Budget Review 2022–23 Index
Rebecca Storen
Introduction
The 2021–22
Budget saw the release of the Australian Government’s generational
plan for aged care in Australia (aged care plan) and its
response to the Royal Commission into Aged Care Quality and Safety (Royal
Commission), alongside a commitment of $17.7 billion over 5 years (from
2020–21). The aged care plan sets out 5 overarching pillars for the reform
agenda: home care; residential aged care services and sustainability;
residential aged care quality and safety; workforce; and governance. In December
2021, the Mid-Year Economic Fiscal Outlook built on the Government’s response
from the last Budget, committing
an additional $632.6 million to the continued implementation of the Royal
Commission’s recommendations.
Now, more than 12
months since the release the Royal Commission’s final report, the
Government has committed another $468.3 million to its aged care reform agenda
through the 2022–23 Budget (Budget
measures: budget paper no. 2: 2022–23, pp. 86–87). However, in light of
the continued pressures facing the sector, with recent and particular emphasis
on workforce, most of the sector, whilst having recognised that the Budget has
some ‘useful things’, overall have found
the Budget wanting.
In addition to the aged care reforms measures, the Budget
also provides funding for the aged care sector under the COVID-19 response package,
which is discussed elsewhere in the Budget review 2022–23 (see the
Public Health article).
Aged care reforms measures
According to Budget
paper no. 2, the Government has committed $468.3 million over 5 years
from 2021–22 with partial funding having already been provided. Total payments
for the Ageing and aged care measure will be $122.6 million across the
forward estimates, with the majority of payments scheduled for 2022–23 at $76.3
million (pp. 86–87).
There are several elements in the Budget’s aged care package
that will require the passage of legislation, in particular the introduction of
the new funding tool into residential aged care, which is briefly discussed below.
Home care
The
Budget provides an additional $5.4 million for the home care pillar over 3
years (from 2022–23) to enable continued work for consultation on the design of
the aged care reforms, including a regulatory package for the new Support at
Home Program (p. 86). This program is set to be introduced from July 2023, and
will require changes to existing aged care legislation. The legislative changes
are anticipated to be achieved through the proposed new Aged Care Act, expected
to commence from 1 July 2023 (Australian
Government response, pp. 1 and 22). An overview
of the proposed design for this new program was released earlier in the
year, providing a draft consultation timeline that identifies consultation
activities taking place from February to August 2022 (p. 14).
Residential aged care services and
sustainability
The
Budget provides $20.1 million over 3 years (from 2022–23) to complete the
implementation of the new residential care funding tool, the Australian
National Aged Care Classification (AN-ACC), and support services to
transition to the AN-ACC model over a 2-year period (p. 86). This is in
addition to the $53.3 million for the transition activities provided in
the 2021–22
Budget. However, whilst the AN-ACC is due for implementation from October
2022, it is unable to commence without changes to the existing legislation
(discussed below).
The 2021–22
Budget confirmed that the AN-ACC would replace the Aged Care Funding
Instrument (ACFI), following several years of work to develop a new funding
model for residential aged care. This funding model has several similarities to
public hospital funding, including the use of a national weighted activity unit
(NWAU), which is a common unit allowing for comparison and value for each
service for a resident’s care classification and the facility description category.
A price is then paid per activity unit (for further details see The
resource utilisation and classification study: report 6 from the
Australian Health Services Research Institute, pp. 11–12). The Budget has
provided the sector with the NWAU starting price for the AN-ACC at $216.80,
with the average resident funding anticipated to be approximately $225 per day
(Health
portfolio 2022–23 budget stakeholder pack, p. 147). This information
has been welcomed
by stakeholders, but they have renewed their calls for the release of the shadow
assessment results for people in their services, which would allow them to
estimate their budgets and plan their resourcing.
The 2020–21
Budget provided funding for a 12-month shadow assessment period. During
this time, providers would continue to use, and be funded through, the ACFI;
however, independent assessors would assess the care needs of most people
already living in residential aged care using the AN-ACC model and assign each
person to one of 13
classes of care. This shadow assessment process was made possible with the passage
of the Aged
Care Amendment (Aged Care Recipients Classification) Bill 2020. It was due
to start
in April 2021 and is expected to take 12 months to complete.
Residential aged care quality and
safety
The
Budget provides $398.4 million for improving access and linkages with
health professionals and providing surge capacity for the Aged Care Quality and Safety Commission
(ACQSC), which is responsible for the regulation of quality and safety in aged
care (p. 86).
The largest financial commitment under this measure is the announcement
of $345.7 million to enhance medication management through better access to
pharmacists either on-site or through community pharmacies for people living in
residential aged care. This announcement responds, at least in part, to the Royal
Commission’s recommendations for increased access to medication management
reviews (Recommendation 64, p. 251) and for residential aged care to include
allied health care (Recommendation 38, p. 235). The program is due to commence from
1 January 2023. The announcement has been welcomed by the Pharmaceutical
Society of Australia, which stated that ‘The evidence is clear –
pharmacists need to be an embedded part of the aged care equation if medication
misadventure is to be minimised and rectified’. The Pharmaceutical Society of
Australia was further of the opinion that the program would need flexibility,
as every residential aged care service is different.
The Royal
Commission recommended improved access to specialists and other health
practitioners through the introduction of multidisciplinary outreach services,
which would be led by Local Hospital Networks, with services funded through an
amendment to the National
Health Reform Agreement (Recommendation 58, p. 248). The Budget provides $22.1
million to trial multidisciplinary outreach services, which will be evaluated
to inform the pricing and delivery of these services for a national rollout,
with cost sharing with the states and territories (Health
portfolio budget stakeholder pack, p. 149). Each state and territory
will receive $2.6 million over 2 years as part of this trial (Federal
financial relations: budget paper no. 3: 2022–23, p. 25).
An additional $21.6 million will be made available to the
ACQSC to engage a third-party quality assessment workforce for aged care
quality and safety assessments and audits (Health
portfolio budget stakeholder pack, p. 150).
Aged care, disability and veterans’
care sectors workforce
The Ageing and aged care measure provides
approximately $50.5 million for workforce, with most activities for the care
and support sector (aged care, disability and veterans’ care sectors) and
featuring in the new National
Care and Support Workforce Strategy:
- $10.8 million for Government to create a Cross-Agency Taskforce
on Regulatory Alignment to better align regulation across 3 sectors
- Legislative
changes are likely be required for these activities in order to facilitate
information sharing between agencies
- $32.8 million across the forward estimates and $2.8 million per
year thereafter for the care and support sectors including:
- $14.9m for addressing barriers to clinical placements in care
and support sectors
- $14.3m
to expand the Rural
Health Multidisciplinary Training program, designed for health students to
train in rural and remote locations, to 5 new locations – the program
evaluation (2020) found that whilst there are opportunities for
improvement, the program has had a number of positive outcomes including
strengthening clinical service delivery across Australia (p. 15)
- $6.9 million over 3 years to support the staged rollout of the
national co-operative and mutual enterprises (CME) support program, starting
with 6 to 7 CMEs to deliver services in areas of need –the Business Council of
Co-operatives and Mutuals will receive funding to support the start-up and development
of cooperative and mutual enterprises and deliver business resources and
professional support (Budget
paper no. 2, p. 87; Health
portfolio budget stakeholders pack, pp. 152–154).
- CMEs
are member-owned businesses that seek to provide value and meet financial
and social goals of their members. There are different membership structures for
co-operatives and mutuals, for example businesses formed by employees or small
enterprises (p. 4).
In addition, as discussed elsewhere in this Budget review
(see the skills and training article), an additional 15,000 low-fee and free
training places in aged care courses will be made available through the
education, skills and employment portfolio (Budget
paper no. 2, p. 74).
The workforce measures in particular have been criticised
by most aged care stakeholders, especially
given the notable exclusion of any commitments to increasing wages for aged
care workers. In its press
release, the Australian
Aged Care Collaboration (AACC) stated that the Budget does ‘nothing… to
improve aged care wages’ and ‘It will leave our dedicated workers on the edge
of poverty and many older Australians without the services they need’. This
position was echoed by United Workers
Union, which
stated that ‘…the Budget has no announcements that address low pay
rates that leave workers with barely enough to live on, working multiple jobs
to feed themselves and their families’ [emphasis in the original]. The press
release goes on to state that the Budget ‘…fails to address the widespread
understaffing that leaves aged care workers rushing to provide even the most
basic levels of care to older Australians who deserve much better’.
Fair Work Commission
In 2020 and 2021, the United Workers Union and the
Australian Nursing and Midwifery Federation lodged applications to the Fair
Work Commission to vary 3 awards: Aged Care Award 2010; Nurses Award 2010 and
the Social, Community, Home Care and Disability Services Industry Award 2010.
The Work
value case – Aged care industry applications seek to increase the wage
rates for aged care employees in all 3 awards by 25%. In a joint
submission from 17 December 2021, several key stakeholders submitted a
consensus statement noting that the wages need to be significantly increase
because the work has historically been undervalued and stating that if the Fair
Work Commission recommend an increase in wages that this must be fully funded
by the Australian Government.
In the budget
reply, the leader of the opposition committed that ‘a Labor government
would fund the outcome of this case’. The Prime
Minister has stated that ‘[the Government will] have to ensure, working
with industry, that Fair Work Commission decisions are honoured’ (p. 4).
Governance
The
Budget provides an additional $6.1 million over 6 months to further support
the regional offices trial announced in the 2021–22
Budget (p. 87).
Necessary legislative changes
In September 2021, the Government introduced the Aged
Care and Other Legislation Amendment (Royal Commission Response No. 2) Bill
2021, which would make changes required to introduce a number of the
Government’s aged care reforms. As discussed in some detail in the Bills
Digest, the Bill would, among other things:
-
enable the introduction of a new funding model for residential
aged care (the AN-ACC) from 1 October 2022
-
enhance the ability of several Commonwealth agencies responsible
for the aged care, disability and veterans’ affairs portfolios, and relevant
regulators from the health sector, to share information on non-compliant
providers and their workers
-
expand the scope of the Independent Hospital Pricing Authority so
it could provide advice on aged care pricing and costing matters (pp. 5–6).
On 30 March 2022, the Senate agreed to several
amendments to the Bill, including the requirement, in most cases, for
residential aged care services to have a registered nurse on-site at all times.
On this particular issue, the Government had previously indicated it accepted
the Royal Commission’s recommendation on minimum staff time standards for
residential aged care, which would introduce the requirement for residential
aged care services to have a registered nurse on site at all times from July
2024 (Australian
Government response, pp. 56–57). The AACC, made up of aged care
provider peak bodies, welcomed
the amendments introduced in the Senate requiring registered nurses on-site
at all times, but asked where the funding and the staff would come from if this
requirement does pass into legislation.
At the time of writing, the amended Bill had not yet
returned to the House of Representatives.
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