As demand for aged care services continues to grow, providers can find themselves in the position of having to choose which prospective resident they want to welcome into their home from a list of multiple applicants.
With a limited number of bed vacancies available and a growing number of individuals needing care, some providers are prioritising admissions based on the potential funding each resident can bring, rather than their care needs. This practice, known as cherry-picking, raises critical concerns about fairness and points to a much larger systemic issue that requires attention.
An anonymous aged care placement specialist with over three decades of aged care experience sheds light on this issue.
“Because aged care is in such high demand, there are lots of scenarios where providers have the choice of who comes into their facility,” the placement specialist explains.
“If you’ve got one bed available and five people who have applied for that bed, but four of the applicants have behaviours and one of them has higher care needs that will bring in more funding, then it’s quite common for the latter to get the vacant bed over the other four applicants.”
The root of this issue lies in the financial structure of aged care funding. According to our specialist, “The funding is better when you have a resident with higher health needs than one with higher behavioural needs. If you’ve got someone who’s got a RAD (refundable accommodation deposit) who requires full assistance with everything like showering and feeding, the provider will receive the full amount of available funding.”
This is contrasted with residents who have behavioural issues or require memory support, which often necessitates higher staffing levels and additional resources. “Caring for that person costs a provider more money than they get in to care for that person,” the specialist notes.
Slim Pickings
According to the anonymous aged care placement specialist, providers cherry-picking prospective residents based on their financial return is not a new problem, but it is rarely spoken about. “Providers won’t tell you that is what’s happening, but that does influence decisions when they have the choice. All they have to say to the applicants that missed out ‘Sorry, we can’t meet your care needs.”
The specialist then revealed that one of their current clients, a gentleman with an acquired brain injury (ABI), is on the cusp of having to move states in order to find placement at an aged care facility. And the specialist believes that cherry-picking is likely to blame.
“We’ve applied at 80 homes in his state and the answer has just been ‘no’ across the board,” he says. “He doesn’t need help showering or eating, and his behaviours are manageable. However, if he was someone who required constant supervision and additional care, he probably would have had a bed months ago.”
The impact of cherry-picking extends beyond individual cases, as people sit on waiting lists for longer, potentially in homes that are no longer a safe environment for them, or clog up hospital beds. The practice exacerbates delays in securing appropriate care and can lead to individuals remaining in unsuitable or unsafe environments longer than necessary.
Addressing this issue requires systemic change. “We need more beds. More aged care homes,” the specialist asserts. The ability of providers to cherry-pick stems from the high demand and low availability of beds. “The larger problem is, there’s no real investment in aged care because every home is struggling.”
The specialist also points out that some larger providers cut costs by reducing standard services and charging for extras. “Lowering expectations on prescribed services and increasing additional services allows some providers to make a bit of money,” he says.
However, many homes that attempt to maintain high standards without additional revenue streams face financial difficulties. But without significant investment and an increase in the number of facilities, providers will continue to prioritise financially advantageous placements over those based purely on care needs.
The article ignores the significant increase in the administrative load that is created when residents are admitted with behavioural issues as the frequency of incidents that are reportable to the ACQSC and Police Service also increases disproportionally. The approach of the ACQSC is then what is the provider doing to manage behaviours and the risk to other care recipients. Furthermore the majority of care recipients in aged care are woman who are often frail and are at increased risk from male residents who have increased propensity for physical aggression.
Couldn’t agree more Alistair Croydon well said. The workload is absolutely huge, and the amount of time spent on reporting is unbelievable and most of the time spent reporting would be better spent on looking at ways to minimise these behaviours.
Agree with these comments Alasdair – This article is a rather simplistic view of the decision making process that providers undertake . Decision making processes take into consideration a plethora of aspects eg Casemix of residents, Priority of need, staffing availability just to name a few. It is certainly clear that funding for mental health related or dementia related behaviours are not available to aged care operators nor wider based support networks (eg acute sector mental health). The holistic health care system needs to work on solutions which in turn will ensure that older people are not left sitting in hospital beds when they realistically need to be in a better environment where their needs are met.
This is sad news.
By this: ‘require memory support’ – do you mean specialised dementia care?
Why, in the aged care industry, are we persisting in calling units designed to care for people with dementia – memory support? Memory is only one and often the least of the care and support needs people living with dementia have.