Before your start, please advise your consent to publish response
1. We would like your permission to publish your online survey responses to the discussion paper. Please indicate your publishing preference:
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Publish response (include both my name and organisation's name)
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Publish response, but keep my name private (include my organisation's name)
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Before you start, please tell us about yourself
4. What is your organisation’s name?
Organisation
(Required)
Palliative Care Australia
5. What stakeholder category do you most identify with?
Please select all that apply
(Required)
Consumer
Carer or other consumer representative
Consumer advocacy organisation
Consumer peak body
Carer peak body
Approved provider of residential aged care
Approved provider of flexible aged care
Approved provider of home care
Aged care provider peak body
Provider of private aged care or seniors accommodation
Aged Care Assessment Team/Service
Aged care worker
Health professional
Workforce association or union
Primary Health Network
State and territory government
Local council
Commonwealth agency
Lender or investor/financier
Ticked
Other
If you answered ‘Other’, please specify:
National peak body for palliative care
6. Where does your organisation operate (if applicable)? Otherwise, where do you live?
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New South Wales
Australian Capital Territory
Victoria
Queensland
South Australia
Western Australia
Northern Territory
Tasmania
Ticked
All states and territories in Australia
Please select all that apply
(Required)
In a remote area
In a rural area
In a regional area
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In a metropolitan area or major city
Design principles for alternative allocation models
9. Are the proposed design principles appropriate?
Please select one item
Ticked
Yes
No
Model 1: Improve the ACAR and places management - Overall model
11. What are your views on the suggested improvements proposed under this model?
Views on model 1
The suggested improvements seem achievable with limited disruption.
Model 2: Assign residential aged care places to consumers - Overall model
19. Overall, what are your views on this proposed model?
Model 2 views
By allocating a residential ‘place’ to a consumer rather than provider moves residential aged care towards a more contemporary, consumer demand driven market which is in line with international approaches to service delivery across many sectors.
Model 2: Assign residential aged care places to consumers - Key design considerations (consumers)
20. What are your views on the establishment of a queue to access subsidised residential aged care, if the demand from eligible persons exceeds the available places?
Model 2 views on queue
The establishment of a queue to access residential aged care places would provide greater transparency as to consumer demand which in turn could be used to better understand and plan funding and services.
The establishment of a queue in theory has the potential to provide greater equity of access to residential aged care places however in reality it is unclear whether the establishment of a queue would improve the experience of consumers and their families or create additional burdens or risks that outweigh the benefits. For example, if there are only a small number of older people living in a particular area, there may be significant time gaps between the allocation of a place to an older person in that area depending on the final prioritisation factors used. This may impact viability for providers in the area with a flow on decrease in services available for consumers when they are allocated a place. Sustainability of services particularly in remote and rural areas may be at significant risk, thus reducing rather than improving options for older people.
It is important to learn from the significant issues that still exist for consumers seeking to access home care packages, since the introduction of the home care prioritisation system over 2 years ago. If there is a delay in being assigned a residential aged care place, older people will be at significant risk if they are unable to access the support they require in a timely manner. This risk is exacerbated for people living with a life-limiting illness. For many people the decision to seek residential accommodation is due to the inability of the person’s carer to continue to provide the support needed so a delay in being able to seek a vacancy risks adding increasing stress to carers or result in people being admitted to acute care or taken to emergency should their care break down. Such admissions may not be in the person’s best interests and may be an inappropriate and expensive use of the acute care system.
Due to limited visibility of demand and wait times the discussion paper uses median elapsed time between approval and entry to residential aged care as a proxy for wait times quoting median elapsed time as 121 days. However, as stated in the paper many people with a Home Care Package approval also are approved for residential aged care and may not immediately be ready for residential aged care. Yet many people would be admitted much sooner than the 121 days, and many of those would be people living with a life-limiting illness. If model 2 is to be implemented, it would be important to look at the cohort of people admitted soon after eligibility assessment to be sure the prioritisation process takes account of the circumstances of this group to ensure they are not disadvantaged.
The establishment of a queue in theory has the potential to provide greater equity of access to residential aged care places however in reality it is unclear whether the establishment of a queue would improve the experience of consumers and their families or create additional burdens or risks that outweigh the benefits. For example, if there are only a small number of older people living in a particular area, there may be significant time gaps between the allocation of a place to an older person in that area depending on the final prioritisation factors used. This may impact viability for providers in the area with a flow on decrease in services available for consumers when they are allocated a place. Sustainability of services particularly in remote and rural areas may be at significant risk, thus reducing rather than improving options for older people.
It is important to learn from the significant issues that still exist for consumers seeking to access home care packages, since the introduction of the home care prioritisation system over 2 years ago. If there is a delay in being assigned a residential aged care place, older people will be at significant risk if they are unable to access the support they require in a timely manner. This risk is exacerbated for people living with a life-limiting illness. For many people the decision to seek residential accommodation is due to the inability of the person’s carer to continue to provide the support needed so a delay in being able to seek a vacancy risks adding increasing stress to carers or result in people being admitted to acute care or taken to emergency should their care break down. Such admissions may not be in the person’s best interests and may be an inappropriate and expensive use of the acute care system.
Due to limited visibility of demand and wait times the discussion paper uses median elapsed time between approval and entry to residential aged care as a proxy for wait times quoting median elapsed time as 121 days. However, as stated in the paper many people with a Home Care Package approval also are approved for residential aged care and may not immediately be ready for residential aged care. Yet many people would be admitted much sooner than the 121 days, and many of those would be people living with a life-limiting illness. If model 2 is to be implemented, it would be important to look at the cohort of people admitted soon after eligibility assessment to be sure the prioritisation process takes account of the circumstances of this group to ensure they are not disadvantaged.
22. What other factors should also be included in the criteria for prioritising a person in the residential aged care queue?
Model 2 other prioritisation factors
If a person is living with a life-limiting illness, this should be taken into account in determining priority.
The documented Guidance on Priority for Home Care Services which guides assessor’s recommendations regarding a client’s priority for home care service says priority should be based on the assessors clinical judgement, information they have gathered during the comprehensive assessment and knowledge of the relative urgency of the client’s need for a Home Care Package and goes on to list a number of specific considerations. Despite this, there is a lack of transparency in how the waiting list and priority allocation works in reality making it difficult for consumers and those making referrals to know if, when or whom may be allocated high priority. Anecdotal feedback as to how prioritisation happens for HCPs indicates the likelihood of being assessed as being high priority relates more to the availability / ongoing support of a carer than the other criteria. It is therefore crucial that the same problems that are still being experienced in the home care prioritisation system are not replicated for residential aged care.
The documented Guidance on Priority for Home Care Services which guides assessor’s recommendations regarding a client’s priority for home care service says priority should be based on the assessors clinical judgement, information they have gathered during the comprehensive assessment and knowledge of the relative urgency of the client’s need for a Home Care Package and goes on to list a number of specific considerations. Despite this, there is a lack of transparency in how the waiting list and priority allocation works in reality making it difficult for consumers and those making referrals to know if, when or whom may be allocated high priority. Anecdotal feedback as to how prioritisation happens for HCPs indicates the likelihood of being assessed as being high priority relates more to the availability / ongoing support of a carer than the other criteria. It is therefore crucial that the same problems that are still being experienced in the home care prioritisation system are not replicated for residential aged care.
24. Where a place is withdrawn, how can we balance the need to allow consumers to re-join the queue while also avoiding creation of perverse incentives for people to join the queue without intention of taking up a place at that time?
Model 2 withdrawn place
Systems must be in place to ensure places are not withdrawn simply because an older person has not responded to correspondence. People assigned a place who have not activated that place should be followed up to ensure they are supported to access accommodation if required.
If a place is withdrawn, the person must be able to re-join the queue and not have lost their original place. To ensure consumers are able to navigate the complex system, all correspondence needs to be clear and unambiguous so they understand the process. This has not been the case with correspondence for HCPs. The impetus for considering residential aged care is often at a time of considerable crisis, meaning they may not take in complex information readily. For many people who do not have a carer or have a cognitive impairment, there needs to be free, readily accessible assistance to navigate the system.
It is important for people to plan ahead and for people living with a life-limiting illness this is particularly important, yet the current HCP prioritisation process does not accommodate people putting plans in place for when their condition deteriorates. If people are discouraged from seeking eligibility assessment early for residential aged care, then the system must be responsive and not require people to wait once assessed as eligible.
If a place is withdrawn, the person must be able to re-join the queue and not have lost their original place. To ensure consumers are able to navigate the complex system, all correspondence needs to be clear and unambiguous so they understand the process. This has not been the case with correspondence for HCPs. The impetus for considering residential aged care is often at a time of considerable crisis, meaning they may not take in complex information readily. For many people who do not have a carer or have a cognitive impairment, there needs to be free, readily accessible assistance to navigate the system.
It is important for people to plan ahead and for people living with a life-limiting illness this is particularly important, yet the current HCP prioritisation process does not accommodate people putting plans in place for when their condition deteriorates. If people are discouraged from seeking eligibility assessment early for residential aged care, then the system must be responsive and not require people to wait once assessed as eligible.
Model 2: Assign residential aged care places to consumers - Exploring the potential impacts
37. If this model were to be implemented, what are the potential impacts on, linkages or interdependencies with, other programs or reforms in aged care that might impact you or the stakeholder group or organisation you represent?
Model 2 impact on other programs or reforms
Currently older people are not able to access HPCs at the level they have been approved as requiring for over 12 months (if approved for a higher level package), and it is very often these people that will then require residential aged care if they cannot continue to manage pending receipt of their HCP. If the current wait times continue for HCPs particularly for people with higher, more complex care needs, then they should not also be required to wait to be assigned a residential aged care place when they decide placement is needed.
People living with a life-limiting illness need to be confident that they will receive a residential aged care place when they require it without undue delay.
Reforms and performance in both HCPs and residential aged care need to be considered together to ensure older people, particularly those living with life-limiting illnesses do not fall between both program areas and require admission to acute care because of a failure of the aged care system.
People living with a life-limiting illness need to be confident that they will receive a residential aged care place when they require it without undue delay.
Reforms and performance in both HCPs and residential aged care need to be considered together to ensure older people, particularly those living with life-limiting illnesses do not fall between both program areas and require admission to acute care because of a failure of the aged care system.