitan cities vs regional towns, medium cost of housing , whether they are receiving housing or accommodation support or paying their own mortgage or rent, other medical conditions and costs, extra expenses related to health and wellbeing, medical conditions which may be associated with costly medication and other circumstances which will affect the individual or couples expenses and available income.
Many consumers are withdrawing from aged care services and packages due to the costs associated. As a result, they are presenting in hospitals and emergency services as at risk and require crisis support for aged related issues which could have been avoided with basic aged care support systems in place. There is also great need to provide greater education to ageing communities to better understand fees policies and structures so that they can pre-plan for their future aged care needs. Forward planning needs to begin with people over 50 years of age who are planning for their retirement and are currently supporting their own older parents and family members. Educational session should also include financial advice, legal advice regarding wills and power of attorney etc.
2.5The effectiveness of arrangements for regulating prices for aged care accommodation
Refers to Section 4(2)(e) in the Act
In this context:
•regulating prices for aged care accommodation means the legislation that controls how a residential aged care provider advertises their accommodation prices.
Response provided:
There is a strong view in the sector that there needs to be greater transparency in the way in which residential care providers advertise and promote their accommodation prices. For many consumers, entering residential care is often a decision made out of need or necessity with often short time frames and during crisis intervention. Comparable prices and services which can be easily accessed and allow families to make informed decisions about residential care is imperative during these critical periods. This includes transparent information about hidden costs such as exit costs, additional service costs, basic services vs options, room sharing, additional aged care therapy’s such as physiotherapy or hydrotherapy, alternative meals and activity options etc.
Transparent and clear accommodation prices and options will mean consumers identify the most appropriate aged care facility from the beginning which results in less complaints, less withdrawal and relocation to other residential care facilities and allow the consumer to make more holistic and long term goals about their care.
2.6The effectiveness of arrangements for protecting equity of access to aged care services for different population groups
Refers to Section 4(2)(f) in the Act
In this contextequity of access means that regardless of cultural or linguistic background, sexuality, life circumstance or location, consumers can access the care and support they need.