Provider survey highlights reform concerns
Most aged care providers think transition timeframes for new reforms are too fast, ACCPA’s inaugural State of the Sector survey finds.
Over two-thirds of aged care providers feel transition timeframes for new reforms are too fast while five in six say new requirements will put a greater strain on the sector.
And just over half of providers agree new requirements resulting from the government’s response to the royal commission will support quality of care and safety (53 per cent).
That’s according to Aged and Community Care Providers Association’s inaugural State of the Sector – which is based on an online survey conducted SEC Newgate Research with 191 organisations. Of those 125 provide residential aged care, 135 home aged care and 81 retirement living services.
“Providers fully support well designed reform, but that reform must be at a manageable pace and not exacerbate already existing problems,” ACCPA chief executive officer Tom Symondson said.
Survey participants represent the breadth of the sector, according to the report, including not-for-profit (142), for-profit (38), government-run (11), metropolitan (121), regional (67) and remote (3) organisations from ACCPA’s membership.
The research also involved in-depth interviews with five participants from different provider types.
It found – consistent with well-documented pressures – providers’ concerns over costs, funding and workforce remain high.
Among the results, more than nine in 10 providers are concerned about increasing costs related to service delivery (97 per cent) and government funding under current policy (92 per cent). And one in five small providers lack confidence in their ability to continue providing services in the next 12 months.
“These responses from providers show even more clearly that the Australian Government’s response to the Aged Care Taskforce as part of the new Aged Care Bill is essential to making the aged care sector more sustainable,” said Mr Symondson.
Among the workforce findings, almost two-thirds have been unable to access the workers required under current migration arrangements (64 per cent).
Mr Symondson said providers were feeling the brunt of worker shortages and the results showed that current migration settings were clearly not the answer.
Providers are not confident about the future with only half considering the aged care system is on the right track (51 per cent) and seven in 10 concerned about the nation’s readiness to support a growing population.
The report includes a list of priorities for the sector care including:
- reform transition times of six-12 months
- targeted support to meet wage increases
- funding measures that support thin markets
- building a sustainable local workforce and reducing barriers for skilled migrants
- funding sufficient to deliver care.
Mr Symondson said the report came at a critical juncture in the sector’s its transformation journey.
“The demand for aged care is also growing, highlighting the urgent need to create a system that delivers high quality care now and into the future.”
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As a Home Care Provider I have several huge concerns about the new Support At Home system as presented.
Number 1 on my list of concerns: The Government is making it mandatory for ordinary people to pay much more for their Home Care services out of their own pocket. Sure – some fortunate Clients can afford to do that – but the new “user pays” system will disproportionately and gravely hurt low income Clients. I am particularly concerned for full Pensioners. Full Pensioners will now pay 5% of costs for services such as showering and personal care. They will also be forced to pay 17.5% of the costs of cleaning and gardening.
Even a 5% charge – let alone 17.5% – will be a SEVERE burden for anyone trying to live with dignity (or to live at all!) on a full Pension – and simply impossible for any full Pensioner who does not own a home and is trying to pay rent.
Most full Pensioners are struggling to pay their power bills. Pensioners who are renting are having to choose between food and rent.
The result: many of those Clients will cancel their cleaning and gardening services and some will even have to cancel help with showering. They will either live in increasing squalor with massive health risks, or some will attempt physical work they are no longer safe to perform, resulting in falls, injury, hospitalisations….
In both cases the end result WILL be increased mortality and more Pensioners forced into residential care which they do not want, and at far higher cost to the Government! This will be a truly perverse and insane outcome for what we are told is an Aged Care “reform.”
And how will those Client payments be collected?
Well the Government has an easy answer to that. Once again the Home Care Providers will be forced to act as the Government’s Debt Collector.
The Government will only pay us the Government subsidised portion of each individual service, and then we – the Home Care Providers – will have to calculate the Client’s payment for each individual service, then invoice the Client and try to collect what they owe to the Government – or else we lose the 17.5% and we go broke.
And what about Clients who simply cannot pay, or who are persistently late in paying and fall steadily into debt?
Well apparently that’s our problem too, and while one member of our team is calling on the Client to make sure that their services are proceeding to their satisfaction, and to see how else we can help, another member of our team will be trying to work out how to ask them to promptly pay up money which they simply cannot spare but which the Government says we have to collect.
This will seriously damage the relationship between Home Care Providers and our wonderful Clients. It will also impose enormous extra and unfunded administrative costs. This system will be very very complex for Providers to manage. Providers are being told that “Admin costs” are being factored into the capped service charge rates – but we won’t see those rates until February at earliest.
(Note: Yes – we are told that there will be “Hardship provisions” allowing a reduction in fees for Clients who cannot pay. Make that “Clients who are destitute but who can also work out how to complete a difficult and complex submission to Services Australia.” My view: by definition every person on a full pensioned paying rent is already living below the Poverty Line. What more does Government need to know?)
The Commonwealth Government has budgeted around $1 billion to upgrade its own IT systems to cope with the complex requirements of the new Aged Care Act and Support at Home. Every Home Care Provider will also have to upgrade their own IT systems, at our own cost, to interface with the Government system – but we have been given no timeframe for when the Government systems will be ready. We are just told that the whole Support At Home scheme will commence – miraculously – on 1 July next year.
My prediction: the Commonwealth IT upgrade will not be complete in time for Home Care Providers to get their own systems ready by 1 July. To be honest – given the Commonwealth Govt record with IT, I will be amazed if even the Government’s own systems are ready by 1 July.
Care Management fees have also been reduced to a flat 10% maximum – which will be inadequate to cover the actual costs of Care Management for Clients with complex clinical care needs and barely enough for Clients with ordinary needs. The result? I predict that some Clients with complex needs will find it impossible to obtain a Home Care Provider willing to take them on.
At the same time as all this, Home Care Providers will also be implementing a whole new set of Aged Care Quality Standards and responding to very important – but also very costly – increased accountability measures imposed by the Aged Care Quality and Safety Commission.
None of that is funded either.
The regional Home Care Provider my wife and I established 10 years ago has always had lower fees than most “Not For Profit” Home Care Providers and we have always had excellent Client satisfaction with zero audit non-compliances, but under Support At Home as currently presented we think our service may not be financially viable.
If a service like ours cannot make the funding work then most of the For Profit and many of the very large Not For Profit Home Care Providers will also pull out entirely, or stop taking on Clients with complex/clinical care needs, leading to profound failure of the Home Care system and a further overburdening of Residential Care.
And ACCPA? The body meant to represent Aged Care Providers has been silent on most of the above key issues. ACCPA did make a submission to the current inquiry into the new Aged Care Act – conducted by the Senate Standing Committee on Community Affairs – but that submission is woefully inadequate in almost every respect.
The new Support At Home program does implement some of the very important reforms recommended by the Royal Commission, but it is rushed, and extremely poorly thought through. The main intent seems to be “let’s reduce Government spending per Home Care Client, by making Client’s pay more themselves, and push all the complex Admin costs onto Home Care Providers.
Unless they pause and rethink, the result will be a net DECLINE in Home Care quality, at real cost to the people who most need high quality care.