A group of industry experts has fronted a Parliamentary Committee investigating the second aged care reform bill, which is yet to pass Parliament, demanding clarity around some of the measures in the bill as the provisions raise major questions about how it will impact the sector.
The Community Affairs Legislation Committee was told on Thursday afternoon that the sector was yet to hear about how the 24/7 nursing mandate exemptions would work.
The Committee also heard from advocates about the importance of home care administration fee cap.
The Aged Care Amendment (Implementing Care Reform) Bill 2022 was introduced to Parliament a month ago alongside the Aged Care and Other Legislation Amendment Bill – which was passed at the start of August.
This second bill – which is currently being examined – includes the 24/7 Registered Nurse (RN) mandate and increase of care minutes in residential aged care, as well as a bid to cap home care service administration and management fees.
However, the second bill did not pass Parliament as quickly as the first due to it “lacking transparency” in what measures it will bring into law.
Interim Chief Executive Officer (CEO) of Aged and Community Care Providers Australia (ACCPA), Paul Sadler, told the Committee that it is paramount that the organisation understands how the nursing mandate exemptions are going to operate for aged care.
Recently, the Government estimated the sector needed an extra 869 Registered Nurses (RNs) to meet the nursing mandate commitment. However, the sector didn’t agree with the modelling.
Government data suggested that 80% of aged care facilities already have 24/7 nursing on site, however, Mr Sadler made it clear that while the figures are correct, they are around 18 months old and the impact of the pandemic has likely created nursing shortages.
“We know that the staff shortage issues have even been pretty extreme in metropolitan areas. There may well be services that, for a short period of time, don’t actually have 24/7 coverage at the moment,” said Mr Sadler.
Mr Sadler added that the aged care sector is currently in competition for RNs with State Health authorities and private medical practices in regional areas and that until the Fair Work Commission case is resolved, the sector will continue to have issues recruiting staff.
He said he didn’t want to see aged care providers experiencing “punitive measures” for not getting enough RNs on-site, as it would put aged care residents at risk.
Dr Nicole Brook, CEO of the Australian Community Industry Alliance (ACIA), agreed with Mr Sadler, suggesting that the exemption process should be a risk-managed assessment process.
On top of that, she said the sector needs to understand how quickly these exemptions will be reviewed and approved, as staff shortages can happen very quickly.
Dr Brook also mentioned that the ACIA wasn’t so much worried about the 24/7 nursing in aged care, but rather the level of quality care and RN experience/skill coverage.
“If you [just] have an RN for a whole facility, [that requirement is] actually not defining the level of expertise suitable to the level of acuity in those residents.
“You can have one RN who is a new graduate, been out for two weeks, and that will still fill the requirement. With the acuity that our members are suggesting with enteral feeding, palliation, dementia, delirium, it just goes on. That level of acuity is not going to be supported by an inexperienced nurse.”
Dr Brook added that the current legislation also has some loopholes that facilities may get around. For instance, if there are five facilities on one site, one RN could be covering all of them and that would constitute meeting the nursing mandate.
While ACCPA estimates 1,440 additional RNs are needed to meet the 24/7 commitment, the additional care minutes requirement would likely mean additional RNs on top of that, as well as between 14,000 to 20,000 extra care staff.
ACCPA has asked the Government to make the exemptions for the 24/7 nursing mandate based on staff availability in the local area of the facility and to make the exemptions time limited.
Home care administration fee caps were also a big topic of the day, with experts stating that home care provision is very different between providers.
Samantha Edmonds, Manager Policy and Systems Advocacy at the Older Persons Advocacy Network (OPAN), explained that fees and charges on home care bills were a constant complaint from older people.
“We often hear of charges that people can’t understand and why they are being applied. Many examples we see, it is obviously excessive, there is no reason for what is charged,” explained Ms Edmonds.
Ms Edmonds said home care services are meant to be delivering care to older people, but the disparity in administration fees is cutting into important services, making it harder for people to receive the care they need.
OPAN believes that having proper protections in place, like home care fee capping, is essential to improving awareness and transparency of charges for older people.
However, with this potential change, Ms Edmonds suggested monitoring of what goes in the home care sector to ensure providers don’t up other fees exponentially.
Chief Advocate for National Seniors Australia, Ian Henschke, agreed with Ms Edmonds that the disparity between providers and what they charge is very stark.
He gave an example of one provider delivering a Level 4 Home Care Package (HCP) and providing nine hours of care a week, compared to another provider with the same level package but delivering 16 hours of care a week.
“That is not what you would call within the realms of reasonable variation. One provider is being either incompetent or has an overly high cost of management to do that, and the other provider is obviously being efficient,” said Mr Henschke.
“You can’t have a system that would have that level of variation in it.”
Mr Henschke explained that it doesn’t make sense that one provider can charge 15% in administration fees on a package but another charge 40%.
He believes that caps and soon-to-be-introduced transparency requirements in the home care sector will help stop some providers from charging excessive amounts for fees.
Totally agree with Dr Brook, the quality/experience of nurses is essential. I am currently sorting respite for my Father who will soon be for palliative care. The facility that has a bed doesn’t change catheters despite having RNs, really how is this possible in a 100+ bed facility. They require doctors or district nurses to do it, how is this allowed?