Residential aged care: Proposed alternative models for allocating places

The City of Kalamunda is submitting through it Aged Care Advisory Committee in order to highlight the potential reduction in suitable aged care facility accommodation in ‘thin markets’ or areas where infrastructure costs may be higher. The City of Kalamunda is situated within the Perth Metropolitan area in the eastern hills with an escarpment which creates building challenges. Under the current arrangement the City is well under its allocation of bed licenses due to poor operationalisation of allocated licenses. This results in many local residents being unable to access aged care within their local area.

The current model has the potential to ensure bed allocations are distributed equally across regions and ensure aged care provision occurs in all localities and not only in those where costs (build environment and labour) are lowest.

A current flaw in the allocation model can lead to organisations being allocated bed licenses with no incentive to operationalise. The enforcement of currently regulations around building timeframes would improve this situation.
For example, in the City of Kalamunda is currently well below the Aged Care Provision Ratio of 125 aged care places per 1,000 people aged 70 years or over by 2021–22. The City of Kalamunda region is also below the 30 June 2015 statistics of 111.5 operational aged care places per 1,000 people aged 70 or over.
An additional pressure on access to residential aged care facilities is early or avoidable admission due to lengthy wait times for suitable home care.

Residential Aged Care Facilities (RACF) – identified problems
The experience of residents in RACF is undeniably improved when family and friends are able to maintain relationships through regular visiting.
In an outer metropolitan area such as the Hills Region of Perth, the majority of families therefore are seeking an RACF in the local area.
The current situation where providers are holding bed allocations and not operationalising them leads to a severe shortage of options for local residents.
It is critical that any Model provide an adequate number of concessional places in all regions.
The City of Kalamunda is a region with a critical lack of RACF places (shortage of approximately 300-400 at 2019) and all issues are exacerbated.
The City of Kalamunda has too many examples of families being separated by having to go to other far away regions to find places.

If the demand Model is adopted, it must be able to provide the principle of equity in regions like Kalamunda where there is currently thin supply.
The principle of equity and distribution is critical to ensure providers do not focus developments in areas where economies of scale can be maximised. Provision needs to be made to ensure regulation of any demand model ensures that RACF developments are spread equally, particularly in thin areas such as Kalamunda.
Any adopted Model must ensure families are not separated by distance.

Any adopted Model must ensure families are not separated by distance.

The City of Kalamunda is most likely to be best served under the existing model, rather than the alternative proposed Model 1.

Government action must ensure adequate residential beds are provided in areas of need, addressing increased building costs, infrastructure needs, zoning and environmental issues which currently act as disincentives to RACF providers. Cooperation between all levels of government is essential, with Federal and State taking a lead in identifying need, allocating licences to such areas and liaising with local governments and aged care providers to encourage and facilitate development.

The City of Kalamunda supports the suggestion in Model 1 to reduce the number of non-operational residential aged care places to maximise the availability of places to consumers; and improvement to the administration of ACAR and places management processes.
The City believes it is essential improvements are made to support the consumer to find and select the most appropriate vacant residential aged care place.
The City has significant concern that full adoption of Model 1 would lead providers to develop future facilities in geographic areas that meet their needs rather an the needs of the consumer.

Equitable access will require the Federal government to monitor and respond to areas that fail to meet the predetermined government ratios for safe provision of residential aged care.

The government must also ensure adequate allocation for dementia specific beds and facilities in all RACFs with the rising demand for these in the future, given that 25 – 30% of people over 85 years are likely to experience this condition.
Adequate allocation of respite beds is also necessary.

Variations would include the government regulating to ensure thin markets are addressed as well adequate provision for dementia and respite places to meet the Aged Care Provision Ratio of 125 aged care places per 1,000 people aged 70 years or over by 2021–22.

Any market based, consumer driven Model must ensure adequate RACF beds are available in all areas to allow supply and demand to operate to the benefit of the consumer. Easy access for consumers to information on available beds and a simple method of registering a request for a place with multiple providers would be essential.

The major impact on the City of Kalamunda stakeholder group will be the disincentive for providers to build in the local area if locational controls on the distribution of residential aged care places are removed. This is due to increased infrastructure costs in areas constrained by environmental, water, sewerage and geological constraints.

Potentially a concentration of aged care facilities in areas/suburbs where the cost of provision, including building cost, is lower.

Currently the home care package program is experiencing significant delays and failing to meet the needs of consumers. This already leads to avoidable admissions into RACFs. If residential aged care is further limited in the local area this problem will only be exacerbated.
The current lack of genuine respite care, which is critical in order to extend a person’s ability to be supported at home and prevent premature entry, also provides stress on RACFs.

As the City of Kalamunda does not support Model 1 as presented it is not able to provide a response.

The benefit of Model 2 will be to provide consumer control of funding for RACF places and the ability to negotiate for services. However, it will only work if excess appropriate places are available in the desired geographic area.
The City of Kalamunda covers a geographic area that is within the greater metropolitan area however, has significantly increased costs associated with building a RACFs due to bed rock and resultant infrastructure issues.
This Model 2 removes any incentive for a provider to build a facility in an area with these additional costs and would likely lead to fewer facilities in the area and increased burden of travel on family and friends to access RACFs built on the escarpment.
The key potential problem with Model 2 is that queuing will persist for allocation as is occurring in Home Care Packages.

The City of Kalamunda has significant concerns that a national queue could result in consumer needs not being met as demonstrated by home care packages.

The current experience in home care package queues does not give confidence that date of approval and urgency of need are ensuring best outcomes for consumers.

Potential factors:
- Physical and mental health of the person being assessed
- Physical conditions in the home - eg stairs, lack of rails and supports in bathroom and toilet, narrow doorways.
- Physical and mental ability of partner/family/carer to provide adequate care.
- Availability and quality of support services coming into the home
- Home situation becoming unmanageable whilst in the queue.

When the consumer is being asked to take the lead role it is imperative that provision is made for people of non-English speaking backgrounds, people with disability and people limited by stress. We have experienced failure in the home care allocation due to lack of understanding on the part of the consumer regarding validity periods and allocations.

Give consideration to professionals assessors (doctors, social workers and other ancillary health care workers) on a case by case basis.

The complex process and responsibility on the consumer to identify, assess and choose an appropriate RACF and negotiate a suitable arrangement with the providers would require support of an expert advocate (financial advice and navigating the system) to help ensure a good outcome. Such expert individuals/organisations should be a funded part of the process.

Adequate numbers of beds overall and, it would seem that a proportion of government funded or concessional places would still need to be provided. Adequate advocates to navigate system.
True equity also includes access to local places where a provided has no incentive to build in a thin market this cannot be achieved.

Not applicable

Not applicable

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Whilst the City of Kalamunda is not a provider of aged care it supports capital financing particular in areas of thin markets.

Incentives such as easier access to land, subsidised land and infrastructure where needed, streamlined planning and approval processes at all levels of government. Willingness by local governments to prioritise the needs of the elderly for residential care in areas of shortage above other community considerations till that need is met to accept Federal Government standards.

Incentives such as easier access to land, subsidised land and infrastructure where needed, streamlined planning and approval processes at all levels of government. Willingness by local governments to prioritise the needs of the elderly for residential care in areas of shortage above other community considerations till that need is met to accepted Federal Government standards.

In areas of need or thin markets, outer metropolitan/semi-rural/regional some environmental requirements may be imposed, as are aesthetic conditions at present. Requirements for a proportion of respite places in a facility could be a condition of licensing to meet established need.

As in Model 1 the lifting of geographical allocation has a potential negative impact on ensuring consumers have access to local RACF.

Not applicable.

No comment.

The Commonwealth Government to make funding arrangements to provide respite in State government facilities (hospitals etc) or establish Commonwealth respite facilities in all areas to support the Commonwealth Home Care Program.
Such government respite beds could be made available under contract to organisations providing Home Care Packages as a service to their clients and could be marketed by them as an extra benefit to their offering. This would help ensure the beds were fully utilised, as the persons in most need would be part of the process via the Home care provider.
Investment is required in purpose build respite facilities particularly catering to the needs of people with dementia.

Not applicable.

No comment.

No Comment.

Response
The City of Kalamunda is experiencing a serious shortage in the provision of aged care places with the current total operational ratio per 1000 people aged 70 and over at less that 90 which is significantly below the 30 June 2015 statistics of 111.5 operational aged care places per 1,000 people aged 70 or over. There are currently 243 beds available at RACF within the City of Kalamunda.

To date two facilities have been commissioned:

1. Redacted text160 beds to become available in 2020
2. Redacted textRedacted text additional 50 beds available by 2021.

In addition to the RACF beds noted above there is also a requirement, under Commonwealth Government targets, for 2 respite beds per 1000 people >70 years, so these figures need to be added to the places required. eg increasing the 2026 figure to 723 beds.

Currently Kalamunda has only 1 identified respite bed.

The City of Kalamunda is facing a crisis and is of the view that the move to consumer demand driven bed allocation model being proposed will only exacerbate the shortage of supply to outer metropolitan regions.