Aged Care Legislated Review – Advocare
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 - consumer
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?
Nil
1.5What is your organisation’s name?
Advocare Incorporated (located in Western Australia)
1.6Which category does your organisation most identify with?
Consumer 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:
Still a significant issue in regards to access to high level care packages. Clients who are assessed for a Level 4 Package often have to go onto a Level 2 package and wait for a Level 4 to become available, which can take a long period of time. Demand will increase over time. Affordable places are still an issue in residential care. If you don’t have capital i.e. don’t own a house that you can sell then your options are extremely limited. Limited fully funded beds which are also often in a facility where the standard of care and the quality of the facility are on the lower end.
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:
It should remain controlled particularly in the areas of fully funded beds and Level 4 packages. A free enterprise system would disadvantage a lot of people.
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:
Tighter regulation of fees charged to clients by service providers. In some cases over 50% of allocated funding is taken up by fees and charges with little transparency as to what those fees and charges actually relate to. Extra fees for other things such as brokering in cheaper outside services are also causing disadvantage to clients. Require improved flexibility of packages. Better communications – web based/online communications are not working and things will get worse as some aged and frail people who need these services have limited computer literacy skills – this means the services they can access are restricted. Require better education for service providers on embracing consumer-driven models. Many service providers are struggling to provide client directed services and are still controlling how funding in a package is spent, and what services a client can access. Service providers are making it prohibitive to broker-in outside services that may be less expensive, by charging large fees, both one off and annual, to broker in services. This is on top of the administration and case management fees already being taken out of the package.
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:
People do not understand what either means testing is or the process they have to follow, and there is a lack of support to assist people to complete their income and assets form for Centrelink. If you provide the incorrect information it is very difficult and time consuming to get it reviewed. Older people need face-to-face or telephone consultation. The time it takes to receive information about the outcome of assessments can be protracted and has caused financial disadvantage for some clients who are charged full means-tested fees until the notification comes through. Outcomes have sometimes not been sent to the service providers directly, further delaying resolution.
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:
Nil
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.
In this context different population groups could include:
•people from Aboriginal and/or Torres Strait Islander communities;
•people from culturally and linguistically diverse (CALD) backgrounds;
•people who live in rural or remote areas;
•people who are financially or socially disadvantaged;
•people who are veterans of the Australian Defence Force or an allied defence force including the spouse, widow or widower of a veteran;
•people who are homeless, or at risk of becoming homeless;
•people who are care leavers (which includes Forgotten Australians, Former Child Migrants and Stolen Generations);
•parents separated from their children by forced adoption or removal; and/or
•people from lesbian, gay, bisexual, trans/transgender and intersex (LGBTI) communities.
Response provided:
In regional, rural and remote areas in WA there are limited options available for both home care and residential care. Indigenous older people are being relocated away from Country and family which has serious implications for their health and wellbeing. Sometimes when an Indigenous person dies the family are not told and the person is buried away from Country, then the family has the responsibility of relocating the body. Some service providers and people in decision-making roles do not understand the kinship relationships of Indigenous families and are obtaining “authority” to make decisions from culturally inappropriate sources. Instances of placing traditional-speaking older people in environments where their language is not available, which socially isolates them. Some are seeing these types of inappropriate interventions/actions as creating a new “Stolen Generation”. Lack of culturally appropriate service provision e.g. someone who only speaks Italian is visited by a non-Italian speaking staff member, which presents issues for them in being able to express their needs. The quality of services accessible to those who are financially or socially disadvantaged is often significantly lower than those that have resources. The lack of fully funded beds also results in difficulties to access services when required. Disadvantaged people also experience difficulty in gaining access to additional services and supports that may be above their home care package budget, leading to them entering into RACFs prematurely e.g. younger people being forced into care. For people who have been long-term homeless, there is a lack of understanding of the impact of living rough and then being placed in an environment that is extremely regulated and often restrictive i.e. placing them in a secure facility. DVA clients do not have access to independent advocacy services. Some people who have experienced trauma in care as children do not necessarily wish to enter another institutional environment – there is the potential that they will experience PTSD etc. as a result of their experiences Still a reluctance by LGBTI community to access aged care services and to feel safe about disclosing their sexuality or gender identity. Sometimes residents and family members of LGBTI people experience discrimination from other residents and staff. Many older people LGBTI people feel the need to “go back in the closet” to feel safe. Regardless of who you are, your cultural background, gender, sexuality etc. you are entitled to equal and high quality, non-discriminatory services. Lack of understanding of the histories of LGBTI people creates barriers to appropriate support. If someone has little family or social support it can be difficult finding help to access aged care facilities, especially in regards to assistance in filling out paperwork and agreements. For people with little mobility, it is difficult to visit facilities to determine if they would suit, and the only services that can assist with this are fee-for-service and the cost is prohibitive for people on a low income.
2.7The effectiveness of workforce strategies in aged care services, including strategies for the education, recruitment, retention and funding of aged care workers
Refers to Section 4(2)(g) in the Act
In this contextaged care workers could include:
•paid direct-care workers including nurses personal care or community care workers, and allied health professionals such as physiotherapists and occupational therapists; and
•paid non-direct care workers including: managers who work in administration or ancillary workers who provide catering, cleaning, laundry, maintenance and gardening.
Response provided:
If these are commonly in place, their effectiveness is questioned. Many facilities are reliant on agency staff which means there is a lack of consistency for care recipients. This is especially problematic in facilities providing services to people living with dementia where a constant influx of new staff can lead to distress. It also means there is less opportunity for staff and residents to form meaningful relationships and to build trust, which improves care outcomes and the quality of life for residents. There has been a reduction in funding for allied health services in care, such as OT and physio. These services are crucial for maintaining independence and quality of life.
2.8The effectiveness of arrangements for protecting refundable deposits and accommodation bonds
Refers to Section 4(2)(h) in the Act
In this context:
•arrangements for protecting refundable deposits and accommodation bonds means the operation of the Aged Care Accommodation Bond Guarantee Scheme.
Response provided:
A Government guarantee, as well for unpaid aged care fees. Family members are having to act as guarantors for fees and charges in aged care facilities. Families may not want to do this. Potential residents may not have family to act as guarantors. Facilities can refuse to accept a person into their care if they don’t have a guarantor and some Aged Care Service Industry organisations are encouraging this practice, so that facilities can protect themselves from unpaid fees. However, this can prohibit eligible people from being able to access the aged care facility of their choice or one that is the most appropriate to their needs.
2.9The effectiveness of arrangements for facilitating access to aged care services
Refers to Section 4(2)(i) in the Act
In this contextaccess to aged care services means:
•how aged care information is accessed; and
•how consumers access aged care services through the aged care assessment process.
Response provided:
Better communication is required – a one stop shop. Making information accessible in hard copy (printed and downloadable) in multiple languages. Online resources are not accessible for some people who need aged care services. Better training and information for people in the community who may be making referrals for aged care services, such as GPs and Allied Health. Support for people to explore aged care options in their area, and preference given to people who live in the area so they can stay connected with their communities. Not enough support to view possible aged care facilities if there is no family support. There is also not enough support to fill in applications if there is no family.
3.Other comments
Response provided:
The lack of regulation over additional costs that are being put in place above and beyond the basic daily fee, the RAD, and the DAP. Some services put additional costs in place as a compulsory cost e.g. RACF instituting an additional fee for newspapers, fresh fruit, wine, internet, access to the library etc. which is compulsory for all residents entering a particular facility whether they access or benefit from these services or not. This means the cost of care is beyond what remains in someone’s pension once they have paid the BDF. In one particular chain of RACFs the fees can range from $140 to $210 per week. Any additional fees for additional services beyond the basic level should be an opt-in system. It is occurring because the legislation in this regard is open to interpretation – providers are getting around having to gain approval from the Department of Health for charging extras by disguising it as a marketing initiative. The facilities should better provide up to date information on bed availability and this information should be made available on platforms other than online. The aged care sector is becoming very risk-averse to the point that it is impacting on clients’ dignity of risk. The legislation does not require services to be innovative, or promote a truly person-centred service. Support and incentives need to be offered for service providers who are providing flexible, innovative care that is driving quality of life and independence for its clients.
Advocare wishes to acknowledge the following staff for their contributions to this submission: Angela Van Dongen, Deborah Costello, Brianna Lee, Tiffany Ugle, Hazel Mangazva, Wendy Bennett, Andy McMillan, Val Hansen and Ann Canham.
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