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Guardian

Jun 30, 2014

An aged-care debacle quietly looms

Watch out -- poorly understood reforms to aged care are about to commence, and this anonymous aged-care worker warns it will end in disaster.

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It’s been touted as a major reform allowing “choice” in aged care — but it will probably end in people of modest means being forced into substandard care, or locked out of residential care altogether.

I’m talking about the so-called “Living Longer, Living Better” reforms to residential aged care, which start tomorrow. I don’t know anyone directly involved with residential care admissions who has the slightest confidence this system will last until Christmas. And the government is wilfully asleep at the wheel.

The package is touted as the great enabler of individual “choice” in aged-care options; a response to the Caring For Older Australians Productivity Commission inquiry in 2011. Nothing could be further from the truth. What we are about to witness is a wholesale disembowelling of aged-care providers’ viability.

Residential aged care is an expensive business, yet everyone feels it should be provided for free, while assuming it’s some cash cow for providers. The bland truth is that providers already work on very tight margins. Most facilities are staffed by good, ethical people trying to do their best. If you want to milk seniors, you get into retirement villages or financial planning instead.

Every bed now has a fixed price to it. Today you hear of the wealthiest people in Melbourne and Sydney paying $1-2 million bonds. Tomorrow they’ll be capped at a $550,000 Refundable Accommodation Deposit (RAD) or a sliding scale of RAD v Daily Accommodation Payments (DAP) at a set interest rate.

Sounds good? Not really. Now the provider has to make up the shortfall from everyone else in the middle. That pushes up the median bond amount that providers will need, which widens the range of people with awkwardly middle-ish assets.

“This is a wholesale skewing of residential aged care away from actual care needs towards a person’s financial station in life.”

If you have assets under $45,000 have absolutely nothing to worry about. You will be fully government supported and residential care facilities are all waiting to hear from you right now. And if you’ve got anything north of $500,000, then you similarly have choices in residential care.

If however, you’re “lucky” enough to have your assets fall between $45,000 and a solid $300,000+ (ie. most people), then prepare for indefinite limbo. Why? Because under the new regime, every liability for every single arrangement you enter into with the aged-care facility is worn by the provider. In short, you look like bad debt.

And consider that from tomorrow, facilities require a combined income and assets assessment to even begin considering someone for placement, and the essential government documentation doesn’t even exist yet. So no one will be going anywhere fast.

Meanwhile, care needs have gone missing. This is a wholesale skewing of residential aged care away from actual care needs towards a person’s financial station in life.

In addition, almost no hospital discharge planner has the slightest idea of what’s coming tomorrow. With more people becoming harder and longer to place, admissions will decrease and what do you think will be the consequences for our already overcrowded hospitals?

Concerned? Confused? So am I. Who’s our minister? That would be the Minister for Desk Toys and Paper Cuts, Mr Kevin Andrews. Nothing from him about the aged care system yet, old or new.

Rest assured though, he will happily let this reform package hit the fan — he has the default excuse that this is a Labor policy, locked and loaded, as we speak. He might think of flagging a review into the unfolding mess before immediately returning to his Candy Crush Saga, or whatever his favoured distraction.

Only admissions officers, placement consultants, and a lucky dip of financial planners of varying knowledge and ethics have any real grasp of all this. No one has the slightest bit of confidence this will be anything short of a national disaster. I’m predicting resi care providers will start going to the wall before too long, meaning fewer beds, fewer choices, more elderly people at risk and ultimately people are going to start dying unnecessarily.

And thus ends another episode where aged care once again finds itself in the too-hard basket — right where it has languished for decades, having slipped through the fingers of successive governments.

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