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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.

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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19 comments

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19 thoughts on “An aged-care debacle quietly looms

  1. klewso

    “Responsibility”? Falling to “Ghoulie” Andrews – the same Howard “Minister for WorkChoices and Haneef’s Detention”? Oh, joy.
    On the bright side, the use of kerosene baths has been discredited?

  2. Doug Clark

    And that’s just for those Homes under the Federal scheme. State schemes are about 2-3 years behind in regulation, and all over the place, but importantly in most States Bonds now have to be held in a trust account, not the owner’s back pocket, which is a huge improvement

  3. Dan Hilvert

    I admire the writer’s bold calls here. Especially given they’ll be very easy to debunk 6 months from now. Good on you for making big calls, not enough of that these days. I also agree that few commentators understand the nuances that are in place and changing here.

    But I disagree with the general thrust of the article.

    Firstly, RAC providers should still be able to charge large bonds its just that they’ll need reg permission and the Liberal appointed regulator would surely waive through most applications for bonds greater then the threshold level.

    Secondly, on the comment “care needs have gone missing” well it might or might not be the case that care is sub-par depending on the facility but that shouldn’t have anything to do with the LLLB reforms in res care because those reforms are predominantly about the accommodation side of res care.

    Thirdly, there is opportunity for many providers to have a stronger business model given that they can now charge a bond or periodic payment on beds formerly known as high care.

    Whilst there are a niche group of Providers who stand to lose from this (financially leveraged Providers who chiefly do low care) because they might be forced to accept periodic payments instead of bonds and therefore have a problem repaying bank finance …. but those Providers are in a small minority and the banks have nothing to gain by playing hard-ball with them.

  4. paddy

    Interesting article and interesting comment from Dan H.
    Let’s hope the “interesting times” ahead are better than Anon suggests.

    Kevin “Bloody” Andrews in the role of “Minister responsible” is not exactly a cheering thought.

  5. leon knight

    Anon’s predictions may or may not come true, but his general thrust of the type of careful planning, and diligent adult government we have come to expect of the LNP team now in charge in general, and Andrews in particular, is hard to argue against….

  6. Yclept

    “more elderly people at risk and ultimately people are going to start dying unnecessarily” which will mean less of the “fully government supported”, so a big win for Tony and Co!

  7. Alan

    Does anyone know what these changes will be and exactly what that means for the carers and nurses?
    Most carers, who do the actual work of bathing, cleaning, feeding, dressing, grooming, brushing teeth, changing incontinence pads, cleaning rooms, mopping floors, cleaning up spills, making morning and afternoon tea, distributing residents clothing, emptying the bins, etc. have to also deal with dementia in many residents, and, from personal experience, dementia isn’t just someone being a bit forgetful, it can present in many very challenging ways.
    Carers are mostly employed on a casual or permanent part time basis and earn just slightly above the minimum wage (depending on the hours worked), burnout is common and high staff turnover is the norm.
    If the profit is the only motivator for providing care and services to the elderly, god help us.
    I would rather die than be placed in living hell that is ‘aged care’.
    Legalising euthanasia can’t come soon enough.

  8. Bill Hilliger

    The elderly Australian sheeples that voted for the coalition are now being shorn.

  9. AR

    Like carers at the other end of the age range,aka mothers, what odds that a return to keeping ones seniors in the family bosom attracts no government largesse?

  10. bluepoppy

    I don’t know enough about the work on these aged care reforms to make comment but as a big picture observation, when aged care is outsourced to the vulture capitalists and where profit overrides service and care, there will be heartache.

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