While considerable challenges persisted for the aged care sector in 2022, the year will be remembered as a period of major reform for the industry.
The new year didn’t get off to the best of starts for the aged care workforce, as the Omicron wave of Covid continued to spread like wildfire throughout aged care homes.
As sister website Australian Ageing Agenda reported in January, the virulent strain of the coronavirus piled the pressure on an already “exhausted” and “demoralised” workforce, impacting on people’s mental health – as did the extended hours, staff shortages, and a lack of protective equipment.
According to a United Workers Union survey of more than 900 aged care workers, almost 80 per cent reported feeling “stressed” by the ever-changing demands of the pandemic and the ever-increasing death toll.
However, despite almost 600 aged care deaths since the Omicron strain emerged in November 2021, the then Minister for Senior Australians and Aged Care Services Richard Colbeck denied the sector was in crisis.
While appearing before a Senate Select Committee on Covid-19 early January, Mr Colbeck was asked whether he accepted that the aged care sector was in complete crisis, Mr Colbeck replied: “No, I don’t accept it is in complete crisis.”
Mr Colbeck’s remark caused uproar and prompted calls from Labor for him to resign. “Today I’m angry,” said then Opposition leader Anthony Albanese. “I’m angry because I’ve spoken to the families of aged care residents who’ve had enough. Richard Colbeck must resign today. If he doesn’t resign today the Prime Minister should sack him.”
Meanwhile, the United Workers Union posted on Twitter: “What does the aged care minister do when finally called to account about deaths in aged care? He denies there is a crisis.”
As StewartBrown reported, the sector was also in a financial crisis. As the aged care sector benchmarking firm’s latest financial performance report showed, aged care homes on average were operating at a loss of $7.30 per bed per day in the first quarter of the 2021-22 financial year.
Speaking to AAA, senior partner at StewartBrown Grant Corderoy said: “Everyday living services when you include administration are still running at a significant loss … so residential aged care has got some significant issues.”
As Omicron continued to wreak havoc in aged care facilities across Australia — and following pleas from unions and peaks – the Australian Defence Force was placed on standby in February. Operation Covid-19 Assist was to provide “targeted support” to sites in “acute situations”.
“The pandemic is magnifying the structural deficiencies in the aged care system,” then Leading Aged Services Australia CEO Sean Rooney told AAA at the time.
Later that month, the mooted merger of Australia’s peak aged care service providers entered the next phase with the formation of a steering committee to oversee the construct and application of the, as yet, unnamed new entity.
Acting on a recommendation of the royal commission, the boards of the industry’s two peak bodies – Aged and Community Services Australia and Leading Age Services Australia – had earlier decided to establish a new peak model, inclusive of the aged care industry as a whole. “It’s about creating one voice, committee chair Claerwen Little told AAA.
One of many reforms scheduled to commence in 2022, was a new funding model for the sector – the Australian National Aged Care Classification.
However, an industry report showed aged care providers were ill-prepared for the incoming model and pessimistic about the readiness of information systems.
By early March, Covid – coupled with chronic understaffing – had left many aged care workers “fast-losing hope”, according to a survey conducted by the Australian Nursing and Midwifery Federation.
“Most concerning for the ANMF and indeed, the whole community, is the number of aged care staff who reported that they will leave their jobs – that’s years upon years of experience just walking out the door,” said ANMF national secretary Annie Butler.
As if Covid wasn’t enough to cope with, some providers had to deal with catastrophic floods that swept through northern New South Wales and south-east Queensland, severely impacting aged care homes.
One, RSL LifeCare’s Fromelles Manor site in Lismore, had to be evacuated as flood waters reached peaks of 14 metres. “The situation in Lismore is pretty dire,” RSL LifeCare CEO Graham Millett told AAA. “Entire streets have been wiped out and literally thousands of people have been evacuated – our staff and residents among them.”
Meanwhile, in south-east Queensland, Bolton Clarke’s Fairview facility was isolated by flood waters. Fairview staff, along with police and swift water teams, ferried relief staff to support the site’s 113 residents.
“I’ve witnessed some incredible examples of courage and commitment to our residents and clients over the past few days,” said Bolton Clarke Group CEO Stephen Muggleton.
The federal budget handed down at the end of March included an additional $468 million, bringing the total reform package to $18.8 billion.
The budget also revealed the AN-ACC starting price: $216.80 – a key piece of information the sector had been lobbying for to plan for the next financial year. A $2.5 billion package to overhaul the aged care sector was at the core of Labor’s Budget reply last night.
Meanwhile, in its budget reply, the Labor party offered the sector a $2.5 billion package to overhaul the industry.
The opposition also committed to:
- a fully funded wage increase for workers
- registered nurses on site 24/7
- an increase in carers
- higher food standards
- more funding for the Aged Care Quality and Safety Commission.
Released early April, the StewartBrown December 2021 Aged Care Financial Performance Survey spelled more doom and gloom for the beleaguered sector showing three in five homes making a loss.
It found that providers on average were making an operating loss of $10.31 per bed per day. “It’s no surprise it was worse than the first quarter, but it’s a surprise it is significantly worse than the first quarter,” Mr Corderoy told AAA.
On 10 April the federal election was called and polling day announced for the 21 May. While maybe not exactly front and centre of the 2022 campaign, aged care was certainly in the spotlight.
Council on the Ageing Australia chief executive Ian Yates was happy to see aged care had become an election issue. “Having an election competition on aged care commitments is a good thing, even if aged care really should be bipartisan. It will help focus attention,” Mr Yates told AAA.
Also helping to focus attention was the announcement that at least 7,000 aged care staff working for some of Australia’s largest providers were to go on a nationwide strike amid increasing anger over low pay and staff shortages.
“Aged care workers are being forced to take unprecedented strike action because of pay and conditions that are failing workers and failing residents,” said United Workers Union aged care director Carolyn Smith.
It wouldn’t be the last day of industrial action by aged care workers – three more strikes followed in May and June.
Early May saw the reveal of the sector’s new consolidated peak body – the Aged & Community Care Providers Association name and logo at the 2022 – and final – ACSA National Summit in Adelaide.
ACCPA’s purpose, steering committee chair Claerwan Little told delegates, “is to lead, advocate and provide support, advice and guidance to aged care providers so that older Australians can lead their best lives.”
A report from the Ageing Research Collaborative at the University of Technology Sydney which took a deep dive into data from StewartBrown’s financial performance survey made grim reading for providers.
The researchers’ findings showed more than 60 per cent of aged care facilities operating in the red during the first half of 2021-22 with an average deficit of $339,000 or $11.34 per resident per day – more than double the average deficit of $5.33 recorded in the previous year. “Aged care providers are facing an acute threat to their financial viability,” report author Dr Nicole Sutton told AAA.
On 23 May, Labor leader Anthony Albanese was sworn in as the nation’s new prime minister after the party’s election win at the weekend saw it take power from the Coalition.
Aged care was a high priority for voters and they will be expecting the Labor Government to deliver on its promises, ACCPA interim CEO Paul Sadler told AAA. “They know what needs to change and we expect it to remain topical as people look to hold the new government accountable in its early days.”
The first day of June saw Mark Butler sworn in as the Minister for Health and Aged Care.
No stranger to the aged care portfolio, Mr Butler held the post of Minister for Mental Health and Ageing from September 2010 to July 2013 under prime ministers Julia Gillard and Kevin Rudd.
In the outer ministry, Anika Wells became the Minister for Aged Care as well as the Mnister for Sport. Speaking to the ABC, Ms Wells said: “I feel very honoured that I have been given such a big reform task in the Albanese Labor Government and I am looking forward to getting started.”
While life had returned to a semblance of normality in the community as Australia moved on from COVID, the pandemic was still very much at play in aged care homes.
Speaking to AAA, Whiddon CEO Chris Mamarelis said: “We’re still seeing a lot of challenges – in the context of the workforce in particular … both in terms of shortages and the wellbeing of the workforce.” Workforce stress was “the one problem we don’t have all the answers for – I hate to say it but it’s a reality.”
If unaddressed, workforce pressures, financial losses, and an ageing population will create an unsustainable aged care system, according to another bleak report from the UTS Ageing Research Collaborative.
“The discussion needs to start with broad recognition that the government’s budget is under great stress and that the situation isn’t likely to get much better over the next 40 years,” said Dr Sutton.
July saw the announcement of the new peak body’s inaugural CEO when Tom Symondson was names as ACCPA chief.
“The sector is facing many challenges, not least the incredible strain on our workforce after more than two years of a global pandemic and the huge financial strain on providers,” said Mr Symondson. “But there are also so many opportunities to work together with our members and governments across the country to build a sustainable future for aged care.”
The end of July saw the Albanese Government introduce legislation to deliver on its election commitments to fix the aged care crisis and respond to the royal commission’s recommendations.
Two bills were presented before parliament: the Aged Care Amendment (Implementing Care Reform) Bill 2022 and the Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022.
“We are wasting no time getting on with the job with fixing the aged care system,” said Prime Minister Anthony Albanese. “The introduction of this legislation is the first step towards delivering new funding, more staff and better support to the sector, while improving transparency and accountability.”
However, it was back to the drawing board for the redesign of the reformed in-home care and support program as the government announced a 12-month delay to the 1 July 2023 start date set by the previous government.
Speaking exclusively to AAA, Minister for Aged Care Anika Wells said: “Home care is a big reform project. I want to make sure that we do it right. In all the meetings I’ve had so far with people they’ve been saying, ‘it needs more work, we want more consultation, we’re worried about it.’”
August started well for the sector, with the Aged Care and Other Legislation Amendment Bill passing through both chambers of the house.
Responding to 17 recommendations of the aged care royal commission’s final report, the bill includes:
- a framework for the new AN-ACC funding model for residential aged care with full implementation from 1 October 2022
- an extension of functions and name change of the hospital pricing authority to the Independent Health and Aged Care Pricing Authority
- the extension of the Serious Incident Response Scheme to home care settings by 1 December 2022
- the publication of star ratings of residential aged care services by the end of 2022
- the introduction of a new code of conduct for approved providers, aged care workers and governing persons from 1 December 2022
- the introduction of new reporting responsibilities for Commonwealth-funded providers.
“Having an aged care bill in response to the royal commission become the first to pass through parliament shows how seriously we take reform in the sector,” said PM Anthony Albanese.
Unfortunately, workforce woes were very much still a story, with half of Australia’s aged care workforce saying they intended to leave the industry.
The findings – featured in the third annual Aged Care Workforce Report, showed up to 139,000 residential aged care workers were planning to leave the sector in the next three years due to low pay and overwork – including 64,000 people within the next 12 months.
In September, the second piece of aged care legislation – the Aged Care Amendment (Implementing Care Reform) Bill – passed through the House of Representatives.
It passed with almost unanimous support with just one dissenting report – from independent Australian Capital Territory senator David Pocock, and a recommendation from the Australian Greens in response to concerns raised by the allied health sector about the new AN-ACC funding model.
The Federal Government announced it was providing more than $840 million in additional funding to support aged care providers with Covid-related expenses, including $35 million for ongoing onsite PCR testing in aged care homes.
Set up to support government-funded aged care services – residential and home care – during the pandemic, the Covid-19 Aged Care Support Program provides personal protective equipment, workforce assistance and cost reimbursements. The $840 million was part of a $1.4-billion package to extend the country’s Covid-19 response measures.
New funding model the Australian National Aged Care Classification came into play on 1 October, replacing the Aged Care Funding Instrument.
Under AN-ACC, the average resident funding is approximately $22 more than the last average subsidy under the ACFI – in part to pay for the mandatory 200 minutes of care time per resident per day which commences from 1 October 2023.
The Serious Incident Reporting Scheme guidelines were updated advising residential aged care providers to only categorise unlawful sexual contact or inappropriate sexual conduct as Priority 1 reportable incidences. Previously, when reporting serious incidents providers had an option to choose between Priority 1 or Priority 2.
When AAA asked the Aged Care Quality and Safety Commission – the body responsible for reviewing incident notifications – for the reason for the change, a spokesperson replied: “This change was made in response to stakeholder concerns that aged care providers may inappropriately assess the level of harm caused as a result of an incident of unlawful sexual conduct or inappropriate sexual conduct, and therefore incorrectly categorise the priority of the incident.”
In what was largest gathering of aged care providers ever assembled in Australia, the inaugural national conference of the Aged & Community Care Providers Association was held in October.
Held in in Adelaide – Kaurna Country – ACCPA chair Dr Graeme Blackman opened the conference, telling delegates: “We stand on the threshold of a new era of aged care in Australia.”
More than 1,700 delegates attended the three-day event. There were also 160 businesses displaying their wares in the exhibition hall.
Making his first sector address, AACPA CEO Tom Symondson told delegates he would focus on how sector issues were impacting older Australians instead of how they affected providers. “It is easy to fall into that trap of talking about ourselves, and I’m afraid in the public arena that’s not going to help us, it’s not going to work. It’s not why we’re here. We’re not here just to exist,” Mr Symondson said. “We are here to support older Australians.”
In its inaugural budget, the Albanese Government delivered on its election promises by gifting $3.9 billion to the aged care sector.
Among other measures, the reform package committed to increasing the number of care minutes residents receive and requiring aged care homes to have a registered nurse onsite 24/7.
In all, the reform package addressed 23 recommendations of the aged care royal commission. Minister for Aged Care Anika Wells said in a budget statement: “The government embraces both the spirit and intent of the recommendations of the Royal Commission into Aged Care Quality and Safety, and through this budget we are taking action.”
Aged care providers largely welcomed the government’s commitment to implement the reforms but also emphasised the remaining shortfalls in funding and workforce.
ACCPA CEO Tom Symondson said the $3.9-billion package represented an important step in fixing the aged care system and realising the vision set out by the royal commission.
“We also look forward to further investment in the coming months as government delivers on its commitment to fund the outcomes of the Fair Work Commission work value case, and the inaugural recommendations of the Independent Health and Aged Care Pricing Authority, which should take us further down the road of recognising the true cost of delivering high-quality aged care services to older Australians,” said Mr Symondson.
While welcoming the passage of the bill, Catholic provider peak body Catholic Health Australia’s aged care director Jason Kara told AAA it’s now time to move to the more difficult stage – implementation.
“CHA will work collaboratively with the government to secure the workforce required to deliver 24/7 registered nurse commitment while continuing to advocate for the sensible inclusion of enrolled nurses into the new model of care,” said Mr Kara.
November began with aged care providers being told to lift their game and innovate in order to compete in a reformed residential aged care system.
That was just one of the first-round consultation findings contained in a government report on the incoming consumer-centred model that will replace the Aged Care Approvals Round from 1 July 2024.
In an interim decision, the Fair Work Commission tabled a 15 per cent pay rise for nurses and personal care workers under revised aged care awards.
The amount fell far short of the 25 per cent called for by the Health Services Union and others, and only direct care workers will be awarded the wage increase.
Speaking to AAA, HSU national president Gerard Hayes said aged care must be viewed as a holistic industry. “It’s got a complementary workforce that doesn’t work in isolation. So to address direct care, and not other important factors of aged care, I don’t think it’s something that should be progressed along those lines. It should be all parties in aged care addressed.”
The Department of Health and Aged Care announced the level at which it will cap home care administration fees in November – care management fees at 20 per cent and package management fees at 15 per cent. As well, all exit fees are to be banned as are brokerage and subcontracting fees.
A statement from the office of the Minister for Aged Care Anika Wells read: “Home Care Package providers will need to review their current charges and discuss and agree any pricing changes with their care recipients by 1 January 2023, ensuring they obtain informed consent for any changes.”
Also in November, AAA was told by Services Australia that payments of residential aged care subsidies under the new Australian National Aged Care Classification funding model “may take longer than usual.”
AAA approached Services Australia – the government department responsible for processing the payments – after it had received reports of delays.
In response, Services Australia said it was taking “a measured approach” to managing payments. And had issued advice to residential aged care providers outlining the approach to processing claims, “including additional verification to ensure payment accuracy.”
AAA reported live from the Australian Association of Gerontology at the end of November.
Speaking to AAA, new AAG president Dr Claudia Meyer said she was optimistic that real reforms can be made and that the AAG and its members have an important role to play in those reforms. “We are a peak body that represents many different disciplines. That is our strength, that we have people from many sectors within our membership. We’re a strong collective voice – that’s probably where we can have our best impact.”
The financial performance of aged care providers remained in the doldrums with more than 60 per cent operating at a loss, that’s according to the second edition of Australia’s Aged Care Sector Report, during the last week of November.
Covering the full-year results for 2021-22, the report – compiled by researchers from the UTS Ageing Research Collaborative and based on data collected by chartered accountancy and aged care benchmarking firm StewartBrown – found the situation in the residential sector particularly challenging, with 67 per cent of aged care homes making a loss.
At the end of the month, the federal government was being urged to prevent aged care providers replacing enrolled nurses with personal care workers.
The call came after it learned that Southern Cross Care in Tasmania was making its ENs redundant and substituting them with personal care workers. As well, some providers in South Australia were also found to be replacing ENs with a combination of registered nurses and personal care workers, whilst in New South Wales some ENs were reportedly being offered care worker contracts.
In response, the Australian Nursing and Midwifery Federation released a statement accusing “greedy” aged care providers of “gaming the system”.
The long-awaited code of conduct for the aged care industry came into play on 1 December. Recommended by the aged care royal commission, the Code of Conduct for Aged Care has been introduced to improve the safety, health and wellbeing for people receiving aged care as well as to restore public trust in services.
The code applies to residential aged care, home care and flexible care services, including the Transition Care Program, the Multi-Purpose Services Program and the Short-Term Restorative Program.
Also on 1 December, the Serious Incident Response Scheme applied in home care service settings – both home care and flexible care.
In operation in residential aged care settings since 1 April 2021, SIRS requires aged care providers to report Priority 1 incidents to the Aged Care Quality and Safety Commission within 24 hours of becoming aware of an event; Priority 2 incidents must be reported within 30 days.
The year ended on a positive note for the residential aged care sector with the release of the new star ratings, which showed 90 per cent of faciities receiving three stars or above.
Under the system, aged care homes receive ratings between one and five stars with three stars indicating an acceptable level of quality.
That nine in 10 services scored three stars or more “shows that services are providing everything they are funded by the government to provide for older Australians, at a good level of quality,” said ACCPA CEO Tom Symondson. “They have achieved this despite extraordinary funding and workforce challenges.”