Budget Review 2021–22 Index
The 2021–22 Budget implements the Australian
Government’s response to the Royal Commission into Aged Care Quality and Safety
(the Royal Commission) and a generational
plan for aged care in Australia. This $17.7
billion package comprises five ‘pillars’:
- $7.5 billion for home care over five years from 2020–21 (p. 100)
- $7.8 billion for residential aged care services and
sustainability over five years from 2021–22 (p. 102)
$942.0 million for residential aged care quality and safety over
four years from 2021–22 (p. 101)
$652.1 million for workforce skills, training and registration
over four years from 2021–22 (p. 103) and
$698.3 million for governance and regional access over five years
from 2020–21 (p. 99).
Stakeholders have broadly welcomed the Australian
Government’s response to the Royal Commission and the associated $17.7 billion
reform package. The Australian
Aged Care Collaborative (AACC) (which represents around 1,000 providers)
said the package provides a pathway to a transformed aged care system, with
resourcing to meet the needs of older Australians. Council
on the Ageing (COTA) Australia identified the aged care reform package as a
‘serious and meaningful response’ to the Royal Commission.
This is one of three articles which provide an overview of
the aged care budget measures and relevant elements of the response to the
Royal Commission. The articles should be read in conjunction with one another.
This article focuses on access to quality aged care and
governance issues. The other two articles cover:
access to aged care, and care and support in the home and
- residential aged care and workforce.
For background information and context, this Parliamentary
Library quick guide provides an overview of the Royal
Commission’s Final Report.
New governance arrangements
The Royal Commission recommended fundamental reform of the
aged care system, in particular the need for the system to recognise that people
need to be placed at the centre of all aspects of aged care to ‘support
people to live well into old age’ (p. 5). To achieve this, the Commissioners made
many recommendations focused on system governance, provider governance, safety
and quality. Their first three recommendations focused on a new aged care Act
… must enshrine the rights of older people who are seeking or
receiving aged care. This will leave no doubt to all involved in the system
about the importance placed on these rights. A rights-based approach must guarantee
universal access to the supports and services that an older person is assessed
as needing. (Vol.
1, p. 79)
In its initial
response to the Royal Commission’s Final Report, the Australian
Government confirmed it would immediately start working towards a new Act.
The Royal Commission recommended new
and robust governance arrangements and proposed two different structures
for the new aged care system. Commissioner Pagone proposed the Independent
Commission model and Commissioner Briggs proposed the Government Leadership
model. Both models included a system governor, quality regulator, prudential
regulator and a pricing authority (p. 4).
A new aged care Act from 2023
The Budget provides $26.7 million over four years (from 2021–22)
to develop a new aged care Act, which will replace the Aged Care Act 1997
and the Aged Care Quality and Safety Commission Act 2018 (Budget Measures: Budget Paper No. 2: 2021–22, p. 99). According to the Australian
Government Response to the Royal Commission, the new Act is intended to
commence from 1 July 2023 (p. 1). The Government has identified that this new Act
will be values
based (p. 7), however it is unclear whether this new Act will reflect the
complete recommendations from the Commissioners of a rights-based approach with
universal access (Royal Commission Final
Report, p. 17).
Additional oversight and advisory
The Commissioners made several joint and separate
recommendations to enhance
the governance of the aged care system, including:
- Commissioner Briggs recommended the Australian Government
establish a Council of Elders to consult and represent older people’s view on
the aged care system and the rights and dignity of older people (Recommendation
Commissioner Pagone recommended the establishment of an Aged Care
Advisory Council to provide advice on areas such as aged care policy and
service arrangements (Recommendation 7).
- Both Commissioners recommended that an independent office of an
Inspector-General of Aged Care be established to be responsible for
investigating, monitoring and reporting on the administration and governance of
the system (Recommendation 12).
The Budget provides $21.1
million over four years to establish the advisory councils and the office
of the Inspector-General of Aged Care (pp. [148–149]). The Government
plan for aged care states that the new National Aged Care Advisory Council
will be established from July 2021 (p. 20). It appears that the Council of
Elders will be established in 2021 (p. 7). A commencement date has not been
provided for the office of the Inspector-General of Aged Care. The Commissioners
recommended an Inspector-General should be appointed under an interim
arrangement before being formally established in the new Act (Recommendation
Provider governance and capability
In its initial
response to the Royal Commission’s Final Report, the Australian Government
provided $14.2 million to strengthen the Aged Care Quality Standards (the Standards)
and announced a new Assistance Commissioner for Sector Capacity and Education
with the Aged Care Quality and Safety Commission (ACQSC). The Department
of Health Budget Factsheet provides some additional information on these
announcements, including that the budget provides $30.1 million from December
2021 to strengthen the governance and enhance capability of the sector (p. ).
Revision of the Standards
In the Final
Report, the Commissioners recommended the Australian Commission on
Safety and Quality in Health Care (ACSQHC) be expanded to include aged care (Recommendation
18). In its response,
the Australian Government has not fully supported this recommendation and
instead, from 1 July 2021, will transfer the responsibility of reviewing and
revising the standards related to clinical care in aged care to the ACSQHC. The
Department of Health will retain responsibility of the non-clinical care
standards. A review of the Standards will be completed by December 2022 (pp. 17–18).
Provider governance will be enhanced with increased legislative
obligations that aim to improve transparency and accountability, and to ensure
people’s needs, preferences and best interests are met. These changes respond
to the recommendations made by the Royal Commission in Chapter
13 on provider governance (Australian
Government Response, pp. 58–59).
Aged Care Quality and Safety
The new aged care Act will replace the legislation under
which the ACQSC is established. The ACQSC will undergo a capability review in
2023 to inform the design of a new independent Aged Care Safety and Quality
Government Response, pp. 11–12).
The ACQSC is estimated to grow from an average staffing
level of 519 for the 2020–21 financial year to 831 for the 2021–22 financial
Budget Statements 2021–22: Budget Related Paper No. 1.7: Health Portfolio,
p. 135). This significant increase reflects the number of budget measures that
impact the ACQSC, some of which are outlined below.
The Budget provides $36.7
million over four years to enhance the ACQSC’s capacity to undertake
compliance activities on home care packages. It is estimated that this will
allow for an additional 750 quality reviews and assessment contacts over two
years from 2022–23 (p. 102).
plan for aged care (p. 14) states that the Budget provides $264 million for
the ACQSC to strengthen its regulatory powers and capability, including:
- $8.3 million to develop a tool to enhance the ACQSC’s
oversight of high-risk home care services (p. 14)
- $24.7 million for 2021–22 for the ACQSC to undertake 1,500
additional site audits in residential aged care, an increase of 900 scheduled
for the year, and
$148.3 million to respond to complaints, undertake
residential aged care audits, home care reviews, pursue cases of non-compliance
and undertake more prudential and financial investigations. In addition, the
ACQSC’s powers to pursue civil penalties, enforceable undertakings, injunctions
and compliance notices will be strengthened (see also Health
Portfolio 2021–22 Budget Stakeholder Pack (DoH Budget Pack) p. ).
Serious incidents and restraints
Budget Pack (p. ) states that the Budget provides $7.3 million
- strengthen existing legislation from 1 July 2021 to:
restraints are only used as a last resort, following attempts of alternative
- appoint a Senior Practitioner in 2021–22 to lead a sector and GP
education campaign on the use of restraints and provide independent oversight
of the use of restraints (see also Australian
Government Response, p. 16) and
- extend the ACQSC pharmacy program until 2025 (p. 125).
In its response
to Recommendation 17 of the Royal Commission, the Australian Government
states that the ACQSC is working with the ACSQHC and the National Disability
Insurance Scheme Quality and Safeguards Commission to align the regulatory
approaches on the use of restraints (p. 16).
There is also $14
million to expand the Serious Incident Response Scheme into home care from
1 July 2022 (p. 14).
Caring for people with dementia and
the use of restraints
To improve the sector’s dementia care capability and to
assist with reducing reliance on restraints, the Budget provides:
- $67.5 million for dementia care, including additional funding for
the Dementia Behaviour Management Advisory Service and the Severe Behaviour Response
Teams to support up to 13,000 more referrals a year and
- training by dementia specialists for aged care providers on the
management of psychological symptoms and behaviour changes to assist with
restraint prevention (DoH
Budget Pack, p. ).
Pricing transparency for home care
Stakeholders have raised concerns about the proportion of
home care package funds that are spent on administration costs (for example, National
Seniors Australia), with analysis
of the Home Care Provider Survey suggesting a sector average of 28% of the
package funds (2018–19) were spent in this manner (p. 4). The Budget builds on
transparency measures introduced by the Department of Health. The $18.4
million budget measure includes assurance reviews of home care providers and
enhanced fraud management capability within the Department (DoH
Budget Pack, p. ).
The Budget provides $100 million to improve visibility and
implementation of quality measures, including:
- a star rating for all residential aged care services will be
available on My Aged Care by the end of 2022
introduction of additional quality indicators in residential aged
care by the end of 2022
introduction of quality indicators for care at home by the end of
- introduction of consumer experience and quality of life
indicators by the end of 2022 and
- development of a National Aged Care Data Strategy by 2024, which
will include an aged care minimum data set and new dementia data (DoH
Budget Pack, p. ).
The Budget provides $94 million to expand independent
advocacy services. This funding will allow the advocacy workforce to double to
over 150 advocates. This will enhance services through the provision of
face-to-face and virtual advocacy and education and networking sessions (DoH
Budget Pack, pp. [132–133]).
In the Royal
Commission’s Final Report, Commissioner Briggs recommended that the
Department of Health establish a network of 50 small regional offices who would
be responsible for a range of functions including local planning and engagement
with older people (Recommendation 8.6). The Budget provides $13.4 million for
2021–22 to trial the establishment of offices in eight Primary Health Network
(PHN) regions, with a broader roll-out being subject to an evaluation (DoH
Budget Pack, p. ).
Budget Pack sets out measures to improve access to primary care for
older people as per below (pp. [129–130]).
The Budget provides $365.7 million over four years to
improve access to primary care and other health services. This measure includes
five main components, with the most financially significant being $178.9
million for PHNs to:
- support the delivery of telehealth for people living in
residential aged care
improve out of hours support for residential aged care
- develop local dementia care pathways to support GPs to link
people with dementia and their carers with services and
support identification and monitoring of people’s health needs so
they can live at home for longer.
Choice for At Home Palliative Care Pilot will be extended to all PHNs with $37.5
million over four years. The intent of this program is to help people access
end-of-life and palliative care in their homes through locally responsive
The Aged Care Access Incentive will be boosted by $42.8
million over two years from 1 July 2021. This incentive seeks to increase the
face-to-face care from GPs in residential aged care, with this additional
funding doubling the existing maximum years payment to $10,000.
Improved medication management in residential aged care will
be allocated $45.4 million will be provided to support transfers between care
settings, which includes use of electronic National Residential Medication
Charts and the My Health Record.
In addition, $23.6 million will be used to enhance data and
evidence to improve planning to better meet people’s health needs. This will
include identifying the drivers of higher hospitalisation rates for people
living in residential care, the use of multi-disciplinary team models to reduce
avoidable hospitalisations, and identifying the allied health workforce
available in both the home and residential care setting.
Australia welcomed the ‘extraordinary commitment to dementia’ announced in
the Budget, saying that the Australian Government was providing a
Care Australia (PCA) welcomed the Australian Government’s response to the
Royal Commission but is concerned that the funding falls short of the amount
needed as recommended by the Royal Commission itself. PCA noted that additional
attention will be required to ensure the palliative care needs of older
Australians are addressed under the Australian National Aged Care Classification
Society of Australia welcomed the Australian Government’s response to the
Royal Commission but noted more must be done to safeguard people living in
residential aged care from harms caused by medication mismanagement.