Sep 03, 2019

Aged care funded to be homes, not hospitals

 

There is a “mismatch” between what people in the community expect from aged care services and what the sector is actually funded to deliver, says the head of one of Australia’s leading aged care peak bodies.

Funding per person for aged care services is significantly lower than for hospitals and disability, a situation that is “discriminatory”, said Aged and Community Services Australia chief executive officer, Pat Sparrow.

The royal commission is a once-in-a-lifetime opportunity to ask what we want from our aged care system, says Ms Sparrow.

Residents older, more complex health needs

Over the last decade, there’s been a significant increase in the proportion of people coming into aged care with high-level, complex health needs, Ms Sparrow told HelloCare.

According to the Productivity Commission, in 2017/18, 53 per cent of all residents  were receiving the highest level of complex health care funding, compared with 12.7 per cent in 2008/09.

“I remember a time when people used to drive their car to and from aged care, but the people coming in now, don’t do that. They come in at a later age, they’ve got more complex healthcare conditions,” Ms Sparrow said.

Aged care not funded to provide high-level healthcare

With a larger population of residents with high-care needs, the cost of caring for them has also risen, but funding has not kept pace.

Ms Sparrow said in many cases the community expects complex healthcare to be delivered in residential aged care facilities, and there is a “mismatch” between expectations and what can actually be provided.

“I think people come in (to aged care) with an expectation we will be more hospital-like than we are able to be,” she said. 

“People come in and they think we’ll be staffed and funded like a hospital, but there’s a big funding differential between aged care providers and what hospitals are funded to do for people, even (for those) with similar kinds of needs,” she said.

Ms Sparrow’s concerns were echoed by dementia advocate and COTA volunteer, Val Fell, at last week’s Criterion Quality in Aged Care Conference, who said she is often asked, “If I’m paying all this money”, why aren’t I getting the care I need?

Older people should have access to the healthcare they need

“An older person needs to have access to the healthcare system, regardless of where they live,” Ms Sparrow told HelloCare. 

“They should be able to get the medical services they need, and we need to make sure it (the healthcare system) works.”

Huge funding differences: aged care, hospitals and NDIS

Ms Sparrow said older Victorians who find themselves in a ‘geriatic evaluation management bed’ in hospitals are usually discharged into nursing homes. 

“One day they’re in a geriatric management bed on around $800 day, and then the’re discharged into a nursing home on around $280 a day (on the top ACFI),” Ms Sparrow said.

Anecdotally, Ms Sparrow said she has heard the funding differential has made some people reluctant to leave hospital.

At the Quality in Aged Care conference, Ms Sparrow said,”I’m not saying that our (aged care) services are the same (as hospitals), but that differential is huge.”

Funding “discriminatory”

There is also a huge difference between disability funding and aged care funding, even for people with the same care needs.

At the conference, Ms Sparrow told the audience of a friend with disabilities who received $78,000 per annum for their care while living in aged care, but received $309,000 when they moved into a disability setting.

“There’s probably less than 10 per cent of people on the NDIS who are on that amount, but the truth is, if that person needs support and they’ve come into residential aged care or they’re on the NDIS, their needs are the same and they should get the same funding wherever they’re living.”

“At the moment…  if you’re under 65 and you get into the NDIS system, you might be able to get a higher level of funding than if you’re over 65 with the same conditions and living in residential aged care, and that to me seems fundamentally discriminatory.”

“Why is it okay if someone ends up in aged care, whether they’re over 65 or under 65, they only have access to $78,000,” she asked. 

Royal commission: what do we want aged care to be?

“People are being treated differently for the settings they’re in, when what we really should be looking at is what are the needs of that person and, regardless of where they live, how are they supported, otherwise it’s discriminatory,” Ms Sparrow said.

These issues, and others, are being examined in the royal commission.

“We have to get serious, and the only way we can do that is to look at all the different angles, which the royal commission is doing,” Ms Sparrow told the conference.

If the community says it wants the aged care sector to operate differently, and if the royal commission recommends more health services should be able to be provided in aged care, then “a different sort of funding for aged care” is needed, Ms Sparrow said.

“The royal commission gives us an opportunity to say… there might be a mismatch now, but what do we want it to be going forward?”

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  1. I read this with interest, the funding is significant different, but so are the policies and procedures and the rules around the the comparable examples. I professionally think Home care is significantly underfunded from many of the programs and our goal should be to age the elderly in place. The funding lacks continuity from Home Care to Residential. Why not do as Tune recommended and issue a level 5 home care package as if it was a residential funding and provide choice. Than create various Levels of funding upwards based on needs increased and provide choice to the consumer. Age in place or go to a nursing home as they are the funding holder and change how we do business with assigning beds to providers etc. Parity is important and we need to look at merging the rules of the two programs to simplify things and create relatively equal playing fields for all . Let us be solution focused not problem focused https://www.linkedin.com/pulse/what-ndis-aged-care-merged-play-books-richard-hoskins/

  2. Our residential place is cutting back on cleaners and AINs. The staff are leaving which means we will probably get younger inexperienced staff. They have said they won’t be replacing staff that leave. Lucky for the company I suppose but not for the reidents or the few leftover experienced staff that will have to carry the load. It is because they cannot fill the facility so a ward with 18 will now be halved from the double shared to single rooms. I would think it would cost a bit. Couples will be able to stay together if they need to is one option apparently. It isn’t always about a few less beds being empty it has always been about the double assists where you need 2 or more staff to attend to their personal cares. Night shift will very soon only have one staff member looking after a ward with 18 and from 14 and up for the other ward. Management don’t believe we need the staff!! With one RN for well over a hundred residents and now they are expected to assist with the cares. Well what can I say. Let us hope that there are no falls/emergencies,regulars buzzing all night for toileting cares and staff calling in sick hey? Seems that The Royal Commission fiasco has not made much impact. Well these guys are probably in the know as they have their own legal people and business minds running the place. It is just another business guys!

  3. For the last 20 years we have been told we have a world class system and been showered with glowing advertisements advertising luxury holiday type care. At the same time companies from Australia and around the world have been enticed into the sector because of the lure of large profits. In reality we have a system where care must be rationed if we are not to impoverish our grandchildren. The system was not designed to do that. We were sold the wrong sort of market in 1997 and it has never worked.

    Whose fault is it that we have unrealistic expectations and are consequently bitterly disappointed by what many of us experience in aged care? Who supported this system of care and tried to take advantage of the opportunities it presented? The sector received a huge boost in funding in 2014/15 and instead of going to staffing and care it went into empire building. Care deteriorated even further than before. If we give you more money that will happen again.

    Let’s be quite clear. This is taxpayer’s money, our money. Before this industry gets more money we want it to be accountable to each of us and our communities for how it spends our money.

    The care of the vulnerable in our society has always been and still is the responsibility of each one of us. Each community is responsibility for the care of its members. Anyone who provides that care is acting as our agent and is directly responsible to us. The right to hold our agents to account has been taken away from us and government needs to return it to us ASAP!

    At Aged Care Crisis we consider that the first step is to create regularly on site empowered visitors and advocates, drawn from our communities and reporting to local community bodies as well as government. Providers should be working transparently with the communities they serve in developing and providing services to their members. Each community needs real objective data about what is happening and the visitors need to be able to verify its accuracy. Each community needs to have some say over the sort of person they will trust and work with.

    Once we have real accountability to communities and know what is happening we can talk constructively and then look at the sort of care that we can afford to provide without damaging the next generation or bankrupting the country. We should not allow this industry to shift the blame and hold us to ransom.

    Please don’t get us wrong. We know there are many who try very hard but they are trapped in a system where there are strong perverse incentives that do not encourage good care. We find it disturbing that our nonprofits have gone along with it.

  4. I don’t think that expecting Mum will not be left in soaking wet incontinence pads, that she will be offered water through the day and that when she is clearly unwell, timely and correct medical treatment will be sort is an unrealistic expectation. But more importantly, that Mum is not drugged solely for the purpose of making life easier is also not an unrealistic expectation.

    1. I totally agree with you Barbara I would expect only the best for my Mum and to do this I have decided I will never place my Mum in care I am not judging those who do as not all families can care for a loved one at home I am fortunate in that I am a RN and have a large family with some that are Nurses and carers who will all chip in. My Nanna never went in care nor my In laws.
      I also want only the best for the Residents I care for but it is getting harder with the hours of paper work and unpaid over time.

  5. I agree with Pat sparrow’s comments and I made comments at the conference, However my name is Val Fell not Val French . I can’t think how the mistake was made because I don’t think there was another COTA volunteer and dementia advocate there named Val.. I am not concerned about it but just wantto keep the record the record straight as I did an interview at a previous. conference and people might think there are 2 volunteers named Val F? .

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