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Has the Budget delivered on aged care? Mixed verdicts on a five pillar package

Croakey readers can download the Department of Health Budget Briefing Pack here.

This is a rolling post, wrapping reaction to the 2021-22 Federal Budget on aged care funding and issues, with comments and analysis from the Australian Healthcare and Hospitals Association, Australian Medical Association, Council of the Ageing (COTA) Australia, Australian Nursing and Midwifery Federation, and more to come.


Aged care is “centrepiece of Budget”

Health and Aged Care Minister Greg Hunt has declared aged care reform as the centrepiece of the 2021-22 Federal Budget, which promises to invest $17.7 billion in additional funding in response to the Royal Commission into Aged Care Safety and Quality to “help ensure respect, care and dignity for our senior Australians”.

This post is a rolling wrap of aged care announcements and reactions from key stakeholders.

First up, is the joint announcement from Hunt and Minister for Senior Australians and Aged Care Services Richard Colbeck listing five pillars of responses in the Budget to the Royal Commission:

Pillar 1 – Home Care: $7.5 billion towards supporting senior Australians who choose to remain in their home, including:

  • $6.5 billion for an additional 80,000 Home Care Packages – 40,000 released in 2021–22 and 40,000 in 2022–23, which will make a total of 275,598 packages available to senior Australians by June 2023
  • $10.8 million to design and plan a new support in home care program which better meets the needs of senior Australians
  • $798.3 million to support the 1.6 million informal carers, including additional respite services for 8,400 senior Australians each year, and
  • $272.5 million for enhanced support and face-to-face services to assist senior Australians accessing and navigating the aged care system.

Pillar 2 – residential aged care services and sustainability: $7.8 billion towards improving and simplifying residential aged care services and to ensure senior Australians can access value for money services, including:

  • $3.9 billion to increase the amount of front line care (care minutes) delivered to residents of aged care and respite services, mandated at 200 minutes per day, including 40 minutes with a registered nurse
  • $3.2 billion to support aged care providers to deliver better care and services through a new Government funded Basic Daily Fee Supplement of $10 per resident per day
  • $102.1 million to assign residential aged care places directly to senior Australians, and to support providers to adjust to a more competitive market
  • $49.1 million to expand the Independent Hospital Pricing Authority to help ensure that aged care costs are directly related to the care provided
  • $189.3 million for a new Australian National Aged Care Classification to deliver a fairer and more sustainable funding arrangements, and
  • $5.5 million to reform residential aged care design and planning to better meet the needs of senior Australians, particularly those living with dementia.

Pillar 3 – residential aged care quality and safety: $942 million to drive systemic improvements to residential aged care quality and safety, including:

  • $365.7 million to improve access to primary care for senior Australians, including the transition of senior Australians between aged care and health care setting and improved medication management
  • $262.5 million to ensure the independent regulator, the Aged Care Quality and Safety Commission (ACQSC), is well-equipped to safeguard the quality, safety and integrity of aged care services, and can effectively address failures in care
  • $7.3 million for additional resources to build capacity within residential aged care for the care of senior Australians living with dementia
  • $67.5 million for the Dementia Behaviour Management Advisory Service and the Severe Behaviour Response Teams to further reduce reliance on physical and chemical restraint (restrictive practices), and
  • $200.1 million to introduce a new star rating system to highlight the quality of aged care services, and better informing senior Australians, their families and carers.

Pillar 4 – Workforce: $652.1 million to grow a skilled, professional and compassionate aged care workforce, which will be the powerhouse of the Government’s reform agenda, including:

  • $228.2 million to create a single assessment workforce to undertake all assessments that will improve and simplify the assessment experience for senior Australians as they enter or progress within the aged care system
  • $135.6 million to provide eligible registered nurses with financial support of $3,700 for full-time workers, and $2,700 for part-time workers.
  • $9.8 million to extend the national recruitment campaign, and to help increase the skilled and dedicated aged care workforce, and
  • upskill the existing workforce and providing training for thousands of new aged care workers, including 33,800 subsidised Vocational Education and Training places through JobTrainer.

Pillar 5 – Governance: $698.3 million to improve the governance across the aged care system. This will embed respect, care and dignity at the heart of the system, guaranteeing better choice, high quality and safe care for senior Australians, including:

  • $21.1 million to establish new governance and advisory structures, including a National Aged Care Advisory Council, Council of Elders and are working towards establishing a new Inspector-General of Aged Care
  • $630.2 million to improve access to quality aged care services for consumers in regional, rural and remote areas including those with First Nations backgrounds and special needs groups
  • $13.4 million to improve rural and regional stewardship of aged care, with Department of Health aged care officers embedded within eight of the 31 Primary Health Network regions, and
  • The drafting of a new Aged Care Act to enshrine the Government’s reforms in legislation by mid-2023.

You can also watch this video overview.

See also earlier Croakey articles about what is needed to drive strong aged care reform.


Cannot be one-off cash splash, must make a difference

Australian Healthcare and Hospitals Association (AHHA)

AHHA Chief Executive, Alison Verhoeven said many of the health and aged care budget announcements made tonight had already been put on the table – “and there’s been strong feedback from stakeholders that this is a good start, but this cannot just be a once-off cash splash before an election,” she said.

Verhoeven said the $17.7 billion commitment to aged care over 5 years is about half of the investment recommended as being necessary by the Royal Commission into Aged Care Safety and Quality.

“It will make a difference, but attention will be required to ensure this investment makes a difference to the care of older people, not just to profit margins for private providers,” she warned, saying much work is still needed to ensure aged care governance, safety and quality reforms aren’t neglected.

“Funding has been made available tonight to support improved regulation – this work must commence immediately,” she said.


Welcome funds for home care packages, primary care support in aged care

Australian Medical Association (AMA)

AMA President Dr Omar Khorshid said the Government’s response to the Aged Care Royal Commission “will help shore up the failing sector”, and additional home care packages would go a long way to clearing the waiting list of older Australians looking for support to stay in their homes and avoid residential care longer.

The $365 million committed to expanded primary care support in aged care will make it easier for older people to see their doctor, and work would now begin on implementation details for increased general practice in aged care, he said.

Khorshid said the move to mandate nurse-resident ratios is “long overdue, but unfortunately we will have longer to wait until these measures are in place,” Dr Khorshid said.


Budget falls well short of reform promise

Australian Nursing and Midwifery Federation (ANMF)

ANMF Federal Secretary Annie Butler said the the $17.7 billion for aged care in the Budget is “definitely not the ‘once in a generation’ reform package promised by the Morrison Government and won’t be anywhere near enough to provide safe, quality care for vulnerable nursing home residents”.

Butler said the commitment to introduce regulated care hours for residents acknowledges that the Government now understands that staffing is at the heart of best practice care, “but it should have gone further and mandated minimum staffing levels commencing now, with a registered nurse on-site 24/7 – as the Royal Commission’s Final Report had recommended”.

“We question which generation will actually see the benefits of any action the Government is taking to fix aged care,” she said, adding that the Budget “falls well short of what residents, their families and the community wanted to fix this broken system”.

Butler said:

“We’ve always said, if you don’t fix staffing, you can’t fix aged care system. So the announcement of a 200-minutes of minimum care minutes per resident is a step in the right direction, but why wait until 2023? Critically, it does not include any requirement for a registered nurse to be on site at aged care facilities.

Why have a Royal Commission and then ignore so many of its recommendations? It’s clear that the Government has failed to deliver on the crucial recommendations of the Royal Commission.”

Butler said the introduction of providers being forced to publicly disclose care minutes for residents is a positive step, as is the drafting of a new Aged Care Act.

“But the apparent lack of transparency and accountability for the use of billions of taxpayer dollars allocated to aged care providers in this Budget continues to be an absolute failure by the Government and ultimately means that unscrupulous providers can continue to put profits before care,” she said.


Starting gun fired on aged care reform

Council of the Ageing (COTA) Australia

COTA Australia said via Twitter it welcomed “the very substantial package of measures in tonight’s Federal Budget that will fire the starting gun on a substantial overhaul of the aged care system over the next five years, supported by additional expenditure of $17.7 billion over four years”.

It said:

The Budget includes a serious and meaningful response to the ‘neglect’ identified by the Aged Care Royal Commission and the need to transform the industry”.

Aged care reform needs proper oversight to get the job done. The new Aged Care Act, along with the oversight mechanisms of an Inspector General, an Independent Pricing Authority, a National Aged Care Advisory Council and the Council of Elders, sets us on exactly the right path.

The reform to the system with a single assessment service and a single Support at Home program is critical to ensuring that older Australians stay at home for as long as they choose.

COTA has long been campaigning for more home care packages and is pleased the government has responded to its repeated calls for a better home care program that makes consumers genuine partners in the design and delivery of their care.

The Government has announced an additional 80,000 Home Care Packages over the next two years, a commitment to develop a single assessment workforce by end 2022, and to implement a new single Support at Home system delivering individualised care by end 2023.

80,000 new packages over the next two years is very welcome and should easily remove any waiting list. Government must guarantee that no older Australians will wait longer than 30 days from the moment they register, to the moment they start to receive services by 1 July 2022.

The Government has accepted the Royal Commission’s recommended minimum staff time of 200 minutes per day (including 40 minutes by a registered nurse and will fund this with an additional $3.9 Billion).

COTA warmly welcomes the decision to put bed licenses in the hands of consumers, for which we have argued for years. The bed licence system has protected poorer quality providers from competitive pressure from high quality providers, who have been prevented from expanding.

Older Australians are pleased to hear that the government says it is serious about improving the pay, skills and careers of aged care workers. Older Australians care about those who care for us.

This will ensure the Fair Work case is dealt with faster, and government should make provision for extra wage support in MYEFO later this year. The new Pricing Authority also needs to take into account the pay required to attract a workforce able to deliver high quality care.

The Government should become a party to the upcoming Fair Work Case to establish the appropriate increase in the hourly rate for aged care workers to ensure we can attract the right people.

COTA has been trialing aged care “system navigators” for the past two years which has demonstrated the need for Care Finders, so we warmly welcome this announcement and look forward to working with government on how best to implement this initiative.

COTA notes and welcomes a range of other initiatives to assist First Nations people’s access to aged care, and to improve services for people living in rural and remote areas.

The package contains a welcome boost to support for informal and family carers of $798 Million, comprising residential respite, Commonwealth Home Support respite and a range of other measures to improve support for Carer and people with dementia.

Putting bed licenses in the hands of consumers and guaranteeing care at home services within 30 days of registering with My Aged Care will ensure that all older Australians get the care they need, when they need it, where they choose it and how they direct it.

The Royal Commission found, and everyone knows, that a lot of aged care providers have got to go. The Budget has delivered a Structural Adjustment program that will get help get rid of the bad providers whilst taking care of staff and residents.

COTA welcomes the investment of $263M for the Aged Care Quality and Safety Commission. A well resourced regulator will help lift standards in aged care. The government has provided the right level of funding, now they’ve got to sort out the right attitude.

See the full COTA statement

Downpayment on important reform but details needed

Consumers Health Forum

Consumers Health Forum CEO Leanne Wells said the Budget has acknowledged that fundamental reform is required for aged care and that this is a long-term game, promising new spending of $17.7 billion over four years on top of existing investment.

“This is a down payment on the additional resourcing desperately required in terms of staffing and services,” she said.Wells said it is “encouraging” that the Health Minister has set out a detailed five year – five pillar Aged Care Reform Plan in response to the Royal Commission report, committing to major reform for home care, residential aged care quality and safety, residential aged care services and sustainability, workforce, and governance, but she said there is little detail how these goals will be achieved.

Wells welcomed another 80,000 new home care packages, and the good news that they are promised to be implemented in the first two years, as well as the commitment to fund increased time that nurses and carers are required to spend with residents, an additional payment of $10 per resident per day to enhance the viability and sustainability of the residential aged care sector, 33,000 new training places for personal carers, and a new Indigenous workforce and retention bonuses to keep more nurses in aged care.

“These are all welcome answers to the Royal Commission into Aged Care Quality and Safety which found poor quality care and “fundamental system flaws” in the design and governance of aged care,” she said.


Welcome, overdue and need for scrutiny

Royal Australian College of GPs (RACGP)

The RACGP welcomed the full aged care package, including $42.8 million to double the GP Aged Care Access Incentive from 1 July this year.

“On the aged care front, the new funding measures are welcome and overdue,” said RACGP President Dr Karen Price.

“General practice has been drawing attention to shortfalls in the aged care system for many years and the doubling of the incentive for GPs who provide care to people in aged care facilities is an important first step,” she said, however warning she would be”taking a magnifying glass to the $365.7 million allocated to improving access to primary care and other health services in residential aged care because the finer details will make all the difference.”


Landmark moment for older Australians

Catholic Health Australia(CHA)

CHA welcomed the Federal Government’s $17.7 billion package for aged care as “a landmark moment for older Australians”, and congratulated the Government on accepting 126 of the Royal Commission’s 148 recommendations.

“After 20 government reviews in 20 years, this Budget, and the government’s response to the Royal Commission’s recommendations, finally addressed many of the challenges facing aged care,” it said.

The suite of measures will enable more Australians to be cared for in their home, increase the number of care minutes and provide more training for carers and the incentives for them to stay, said CHA CEO Pat Garcia.

He said:

“This is a landmark moment for older Australians. In the last 12 months, aged care has exploded onto the public consciousness because of the COVID pandemic, the findings of the aged care Royal Commission and the Aged Care Collaboration’s 50,000 petitioners across the country.

“The budget announcement is a welcome recognition of the community’s changing priorities and a legacy defining moment for the Morrison government.”

Garcia said the aged care sector was ready to work with Government to implement these reforms immediately.

CHA is one of the largest grouping of non-government aged care service providers with 25,000 residential aged care beds and 28,000 home care package consumers. Its members include Mercy Health, St Vincent’s, Villa Maria Catholic Homes, OzCare, the Southern Cross Care network and Catholic Healthcare.


Welcome investment in rural and remote communities

Rural Doctors Association of Australia

The RDAA welcomed:

  • increased support for GPs to provide aged care services – important in rural and remote communities, given many rural doctors provide medical services to aged care facilities in their towns.
  • a range of other initiatives to support the aged care workforce – particularly to support Registered Nurses and allied health professionals who are working in aged care – including a retention bonus to encourage RNs to stay in aged care settings.

Further work needed

Victorian Healthcare Association

The VHA said the Federal Government’s commitment to aged care needs further scrutiny, with the $17.7 billion announced for the initial response to the Royal Commission into Aged Care Quality and Safety “being only the start of the investment required” to deliver on its recommendations.

“The Royal Commission demonstrated the need for a complete rethink of our aged care system and while this funding provides a strong foundation for that process, it cannot, and must not, be the end of the conversation,” the VHA said.


Extraordinary commitment to dementia

Dementia Australia

Dementia Australia welcomed the “extraordinary commitment to dementia” announced in tonight’s Federal Budget, thanking the Government on behalf the half a million people living with dementia and the 1.6 million people involved in their care for the $229.4 million allocated.

Dementia Australia CEO Maree McCabe said this record investment will provide the impetus for systemic change required in the aged care industry.

“Elevating the capability and capacity of the workforce is a focus of this budget. Dementia must be core business for aged care,” she said.

Key measures in the budget relating to dementia include:

  • Enhanced early support for people living with dementia in the community their families and carers through an expansion of the National Dementia Support Program.
  • An additional outreach capability for the National Dementia Helpline.
  • More support at diagnosis for people to access the services they need.
  • Dementia training throughout the sector.
  • Improvement in aged care regulation – transparency of performance, restraint and dementia-friendly building practices.
  • The introduction of a nationally consistent worker screening register and code-of-conduct for all care sector workers including aged care workers.

Dementia Australia also welcomed the Government’s significant investment in response to the Royal Commission into Aged Care Quality and Safety, saying announcements on the increase in Home Care Packages, respite services, and strengthening of regulation of chemical and physical restraints “will have significant benefits for people living with dementia, their families and carers”.

“We are now looking forward to working with the Government and health and aged care sectors to realise the Roadmap to Quality Dementia Care to make a profound and lasting difference to the lives of all people living with dementia, their families and carers.”.”


Via Twitter


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