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:
Please select one item
(Required)
Ticked
Publish response (include both my name and organisation's name)
Publish response, but keep my name private (include my organisation's name)
Publish response anonymously (remove both my name and organisation's name)
Do not publish response
Before you start, please tell us about yourself
2. What is your name?
Name
(Required)
Luke Hays
4. What is your organisation’s name?
Organisation
(Required)
WA Department of Health
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
Ticked
State and territory government
Local council
Commonwealth agency
Lender or investor/financier
Other
6. Where does your organisation operate (if applicable)? Otherwise, where do you live?
Please select all that apply
(Required)
New South Wales
Australian Capital Territory
Victoria
Queensland
South Australia
Ticked
Western Australia
Northern Territory
Tasmania
All states and territories in Australia
Please select all that apply
(Required)
Ticked
In a remote area
Ticked
In a rural area
Ticked
In a regional area
Ticked
In a metropolitan area or major city
Current arrangements
8. Are there other issue/s with the current model for the allocation and management of places for residential aged care that have not been covered in this paper?
Other issues with current arrangements for providers
National health and aged care systems are highly inter-related; there is a significant flow of people across the interfaces between residential aged care (RAC) and health services. At times and in locations, these interfaces can be highly contested.
State and Territory Governments that run national health systems therefore have an interest in the allocation and provision of RAC services to reduce the risk of poorer health outcomes for older people that derive from poor access to care, as well as increased demand, hospital length of stay and cost.
Currently, there is no capacity in the RAC allocation process for external stakeholders such as State and Territory Governments to have input. This creates a risk that key issues relating to the interface between RAC services and national health systems are not able to be considered in the allocation process.
The methodologies for the planning and allocation of RAC places are not transparent. Over time, significant inequities in the access of people to RAC have developed within and between jurisdictions; for example, Western Australia has had a chronically low rate of operational RAC for over ten years, and one of the highest RAC occupancy rates. This creates delays in older people accessing RAC that increases the risk of poorer health outcomes, increased hospital demand, length of stay and cost.
There does not appear to be a mechanism in the current allocation process to support greater equity of access to RAC.
State and Territory Governments that run national health systems therefore have an interest in the allocation and provision of RAC services to reduce the risk of poorer health outcomes for older people that derive from poor access to care, as well as increased demand, hospital length of stay and cost.
Currently, there is no capacity in the RAC allocation process for external stakeholders such as State and Territory Governments to have input. This creates a risk that key issues relating to the interface between RAC services and national health systems are not able to be considered in the allocation process.
The methodologies for the planning and allocation of RAC places are not transparent. Over time, significant inequities in the access of people to RAC have developed within and between jurisdictions; for example, Western Australia has had a chronically low rate of operational RAC for over ten years, and one of the highest RAC occupancy rates. This creates delays in older people accessing RAC that increases the risk of poorer health outcomes, increased hospital demand, length of stay and cost.
There does not appear to be a mechanism in the current allocation process to support greater equity of access to RAC.
Are these problems occurring at national level, or only in certain areas (e.g. rural, regional and remote areas) or for particular consumer groups?
These issues appear to be occurring at the national level, noting considerable variation in the access to RAC between and within jurisdictions.
The issue of equity of access to RAC affects people more greatly in rural and remote locations, but is also present in Aged Care Planning Regions in urban locations.
The issue of equity of access to RAC affects people more greatly in rural and remote locations, but is also present in Aged Care Planning Regions in urban locations.
What evidence supports your view that these are significant issues which need to be addressed?
Please see annual Reports on Government Services, Aged Care chapters and tables. Please also see annual Australian Institute of Health and Welfare GEN Aged Care reports on Commonwealth aged care services.
Design principles for alternative allocation models
9. Are the proposed design principles appropriate?
Please select one item
Yes
Ticked
No
Please elaborate on your response
The design principles would benefit from the addition of a points about improving the transparency and equity of the process, and inclusion of key stakeholders in the process.
10. Are there any other principles that you consider should be included?
Please select one item
Ticked
Yes
No
Please elaborate on your response
The design principles would benefit from the addition of a points about improving the transparency and equity of the process, and inclusion of key stakeholders in the process.
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 opportunity to reduce the number of non-operational RAC places is a positive aspect to model one.
This model may benefit urban Aged Care Planning Regions at the expense of rural/remote ones, and benefit more urbanised states and territories over less urbanised ones.
The model contains no apparent mechanisms to manage inequity of access.
This model may benefit urban Aged Care Planning Regions at the expense of rural/remote ones, and benefit more urbanised states and territories over less urbanised ones.
The model contains no apparent mechanisms to manage inequity of access.
Model 1: Improve the ACAR and places management - Key design considerations
12. How can this model ensure/encourage adequate supply of and equitable access to residential aged care and residential respite care (aside from increasing funding or revising the funding model), including:
in rural, regional and remote areas and other thin markets?
Introduce targets for equity of access to be applied at the Aged Care Planning Region level.
Develop innovative co-commissioning approaches with other levels of government when equity of access targets are not met, eg Multi-Purpose Services.
Develop innovative co-commissioning approaches with other levels of government when equity of access targets are not met, eg Multi-Purpose Services.
Model 1: Improve the ACAR and places management - Exploring the potential impacts
15. In overview, what would be the potential impact of this model (consider benefits, costs and risks) on you or the stakeholder group or organisation you represent?
Model 1 potential impact
Model one may reduce the number of long-term unallocated RAC places but without a mechanism to develop alternative options for the target population (eg more high level Home Care Packages), this would increase inequity of access in Western Australia.
Inadequate access to RAC increases the risk of poorer health and wellbeing outcomes for older people, their carers and families.
Inadequate access to RAC increases the risk of poorer health and wellbeing outcomes for older people, their carers and families.
Model 2: Assign residential aged care places to consumers - Overall model
19. Overall, what are your views on this proposed model?
Model 2 views
Model two appears to increase the transparency of RAC demand which is positive.
Model two also does not appear to have mechanisms to support greater equity of access and also appears to have greater risks of increasing inequity than model one.
Model two also does not appear to have mechanisms to support greater equity of access and also appears to have greater risks of increasing inequity than model one.
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
If reported, a queue can increase the transparency of demand patterns. Consideration would need to be given as to prioritisation of people who have greater acuity of need.
21. What are your views on using date of approval and urgency of need as factors in determining a person’s priority (noting these are the factors used in home care)?
Model 2 views on date of approval and urgency
These factors should only be two of the determinants to determine priority; other factors to include may be care need, risk of clinical deterioration and/or critical event, capacity of other supports.
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
Care need, risk of clinical deterioration and/or critical event, capacity of other supports.
26. What would need to be in place to ensure equitable access to appropriate services when requesting entry to an aged care home i.e. in particular for consumers with limited capacity to pay, consumers from Special Needs Groups and those with dementia?
Model 2 equitable access for particular consumers
Equity of access targets, potentially at the level of Aged care Planning Region.
Mechanisms to engage other stakeholders, including other levels of government, in the provision of care through a co-commissioning approach.
Mechanisms to engage other stakeholders, including other levels of government, in the provision of care through a co-commissioning approach.
Model 2: Assign residential aged care places to consumers - Key design considerations (providers)
33. How can adequate availability of residential aged care services be supported (aside from increasing funding or revising the funding model):
in rural, regional and remote areas and other thin markets?
Pooled resourcing from other levels of government to employ co-commissioning approaches to the provision of care.
34. Is it possible to attach conditions to being an approved provider, and could these conditions be specific to locations or particular consumer groups?
Model 2 attach conditions to approved provider status
It should be, and yes, agree.
General views
42. Aside from the two proposed models, how else could we encourage greater consumer choice and a more consumer driven market in residential aged care?
Other models to consider
Developing and implementing equity of access targets and mechanisms to meet these.