Residential aged care: Proposed alternative models for allocating places

Local input into the quality and capacity of the provider to deliver. This was even better when each Jurisdiction had their own ACPAC-Aged Care Planning Advisory Committee.

Able to indicate a good understanding of need and unique dynamics of local areas where particular issues.e.g dementia might need extra support.

Rural remote and CALD and single service providers are prejudiced by a system that rewards the most professional and articulate applications.

There is a industry for contractors to apply for fee for service a rudimentary analysis of applications would reveal a high level of cut and paste and formularised appliactions.

Spatial equity is not well addressed in the current system. When this system was introduced it was overlayed over a mal distribution of places particularly in the eastern suburbs of Sydney Melbourne and Adelaide. This mal distribution has continued to impact on the number of new places available to a jurisdiction even if their resources are concentrated into one area and not providing access more broadly.
Further this mal distribution has further been used to justify a smaller allocation of home care packages into SA in particular where we are supposedly over bedded with residential . The Government continues to look at the combined provision of resi and HCP in the Report on Government services even after the HCP are no longer distributed according to any regard for spatial equity. Hence SA is deemed over bedded (even if this is a historical legacy) and this has seriously impacted in the allocation of packages in SA where we are well below a per capita rate.

Rural Remote Cald and single service providers are all over represented in those services tat are less financially viable (see Stewart Brown) yet a high proportion of new places go to For profits who do not provide for these groups in the main.

In SA in the round before last Golden Grove was the Only SLA that was deemed a priority in the ACAR planning documentation However no places were allocated as an exisiting provider moved places to the area just prior to ACAR yet other providers were not aware that the only priority area would not be supported-This indicates a difficulty where providers are applying for what may not be available

Market failure will continue in areas where there are 50% of providers making a loss, years of trying to get ACAR applications in these areas with various strategies has been unsuccessful

A disproportionate number of small rural facilities have encountered compliance issues and are also prominent in those making a loss (see StewartBrown) yet we expect these small organisations to compete with the large for profits and not for profits who have teams to write their ACAR applications or use expensive consultants.

The Aboriginal Flexi model might provide a better approach for increasing availability of care in these regions rather than the current ACAR.

History has indicated that the market is non existent for some rural and remote regions

The existence of available aged care, the existence of a local health service the presence of a doctor and the communities viability can all be tied together in communities with Ageing and declining populations . To lose the Aged care can have knock on consequences for the hospital and the doctor. Thus whatever allocation methodology is adopted in rural and remote will be better predicated on govt intervention than the effectiveness of Adam Smiths invisible hand.

Spatial equity across Australia

Generally good however the market will follow profit and with any reduction in locational specificity we could see the continuation of larger numbers of aged care in areas with good existing provision.

There also needs to be a re-examination of the concept of permanent care increasingly timely capacity building and episodic support in a residential facility may be a more appropriate and a more contemporary approach

When providers go broke or are taken over I have seen the rules regarding where you can transfer places bent or ignored when there are viability issues and prudential concerns.

Look at the flexi model where they may be funded for 20 but care for 15.

Financial incentives

Partnering up a group of small facilities in a region to reduce the purchasing training compliance costs

Dementia specific care stream needs to be developed then dementia places could be allocated to facilities that can demonstrate the capacity and design elements to provide good care. With the numbers coming through the system this should be a priority.

Limit the secondary market in places if an approved provider wins the places and doesn't need or want them any more they should go back to a central pool and be reallocated according to the existing area of highest need not sold for profit

Organisations who dip below accepted levels of performance should not be continued to be allocated places if the are non compliances in another state then this should impact on the applicants allocation.

For profit providers should be made to retain a higher level of liquidity if they apply for places. places were this year allocated to for profits that have such high debt gearing that if they fail it will have serious knock on for the industry as a whole. There should also be more significant consequences for large providers who demonstrate systemic failureRedacted text

Clearer support and inclusion of TCP in the planning approach currently only unlicensed places can be used this enforced differentially in the different states.

There is currently a blurring of out of hospital in home and residential care with new options being available, maintaining the current approach limits how creative providers can be with vacant places.

Much better for a larger proportion of metro seniors seeking residential aged care if providers have more flexibility but potential negative consequences in the current areas on market failure

The biggest concern in the sector is the seriously constrained profitability. If the current terms of trade continue how the places are allocated is irrelevant as there will be many more viability issues , currently the number of facilities up for sale is high and growing . Rural remote Cald are highly overrepresented in the group with compliance issues and market reforms or greater flexibility in setting the location will not change this.

discussed above

Markets respond to demand but there will be demand in areas where it is profitable and demand in areas where it is not im unsure what is being proposed in areas of market failure that will change what currently occurs.

Change metro fist with sensible increased flexibility and keep a different system and quarantine a proportion for the areas and streams of care that are less attractive to providers.

Roadshow, webinar , info through the department communiques.

If we want to replicate the wait list mess in HCP then this would do it. There is already considerable evidence to suggest the ACATs in different jurisdictions allocate priorities differently . eg for HCP level; 4 in SA less than 1/3 received a high priority but in NSW over a half did. While the state govt run ACATS remain the gate keeper and there is differential practice we will see spatial equity decline and where you live may well determine what you get not what you need.

The complex financial issues militate against the consumer and the provider being confident that what might be the consumers choice is also a good fit for the provider. Current terms of trade are such that any reduced discretion by the provider could impaxct viability

There could be inadvertent extra wait time and process that would see numerous prospective residents having to look at a third or fourth choice we could see a large number of eligible citizens in dire need wait longer to source a place.

Just the creation of a queue can exacerbate wait times.
With 100,000 plus waiting for the right package it would not be long and a proportion of those who need a package will go from not getting a package to exceeding the dependency levels for package care amove from waiting for a package to waiting for a residential place . No government would want the continual reminder that older Australians are systematically excluded from any support..
We need to ensure that increased notional options does not translate into reduced real choice.

The ACATS in each state are very different in their approach SA only allocates a high priority to less than a third of their level 4 package recommendations where NSW its over half. Again the begnign assumption that the existing system returns fair outcomes needs challenging.

Date of Approval would also present difficulties. recently at the Royal Commission Redacted text Aboriginal Community Services in SA stated that there are about 50 Aboriginal Elders awaiting an ACAT on the remote APY lands and some have been waiting over a year.

Untill there is a single standardised national process where priority is standardised and fair these changes may just amplify the inefficiencies and inequities in the existing system.

Currently if your concessional or a bond payer impacts on the relative attractiveness of prospective residents . Some diagnosis are harder to find appropriate care. Some providers specialise in specific areas of care . Centerlink and Medicare-ACFI info often determine weather prospective residents are a good fit how these compatibilities are managed in the proposed process would determine if it can meet timeliness objectives.

Acat assx can be taken up at any time . We don't wont to make people have repeated assx where it isn't necessary.

For some an ACAT approval for resi care is not taken up immediately and it would not be fair to force people into care prior to them electing to do so.

I am uncomfortable with the perception that older people will cynically manipulate the system for their benefit. Not many people elect to enter Aged care prior to needing it and consumers need the option of choosing a service that is right for them not being turfed of the list for not taking the fist option etc.

They will probably need to continue to contact each prospective service like they do now to discuss the services care philosophy ancillary costs and charges, and vacancies available. Inspite of listings on my aged care these things can change several times in agiven day and no provider is going to be able to update my aged care in real time.

Better differentiation of services that provide quality dementia care

A navigator or key worker dedicated to assist the consumer

Reviews from existing residents with similar needs on the quality of care they receive

Any serious compliance issues related to special needs care visable.

As discussed above avoiding extra wait times in the system

The differential approach from ACATs around the country

The existing provision gaps -regional-specialist-cultural and to ensure the new approach addresses these not exacerbate them

There is a fundamental question here is the government prepared to have better market interventions in the existing areas of market failure or are they expecting more miracle's associated with the magic of the market that is hard to see currently.

Profitability is currently poor greater commerciality will mean winners and losers and it will be the rural remote cald and specialist care services that need more support.

Changing the allocation process may make metro residential care more viable but without significant government intervention with or without these changes the sector is marginally unattractive and the listed providers share price reflect limited market confidence with one assumes some of these long discussed reforms factored in.

Timely movement from the acute care sector could be impacted by introducing new steps or processes.

The concerns over the future availability of capital to meet projected future demand will continue in this new approach

Non government regulated models may emerge because of the increased level of process and reduced viability.

ON a per capita basis as is done oversees. or develop specific respite centres.

Respite TCP ,CAP ,episodic capacity building are all aspects of care that need to be incorporated into any future models. the notion that there is only a one way recipe for the future senior Australians is robbing older Australians opportunities for a better quality of life. Currently a high proportion of all those who receive TCP get to go home but only a small percentage get to receive this service. It should be offered to every one at the Acute Aged Care interface

It will remain as is I assume
The myriad of charging arrangements that exist reflect a spectrum of choices and budgets.
Im sure that people shouldn't pay for things hey cant benefit from but to deny consumers the opportunity to continue full citizenship by continuing to be able to make discretionary purchases is very important.

I think the world has moved on from the extra service non extra service dichotomy

Government should be cautious when limiting what consumers can and cant do

Rigorous identification of areas where the market has failed and then with structured interventions develop regional plans with communities and providers that provide a road map of how in each of these regions or areas of specialist care there is a plan to ensure that where there are gaps or needs not being meet the Govt partner with Associations or individual providers to insure the future infrastructure and workforce capacity is bolstered through direct interventions.

We need to be honest here in the large part it will be family members that will need to undertake the majority of the info sourcing and navigation through the maze.

Currently the complexity of the system and the legal and financial requirements are onerous introducing changes that further articulate processes may improve this but most likely will introduce new layers of complex process.

Current feedback from the royal Commission is that MY Aged Care is complex and difficult particularly for ATSI and CALD consumers what is in this proposal that addresses this???

Industry consultation with the Peaks and COTA -ACFA-NACA etc

Staged implementation ensuring a step wise approach

Clear communicated shared view of the end state and its advantages

as above

Residential Care is the second Largest grudge purchase after your funeral .
Getting people to think about it little own plan for it has been historically unsuccessful.

A coordinated local community approach where providers and the community work together will important.

There is a danger that we are putting all this thought and energy into what many in the future may see as anachronistic. A didactic view of residential care as being the last place you go or somewhere from which you never return may be fostering a redundant attitude that itself needs to change. Retirement living with serviced appartments or package care being delivered with the opportunity for short term or end of life care is increasingly the international response to ageing. These proposed reforms don't step outside the prevailing conventional views of residential aged care

Redacted text . The local understanding from a regional- cultural perspective and the on the ground knowledge of what is working and not working was valuable information that was used to good effect.

With the current centralised process local understanding is not as prominent.

Over 200,000 older Australians call resi care home any changes need to address the complexity and difficulty many currently experience in accessing the right place.

We need an unequivocal view of the govt view of the substitutability of package care and residential care . On the one hand they are combined for the ROG report but packages are no longer allocated with any regard for spatial equity.
Do we have an integrated aged care system of a series of discreet programs that require navigation and even then you may not get what you need.