The Australian Greens are broadly supportive of the measures in the Aged Care Amendment (Aged Care Recipient Classification) Bill 2020 (bill).
This bill allows for the introduction of a new classification system of older Australians accessing residential aged care and some types of flexible care. It marks an important step towards a new funding model for residential aged care by allowing the Australian Government (government) to undertake shadow assessments using the Australian National Aged Care Classification (AN-ACC) tool.
It is widely acknowledged that the existing Aged Care Funding Instrument (ACFI) is no longer fit-for-purpose and does not adequately address palliative care, dementia care or restorative care.
While the Australian Greens are broadly supportive of the bill, there are a number of issues that we will be monitoring throughout the shadow assessment process.
The assessment workforce
As part of this measure, the government will need to recruit and train a new workforce. The Federation of Ethnic Communities’ Councils of Australia (FECCA) recommended that aged care assessments of older people from culturally and linguistically diverse (CALD) backgrounds should be guided by a Diversity Advisor who will help ensure training of assessors includes cultural competency, cultural safety and trauma-informed approaches. The Australian Greens support this call and will be monitoring the implementation of cultural training for the assessment workforce.
Aged and Community Services Australia (ACSA) noted that when it comes time to implement the new funding system after the shadow assessments, we will need to ensure that the assessment workforce has the capacity and capability to undertake the assessments. The Australian Greens endorse the need to put in place a robust, well-paid and well-trained assessment workforce from the very beginning of this process.
Use of computer programs for decision-making
Section 29C of the bill allows the secretary to arrange for the use of computer programs for making decisions on the classification of care recipients. This provision provides that a decision made by the operation of a computer program under such arrangement is taken to be a decision made by the secretary.
Several submitters raised concerns about the use of computer programs to classify care recipients, especially in light of the failures of the robodebt program.
The Older Persons Advocacy Network (OPAN) noted that:
The recent impact on people’s health and wellbeing caused by robodebt, coupled with the costs to people and Government, means that any such computer program must be thoroughly tested, reviewed and the outcomes monitored closely to ensure such an issue does not arise for older people.
FECCA also noted concerns that it is unclear how computer programs will be used to guide particular classifications:
While it can help optimise management and administration, the recent Robodebt case served a fair warning of how algorithm-based and automated decision-making processes can fail in human services … FECCA asks that there be more transparency and disclosure in all aspects of this section.
The Select Standing Committee for the Scrutiny of Bills (scrutiny of bills committee) also requested:
… the minister’s more detailed advice in relation to what factors are likely to be taken into account in classifying care recipients and how computer programs will be able to appropriately evaluate and weigh such factors.
The Australian Greens have strong concerns about how computer programs will be used to make decisions and classify care recipients under the AN-ACC tool. We do not want to see older Australians fall prey to repeat of the errors made under the illegal robodebt program. We will be requesting more information from the Minister for Aged Care and Senior Australians (minister) regarding the use of computer programs to classify care recipients and watching the implementation of this process closely.
Use of delegated legislation
The Australian Greens echo the concerns highlighted by the scrutiny of bills committee regarding the use of delegated legislation for significant matters, including the Classification Principles for assessing a care recipient’s needs. We will be seeking clarification from the minister about the use of delegated legislation for significant matters during the debate.
Information collected under the shadow assessments
Submitters to the inquiry highlighted what information we need to understand about the new classification system following 12 months of shadow assessments. For example, ACSA suggested we need to understand the following information:
Whether the alternate resident classification delivers the required support for an individual resident;
The financial impacts at both the aggregate and provider level of a change from the current funding instrument (ACFI) to an alternate funding instrument (in this case AN-ACC);
Whether the proposed five per cent stop loss is adequate in all circumstances; and
The potential values assigned to the national weighted activity unit of AN-ACC.
OPAN also suggested the shadow assessments period should be used to address areas identified by the Royal Commission including:
… components relating to enablement, allied health, the improvement in psychosocial, cultural and spiritual aspects of quality of life, the cost of the enteral feeding, oxygen, and veterans’ supplements.
The Australian Greens will continue to monitor how the government will collect and evaluate this information and how it will be informed by the recommendations from the Royal Commission.
We note Recommendation 88 from Counsel Assisting the Royal Commission regarding casemix-adjusted activity based funding in residential aged care:
Ongoing evidence-based reviews should be conducted thereafter to refine the model iteratively, for the purpose of ensuring that the model accurate classification and funding to meet assessed needs.
We also strongly support the open publication and consultation with stakeholders from across the board about the information gathered through this process.
The Australian Greens agree with the committee view that the department is encouraged to closely monitor and evaluate the shadow assessments process and the outcome of the Royal Commission, and consult appropriately on any proposed changes, before a decision is made on the final model.
Independent pricing authority
The current funding model, ACFI, has suffered from freezes and indexation pauses. As a result, the instrument did not keep pace with costs of care and did not meet the needs of older Australians. While it is outside the remit of this inquiry, it is clear that a new funding model will not be enough to address the past issues with ACFI. The Australian Greens support calls for an independent pricing authority, for example as recommended by Counsel Assisting the Royal Commission, to ensure funding for residential aged care keeps pace with need.