The Australian Government subsidizes residential and community aged care to a large extent, with care recipients making co-contributions through daily charges, which are taken out of their pension and/or private income subject to means-testing.
Accommodation and living costs can also be covered through accommodation bonds, which are only available for ‘low’ care (formerly known as hostels), or Extra Service places which, as the name suggests, offers more 'hotel' like services in high care or nursing home places. Owners of residential aged care facilities invest the bonds and use the return and retention amount (part of the principal) to fund capital costs associated with housing residents. The current average bond is $233,000. Bonds are generally funded through the sale of the care recipient’s home.
The aged care industry has been saying for years that its funding for both hostels and high-care nursing homes needs to be significantly increased. Several formal inquiries and reviews have focussed on this issue. These inquiries and reviews have looked at the issue of funding in the absence of cost-and-quality benchmarks, assuming that currently the quality of aged care is adequate.
Given the inadequacy of the formal standards of aged care and the way compliance with them is assessed, it could be argued that Australians do not know whether the quality of aged care is good, bad or indifferent and whether they are getting value for money in aged care.
The recent Productivity Commission inquiry Caring for Older Australians makes draft recommendations about ways of increasing care recipients’ financial contributions to the cost of their care and the cost of accommodation and living if in residential care. The inquiry, as so many inquiries before it, looks at funding in isolation, ignoring quality issues.
The Productivity Commission recommends that residents should pay higher contributions by using the equity in their house, either by selling their house or by reverse mortgaging it.
While there are many practical problems associated with making equity release work as a significant funding source for aged care, CPSA is fundamentally opposed to forcing people who have no other significant assets to sell or reverse mortgage their home to pay for residential or community aged care. Their home is all they have got and it is something they have worked long and hard for. They need to keep control of their home ownership for as long as they want or need to for the sake of their dependant/s.
An independent analysis of the cost of care, including community care should be carried out to set appropriate benchmarks for aged care subsidies.
If it is demonstrated that residential aged care is underfunded, CPSA supports the adoption of an insurance scheme along the same line as that being proposed to fund disability services.
The Aged Care Standards and Accreditation Agency Ltd (ACSAA) is responsible for accrediting residential and community aged care providers and for monitoring their compliance with aged care standards. The Board of Directors consists of people with expertise in aged care, including staff employed by aged care providers.
The Board of Directors of Aged Care Standards and Accreditation Agency should not have members who are employed by an aged care provider and who, therefore, have an inherent conflict of interest in monitoring the performance of the provider industry that employs them.
Australia’s nursing homes operate under an accreditation and compliance monitoring system. Compliance monitoring tends to focus on nursing homes having administrative and operational systems in place to deliver quality aged care. Aged care providers are able to nominate a specific auditor to conduct the full three-yearly audit. The existence of systems is usually demonstrated by showing aged care auditors documentation. Where systems are in place and where no evidence exists that systems are not used or do not work, a nursing home will receive a tick. Where nursing homes fall short, they can be sanctioned. There have been cases where nursing homes, which had been recently audited, came to public attention as a result of incidents caused by serious neglect or systemic misconduct.
Continued accreditation of nursing homes and compliance monitoring of nursing homes’ performance should focus on outcomes: that is the wellness and wellbeing of residents rather than on processes such as administrative and operational systems.
Audits of aged care services should be carried out by randomly selected assessors and the ability of aged care providers to nominate an auditor for an accreditation audit should be abolished.
Unannounced visits, colloquially known as spot checks, are subject to restrictions. They can only be conducted during business hours, notice must be given even if it is just in advance of the visit and aged care providers are able to refuse admission to auditors.
Spot checks should enable auditors to obtain a snapshot of normal operations in an aged care facility and should therefore be able to be conducted at any time without any notice.
Investigation of only one-in-eight complaints made to the Aged Care Complaints Investigation Scheme (CIS) identifies a breach of aged care regulation. The CIS is located in the Department of Health and Ageing. The Aged Care Commissioner, also located in the Department, can review decisions made by the CIS, but cannot override them. The Commissioner can only make non-binding recommendations. It is also common practice to refer complaints to the relevant aged care provider for internal investigation and to notify providers of complaints investigated externally.
The Aged Care Complaints Investigation Scheme should be overhauled to ensure its operations reflect best-practice in complaints handling and to ensure its independence.
Specifically, the privacy of complainants should be respected, that is, aged care providers should not be notified of complaints made against them.
Also, complaints made to the Aged Care Complaints Investigation Scheme, particularly where serious abuse or neglect is alleged, should not be referred to aged care providers for internal investigation.
There is a dearth of public information about individual aged care facilities. There is no requirement for facilities to make public information about service fees charged, including accommodation bonds, nor is there a requirement for facilities to make public their audited accounts. The lack of transparency in the aged care sector leaves the consumer unable to make an informed decision about nursing homes and stymies public scrutiny.
Up-to-date information about individual nursing homes’ fees and charges and about accommodation bonds should be made publicly and readily available;
The audited accounts of nursing homes should be made publicly and readily available;
Government subsidies received by aged care providers should be acquitted against actual expenditure and this information should be made publicly and readily available;
All accreditation and compliance monitoring reports compiled by the Aged Care Standards and Accreditation Agency should be made publicly and readily available.
Adequate staffing levels and correct skill mixes improve care and quality of life outcomes for residents in homes. The current accreditation system relies on an assessor’s determination of what is an appropriate staffing configuration. Assessment of staffing levels involves in part looking at rosters and observing activity in the home during the visit. As there are no checks on homes at night, the only way to examine night staffing levels is to look at rosters and question staff about their workloads.
The wage gap between nurses working in hospitals and nurses working in aged care goes a long way in explaining why the aged care sector has trouble attracting nurses.
Mandatory staff to resident ratios should be used in aged care facilities to ensure quality of care and lifestyle of residents are achieved and maintained.
Inadequate remuneration for nurses working in aged care must be addressed.
Home care services are underfunded, meaning that many older people cannot access a sufficent number of hours of home care or have no other choice but to go into residential aged care. It has been widely acknowledged that home care services prevent or delay going into a nursing home, improve the health and wellbeing and supports older people's participation in their community. For these reasons, home care services should be better funded so as to meet demand and prevent early admission into residential aged care or acute care.