Aged care
Rebecca de
Boer
Funding and policy arrangements for aged care have long been
subject to calls for significant structural reform. In response to
the recommendations of the National Health and Hospitals Reform
Commission (NHHRC) and as part of the National Health and Hospitals
Network (NHHN), the Government has announced that it will assume
full funding and policy responsibility for aged care in all states
and territories apart from Western Australia and Victoria. In
addition, the Government has announced the Productivity Commission
will inquire into options for further structural reform of aged
care and report by April 2011.[1]
Although the specific arrangements for aged care in the NHHN are
lacking in detail, the recurring themes are improved integration of
aged care with other parts of the health care system as well as
greater availability and flexibility of care in the community.
Funding has been allocated to:
- expand the capacity of multi-purpose services to provide aged
care or sub-acute services
- improve access to general practice and primary health care for
older Australians in residential aged care facilities
- incentives for community care providers in regional, rural and
remote areas; and extra ‘one-stop shops’ to assist
older Australians in accessing information about aged care
assessment services.
The benefits of these initiatives may take some time to realise
but represent the first stage of the Government’s commitment
to full policy and funding responsibility for aged care.
The Budget provides $10.8 billion for aged and community
services in 2010–11, part of a $47 billion package over four
years.[2] The
majority of this funding is directed towards residential aged care
and community aged care packages, but there is some additional
funding for the aged care workforce, improved access to primary
care services and zero interest loans for capital
infrastructure.
In contrast to previous budgets, this Budget contains greater
investment in the aged care workforce. Over $310 million over four
years has been allocated to a combination of workforce programs,
including additional nursing places and scholarships, incentive
payments for the aged care workforce to undertake additional
training and/or upgrade qualifications and the introduction of the
Aged Care Nurse Practitioner Program which will promote access to
aged care nurse practitioners as well as explore appropriate models
of care for aged care nurse practitioners. The Australian Nursing
Foundation (ANF) was supportive of the Government’s
announcements but continues to lobby for minimum staffing levels in
aged care.[3]
Previous budgets that have focussed on the return of nurses to
the aged care workforce have met with limited success.[4] The budget announcements
are intended to create a career pathway in aged care, provide
greater flexibility for training initiatives and assist the
industry in recruitment and retention of the aged care
workforce.[5] There
are considerable workforce shortages in aged care and it remains to
be seen whether these measures will address this. Furthermore, the
aged care workforce is ageing and unless there are sufficient
incentives to attract nurses to aged care, this will remain an
ongoing policy challenge for government. For further analysis of
aged care workforce issues refer to the Health Workforce
brief in this publication.
Peak lobby groups and aged care providers all expressed
disappointment that there were no increases to aged care subsidies
in the Budget.[6] The
funding gap between government payments and the costs of providing
residential aged care is considered
‘unsustainable’[7] and insufficient to meet both community and government
standards of care.[8]
Complex policy issues, such as accommodation bonds and reform of
aged care funding and regulatory arrangements, have been referred
to the Productivity Commission. However, it was argued that interim
arrangements should be established to address this perceived
shortfall.[9] Under
the current arrangements many aged care providers consider the
building of new nursing homes unaffordable.[10] Furthermore, the future viability of
the sector has been described as ‘untenable’ under the
current arrangements.[11]
One of the more notable initiatives in the aged care budget was
the introduction of consumer-directed aged care packages. These
were a recommendation of the NHHRC and will give older Australians
and their carers greater flexibility and choice about the type of
care they access.[12] Under this initiative, consumers will be able to tailor
their care to their needs and make decisions about the design and
delivery of the care provided to them. This represents a shift from
the current model where care is largely linked to the package, not
the consumer. Implementation will be phased, with 500 consumer
directed packages to be released in 2010–11.[13] The Government has not detailed
what support (if any) will be provided to consumers about making
decisions in relation to their care or when negotiating with
service providers to ensure value for money.
[1]. Productivity Commission (PC),
‘Caring for Older Australians: public
inquiry’, PC website, viewed 13 May 2010, http://www.pc.gov.au/projects/inquiry/aged-care
[2]. J
Elliot (Minister for Ageing), Building a national aged care
system, media release, 11 May 2010, viewed 12 May 2010,
http://www.health.gov.au/internet/ministers/publishing.nsf/Content/B36A2C8D95246C74CA257722000974B8/$File/amedia07.pdf
[3].
Australian Nursing Foundation (ANF), Aged care workers and
residents big winners in Budget 2010, media release, 11 May
2010, viewed 12 May 2010, http://www.anf.org.au/html/media/news_media_100511.html
[4]. As
at February 2010, only 139 nurses (of an anticipated 1000) had
returned to the aged care workforce under the Bringing Nurses Back
into the Workforce initiative. See Senate Community Affairs
Legislation Committee, Hansard, Additional Estimates
2009–10, 10 February 2010, viewed 15 May 2010, CA 121,
http://parlinfo.aph.gov.au/parlInfo/download/committees/estimate/12751/toc_pdf/7376-2.pdf;fileType=application%2Fpdf#search=%22committees/estimate/12751/0003%22
[5]. Australian Government, Portfolio
budget statements 2010–11: budget related paper 1.11: Health
and Ageing Portfolio, Commonwealth of Australia, Canberra,
2010, p. 164.
[6]. See
media releases from: Anglicare, Federal Budget: a
‘restraint too far’, media release, 11 May 2010,
viewed 12 May 2010,
http://www.anglicare.org.au/news-research-events/latest-news/budget-a-restraint-too-far
; (COTA), Federal budget – aged care still in
waiting, media release, 11 May 2010, and Aged Care Association
Australia (ACAA), Budget 2010: a mixed bag for aged care,
media release, 11 May 2010, viewed 12 May 2010,
http://www.agedcareassociation.com.au//content/Budget%202010%20A%20Mixed%20Bag%20for%20Aged%20Care.pdf
Also refer to J Breusch, ‘Nursing homes press funds
case’, Australian Financial Review, 14 May 2010, p.
20, viewed 12 May 2010
http://parlinfo/parlInfo/search/display/display.w3p;adv=yes;db=;group=;holdingType=;id=;orderBy=customrank;page=0;query=Author%3Abreusch%20Date%3A14%2F05%2F2010%20Dataset%3Apressclp;querytype=;rec=1;resCount=Default
[7]. Anglicare, Federal Budget: ‘A
restraint too far’, media release, 11 May 2010. op. cit.
Refs 8,9,10,11
[8]. ACAA, Budget 2010: a mixed bag for
aged care, media release, 11 May 2010.
[9]. COTA, Federal budget – aged care
still in waiting, media release, 11 May 2010 and Anglicare,
Federal Budget: ‘A restraint too far’, media
release, 11 May 2010.
[10]. J Breusch, ‘Nursing homes press funds
case’, Australian Financial Review, 14 May 2010, p.
20.
[11]. N Bita, ‘Nursing homes failing on care, The
Australian, 17 May 2010, p. 4, viewed 17 May 2010,
http://parlinfo/parlInfo/search/display/display.w3p;adv=yes;db=;group=;holdingType=;id=;orderBy=customrank;page=0;query=Author%3Abita%20Date%3A17%2F05%2F2010%20Dataset%3Apressclp;querytype=;rec=1;resCount=Default
[12]. Portfolio budget statements, op. cit., p. 193.
[13]. Ibid.