Residential aged care: Proposed alternative models for allocating places

Having a percentage of beds for concessional residents works well, but only if there is beds available. Current model provides more guarantees of beds in rural & remote areas.

A consumer on a full pension (low socio economic) entering into residential aged care facility may not encounter same complexities as do consumers who are partially/fully self- funded in retirement.

Some stability around numbers of allocated beds, which provides a degree of certainty regarding projected annual income.

At present, local Aged Care Assessment Team (ACAT), Hospital Health Services (HHS's) and community based home care service providers work well together sharing information.

Current model is highly challenging if you do not have family, friends or a social worker to assist in navigating the complex system. If a client is new to the aged care maze and has a chronic disease, then completion of paperwork can be difficult. The trial of the Aged Care Navigators may assist consumers to alleviate some of the challenges.
RACF's are not suitable for younger residents (NDIS participants). They face particular disadvantages such as mental health issues, communication barriers, lack of access to information, social isolation, and inadequate or non-existent mental or allied health information about their health needs. Additional housing or facilities would be more appropriate for younger residents. The younger residents living skills decline in aged care facilities, so when they finally do enter into appropriate housing their support will be significantly higher.
Older people from LGBTI communities still face discrimination when entering RACF's. Training should be made mandatory to raise awareness across the aged care sector of LGBTI people and their ageing related issues, and provide the knowledge & skills for their staff to become more LGBTI inclusive.

The majority of RACF's are in support of patient choice, however there are a number of barriers to this: lack of home care packages (HCP), waiting times, and clients inability to access the correct level of care to keep them safe and at home, resulting in their conditions deteriorating rapidly so they require aged care beds sooner than they should. Some families would prefer to take care of their loved ones at home but with the limited number of HCP's the condition of the consumer will deteriorate because they have been trying to manage at home without adequate support.

Multi-purpose Health Services (MPHS) raise the issue of the unsuitable environment (ward type bed) as an alternative to a person's home, or a home-like environment in a suitably designed residential facility.

Our organisation can only comment on the rural, regional and remote areas of Redacted text, however, I understand that the problems are at a national level as well.

The majority of remote and very remote consumers have to leave their community & island to enter into an aged care facility. This places great strain on them and the extended family.

Evidence is collected via engagements held with ACAT and community based aged care services and assisting members of the community with their queries

Regional and Urban areas
Consideration should be given for the identified needs to improve access in thin markets and for vulnerable consumers.

Remote
Financial sustainable between consumer, provider and government will not be achievable with the low number of residents and the cost of Fly in Fly out staff, and infrastructure.

For remote people from Aboriginal and Torres Strait Islander communities, relocating to regional centres for aged care facilities results in loss of language, no connection to community and family, and they become culturally isolated. This has a detrimental effect on their health and well-being.

Flexible models of care should be included for special needs groups.

Remote Areas
Beds could be attached and blended in with other health services i.e. existing hospitals and primary health care clinics (PHCC)
State housing and hospitals could work together utilising existing infrastructure
Design small RACF's that are geographically aligned with PHCC (10 beds and under)
The Aboriginal and Torres Strait Islander consumer would be more accessible to family, language and country
Provides a seamless pathway if the consumer is already utilising aged care services

This model would work well in regional centres, however, in remote areas there would need to be a minimum number of beds allocated to maintain staffing levels. Remote communities face specific challenges related to their geographic isolation, such as limited workforce and thinly dispersed services.

As a result of the Aged Care Royal Commission, there will likely be mandatory staffing ratios which will require some flexibility in areas where there are chronic shortages of qualified staff.

Cultural values and community preferences often go unrecognised as living in a regional area does not necessarily mean better access to services.

The model does not give specifics on how to improve access in thin markets will occur.

Appropriate guaranteed minimum funding levels must be considered for rural and remote areas.

Blending of services would assist in efficiencies of funding. Funding should be allocated in partnership with relevant stakeholders to ensure best funding model.

Locations targeting would encourage services to invest in Aboriginal and Torres Strait Islander communities below the aged care provision ratio.

Encourage collaboration with key consumer groups around best practice design features.

The ability to 'top up' allocations in order to respond to respite care for vulnerable cohorts.

Community cultural appropriateness should be taken into consideration.

Impact analysis should include data for rural and remote areas and vulnerable groups.

For consideration: People still have to go onto waiting lists or end up in hospitals before they get into an RACF, but after the experience of the introduction of HCPs and the resulting reduction in capacity of community-based providers to be flexible with funding, there is a concern that the same could happen to RACF funding. Community-based providers are having more difficulty maintaining their financial viability and needing to find the money to advertise in the main-stream media to attract package-holders. Almost half of RACFs are currently running at a loss so there is a concern that the additional challenges and costs associated with Model 2 would be insurmountable for some, particularly in regional, remote, and thin markets.

A significant number of people who have been approved for Level 4 Home Care Packages either die or move into residential aged care before a Level 4 package is offered to them. Under Model 2, will there be the option of being approved for RACF placement in addition to a Level 4 HCP, or would people need to nominate one option or the other?

If they can only be approved for one or the other, what mechanism will be in place to support people approved for a HCP whose condition deteriorates quickly, or whose carer/s are no longer able to undertake their care? Would they need to go onto the waiting list for approval for RACF funding, then go through the process of negotiating with multiple RACFs?

Change ACAR to SLA allocation of places rather than regions so that needs can be met. Consultations with key organisations would provide a better understanding of the need within communities.

Currently allocated places do not match needed hotspots.

For Primary Health Networks: Social & Emotional wellbeing of the community especially rural & remote areas would improve if older people were able to access permanent & respite care in their community.

Residential care would be more responsive to actual identified consumer needs .

n/a

Model 1 is an improvement on the current model as it allows existing business to continue in an enhanced way with minimal disruption to providers and residents.

Model 1 would enhance existing pathways with a 12 - 18 month transition

Information & Education sessions for RACF's, community based aged care services and broader community so that a seamless pathway is provided. Recruit staff to work with Aged Care services to implement change.