Aged care


Budget Review 2020–21 Index

Alex Grove

The 2020–21 Budget includes $2.7 billion in new funding for aged care. This funding is outlined in two omnibus measures in Budget Measures: Budget Paper No. 2: 2020–21. The ‘Ageing and Aged Care’ measure (pp. 90–91) comprises $2.0 billion over four years, including increased funding for existing programs, and funding to explore or implement aged care reforms. The ‘COVID-19 Response Package – ageing and aged care’ measure (pp. 94–95) provides a further $700.2 million over four years to continue the Government’s response to the pandemic in aged care. Some measures respond in part to reports already handed down by the Royal Commission into Aged Care Quality and Safety (the Royal Commission), while others lay a foundation for a response to the final report which is due on 26 February 2021. The most significant initiatives in terms of funding or policy change are briefly outlined in this article. Of the initiatives listed below, only the Serious Incident Response Scheme appears to require legislation.

More home care packages

The largest single item is $1.6 billion over four years to release an additional 23,000 home care packages (HCPs). HCPs are coordinated packages of care to help eligible older people remain at home rather than entering residential care. As at 31 March 2020, there were 103,599 people waiting for an HCP (p. 12). 44,528 (43%) of these had been offered a lower level package while waiting for a package at their approved level, and most of the rest had been offered access to entry-level support services through the Commonwealth Home Support Programme (CHSP) while waiting (p. 3). Waiting times for an approved package exceed 12 months for all but the lowest level HCPs (p. 13).

The Royal Commission’s Interim Report: Neglect: Volume 1 recommended that the Government urgently release more HCPs to ‘reduce the waiting list for higher level care at home’ (p. 10). The Royal Commission heard evidence in March 2019 that it would take ‘an additional two to two and a half billion dollars per annum’ to give everyone on the waiting list a package at their approved level with a three month waiting period (pp. P1057–P1058).

Support for people with disabilities

The Commonwealth Continuity of Support (CoS) Programme supports older clients who were receiving state-managed specialist disability services but not eligible to transition to the National Disability Insurance Scheme (NDIS). The CoS will be replaced by a new Disability Support for Older Australians program (p. 96) at a cost of $125.3 million. The new program will be more in line with the NDIS, providing a client-centred program and funding for higher needs.

For younger people with a disability living in residential aged care, or at risk of entering such care, the Budget includes $10.6 million to establish a network of up to 40 system co-ordinators to help them find age-appropriate accommodation and support. This aligns with the Royal Commission’s Interim Report recommendation that the Government should stop young people entering residential aged care, and speed up the process of getting younger people out (p. 10).

Aged care reform

The Budget provides a further $29.8 million to bring forward the implementation of a Serious Incident Response Scheme (SIRS) for aged care. The scheme will replace the current reportable assaults provisions in the Aged Care Act 1997. The SIRS was a key recommendation of the Australian Law Reform Commission’s Elder Abuse – A National Legal Response final report (p. 111), and will broaden the types of abuse and neglect that must be reported. The Government plans to introduce legislation for the SIRS this year, with the scheme to commence in early 2021.

$91.6 million has been provided to continue reforming residential aged care funding. The current Aged Care Funding Instrument (ACFI) is used by providers to assess the needs of each resident, which in turn determines how much government subsidy they will receive for that resident. The Legislated Review of Aged Care 2017 recommended that independent assessors should be used to reduce the risk of a conflict of interest (pp. 140–141). The budget measure funds a year of ‘shadow assessment’ (p. 90) in which residents will be assessed by independent assessors using the proposed new Australian National Aged Care Classification (AN-ACC) funding model (but still funded under ACFI). The AN-ACC has been trialled in a number of nursing homes but a final decision on implementation has not been made.

Home care reform is also foreshadowed, with $4.6 million for further research and consultation on options for a single in-home care program (p. 72). This appears to relate to a proposal to merge the HCP and CHSP programs, which was first canvassed in the 2015–16 Budget.

COVID-19 support

The Government has provided extra funding to the aged sector to address the COVID-19 pandemic. Key measures in the Budget include:

  • $245.0 million for further lump sum payments for residential aged care providers, and the continuation of increased supplements for rural, remote and specialist homelessness providers
  • $205.1 million ($159.0 million after income tax is paid) for a third instalment of the Aged Care Workforce Retention Bonus for direct care employees, and additional funding for the second instalment
  • $103.4 million for preparedness measures, including infection control
  • $92.4 million to expand Support for Aged Care Workers in COVID-19 grants in ‘hotspot’ areas, to allow workers to work at a single site, or to quarantine if necessary
  • $71.4 million to provide CHSP services to aged care residents who have temporarily moved back home and
  • $10.8 million for scholarships and skills development for aged care nurses.

Some of these measures were announced in August, and later cited in the Government’s initial response to the Royal Commission’s Aged care and COVID-19: a special report, particularly with regard to recommendations that funding be provided for staff to support visits to aged care residents (p. 6), and that infection control expertise should be increased (p. 22).

Stakeholder reaction

The extra funding for HCPs has been widely praised, including by peak provider and consumer bodies. However, some also point out that the 23,000 HCPs will not be enough to clear the current waiting list. Funding for system coordinators to help younger people leave residential aged care has been welcomed by the Australian Healthcare and Hospitals Association and the Young People in Nursing Homes National Alliance. Consumer peak body COTA Australia has welcomed the implementation of the SIRS and the trial of independent assessors for the proposed new residential aged care funding tool. The Combined Pensioners and Superannuants Association has welcomed funding for various residential care measures, and the Australian College of Nursing has commended funding to enhance the skills of aged care nurses.

Dementia Australia raised concerns about the ‘lack of focus on dementia’ in the Budget. National Seniors Australia were hoping for measures to ‘make aged care providers more accountable’. Both the United Workers Union and the Australian Nursing and Midwifery Federation wanted to see measures directly addressing aged care staffing. For-profit provider peak body the Aged Care Guild hopes to see more long-term reform in next year’s Budget, noting that the Government has promised a comprehensive response to the Royal Commission’s final report.

 

All online articles accessed October 2020

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