Jan 09, 2020

Question marks hang over government’s ACAT reforms

 

The government will put aged care assessment team services up for public tender this year, in a bid to create greater efficiencies.

The government is pushing ahead with plans to merge the Regional Assessment Service (RAS) and Aged Care Assessment Teams (ACAT) into a single “streamlined” service.

The proposal to merge the two services came from David Tune’s 2017 review of the aged care sector, and was suggested to be “progressed urgently” in the Royal Commission into Aged Care Quality and Safety’s interim report.

“We will… maintain a continued interest in these developments and will monitor their progress,” the report states, adding it will make recommendations on the reform, if necessary, in its final report.

In his report ‘The Legislated Review of Aged Care 2017’, Mr Tune states, “This (merging) will result in less duplication, greater efficiency, and above all, better service to consumers, who will experience less confusion and ‘tell their story’ once.”

Though widely accepted as a necessity, resistance has come from the states. The Minister for Aged Care, Richard Colbeck, said at last year’s Criterion conference ‘Future of Aged Care: Beyond the Interim Report of the Royal Commission’, “We’ve had a dust-up with the states, who want to retain assessment services, but we are taking it national.”

What the reforms look like

The government will release a draft tender in April 2020, and expects to release the tender in late May 2020, closing it in June. The current assessment services will continue until the new arrangements are in place in April 2021.

ACAT services are currently provided by healthcare workers through the healthcare network. The RAS provides assessments for Commonwealth Home Support Programmes only. The new model is expected to look more like the current RAS service.

A spokesperson for the Department of Health, Aaron Langmaid, told HelloCare, “The new measures will ensure all assessments fall under one contract, so those in need get access to the right assessment faster.”

“Under the new arrangements, the aged care assessment workforce will be required to continue to apply team-based and multi-disciplinary approaches involving allied health and medical professionals working in hospital and the community.

Aged care assessments will continue to be provided free of charge.

“The Australian Government will expect assessment organisations to undertake high quality assessments and to have the appropriate expertise,” Mr Langmaid said.

Stakeholders identify “conflict of interest” a real risk

But a number of question marks hang over the reforms.

Participants in industry consultation said “conflicts of interest within assessment organisations” are a “key risk”.

Some stakeholders suggested there should be strengthened conflict of interest management measures to ensure aged care assessment is independent from service provision.

Mr Langmaid told HelloCare, “the Government will ensure that companies that run aged care services are not advantaged by being associated with an assessment organisation.”

“Current contractual arrangements require organisations to keep an operational separation and this is assured by the Department as appropriate,” he said

Market forces not delivering aged care consumers favourable outcomes 

It was “incorrect” to say aged care assessments are being “privatised”, but private organisations will be able to offer their services for tender, Mr Langmaid said. 

In a webinar titled ‘New aged care assessment arrangements’ held on 11 December 2019, Joshua Meldon, director, Home Support and Assessment Branch, said key performance indicators will be used to identify if conflicts of interest are arising. 

“There will be key performance indicators. We’ll definitely be looking at quality… there will be regular reviews of the business allocation in line with those performance KPIs being met,” he said.

The shift towards private operators comes in the wake of the royal commission’s interim report, which said the government has adopted the use of market forces without enough consideration, and the market has not delivered favourable outcomes to aged care consumers.

“In the main, reviews conducted since 1997, have not questioned the evolution of the aged care system into one more reliant on ‘market forces’ or re-examined the institutional structures through which aged care is provided,” the royal commission’s interim report states.

“It is a myth that aged care is an effective consumer-driven market,” the report says.

Deep ACAT knowledge, experience lost: geriatrician

Healthcare expertise may be lost, including geriatrician involvement, said Dr John Madison, President of the Australian and New Zealand Society for Geriatric Medicine, in his hearing at the royal commission.

“In a large number of places across the country, those ACATs are embedded or very closely associated with public-hospital departments of geriatric medicine,” he said. 

“As a consequence of the move to centralise all of these services under a regional-assessment model, that association, that close association, will be lost.”

“I think the ACATs as they are structured have been working closely with geriatricians, and in fact, going back to the 80s, when the whole process was established, geriatricians were involved from the outset,” he said. 

“Those teams and those staff members themselves are very expert at what they do. 

Dr Maddison said the connections and knowledge of his own well established ACAT may be lost under the reform.

“I run an ACAT as part of my public hospital profile, and the assessors we have, which are multidisciplinary nurses and allied health, are extremely good at assessing an older person and the older person’s need… 

“How that level of expertise will be maintained under an alternative model is not clear,” he said.

Indeed, industry consultation about the reform said a “key risk” of the “streamlined” services was “breaking existing relationships between assessors, providers and health services.”

The necessity of input from geriatricians was covered in the webinar, but appears to still be a work in progress. Nick Morgan, assistant secretary, Home Support and Assessment, said it was an issue “we’re acutely aware of.” 

He said the Department is talking to state and territory officials to make sure the current integration between the ACATs and the hospital teams and the hospital system isn’t “broken in the new arrangements, and that we can replicate some of those information flows and build up some of those relationships.”

Competitive model “unsuitable” for ACAT services

Other risks associated with the reform are a backlog of assessments during the transition, lack of sector readiness, lack of training, and unintended consequences of a new model.

Some stakeholders said “a competitive model is unsuitable for assessment functions that focus on quality, consistency and equity of access”.

The magnitude and speed of the changes was touched on at the webinar. Mr Malson said, “We’re absolutely conscious that this is a significant change to the existing aged care assessment arrangements.”

Caragh Cassoni, director Streamline Assessment Policy, said it would be a “busy transition period” requiring “intensive training”.

Image: Stock photo, model used. Source: iStock, Cecilie Arcurs.

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  1. The thought of a streamlined assessment service , meaning a merger of RAS and ACAt under current providers of the service had some merit .
    I am sure that that was the intention of the royal Commission interim report. However I doubt that any person over the age of 65 would welcome the new service being put in the hands of a private organisation-considering how much stress already exists for people in the aged care sector waiting for packages or trying to find an affordable place in a residential care facility..
    Does a “national system ” mean one provider is given the tender or will there be one provider in each state or primary health area abiding by the same rules and regulation. I doubt if there is one provider who has the combined expertise required to carry out the assessments in every part of the nation.Who will do the assessments in rural and remote areas.? i can forsee a situation where the approved provider says they cannot carry on without extra funding and the consumer will be asked to pay the shortfall.? Privatisation means the consumer pays . Wll there be an accreditation process for the provider(s)- resulting in non-compliance notices or sanctions???. As a former carer and volunteer in the aged care sector I can see so many problems with the proposed system that my head is reeling..

    Did anybody consult with the consumers before deciding tomprivatise the system????

  2. Can anyone name any government entity that has been privatised that has benefitted the Australian community? Government just devolves responsibility to those wishing to make a profit and subsidises them as well. I hope that this isn’t a greater disaster in the making.

  3. Apparently the Government states that ‘the consumers’ are the focus of this decision! Inconsistent processes between ACATs are one of the reasons given, however the highly bureaucratic requirements of the Aged Care Program and IT algorithms in My Aged Care lead to consumer frustration and lack of service options. Tenders to private entities to manage a new assessment workforce will not result in a streamlined service. Opening up the assessments to fee for service, lowered costs of workforce and subsequent loss of the skilled staff will be the result. Streamlining could have been achieved without decimating the strengths of the current Aged Care Assessment Program.

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