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Tell me about recent focus areas?
We got a win on the Medicare Benefits Schedule assignment of benefits. The issue was they were going to essentially make everybody who gets a bulk-billed appointment in aged care, or anywhere, sign the assignment of benefits forms with a physical signature every time they had an appointment. This is the thing that says the general practitioner can claim the money and take it for themselves, the thing that generally happens in the background.
In residential care this is a huge issue because you’ve got people who can’t physically sign or have capacity issues and you cannot possibly have the supported decision-maker there every time there’s a need for a GP.
What are the main benefits of this?
It’s more the avoidance of a problem, because we were going to lose GPs – and you know how difficult it is anyway to get GPs – we were going to lose GPs coming into residential care and lots of them were already saying they just wouldn’t come, so that’s why everybody got so concerned. We only heard about this a month from the change coming in.
The change was brought in to stop fraud, there are stories of GPs ringing up a patient on their list, not really doing an appointment, but just saying, ‘Hi, how are you? Just checking in,’ and then claiming the money – so it’s to stop that. But they’ve taken a one-size-fits-all approach to fix that problem, and now they’ve [delayed] it for 12 months, and then they’ll try and get a permanent fix in the background.
Have providers got any new concerns since the May Federal Budget?
Broadly speaking, everybody’s happy about the changes on showering. We’re happy with things like the funding for a review into how the Integrated Assessment Tool works. People were happy about the Motor Neurone Disease decision that came more recently [to give urgent priority to Support at Home access], although we’re hearing a lot of feedback from advocates for people with dementia – ‘what about dementia?’
The MND decision is good in isolation, but it’s raised a whole heap of other questions about other people who perhaps should be prioritised.
Has it highlighted where there are other gaps?
It has, and certainly the dementia advocates are concerned that it’s missed their issue, which obviously covers a lot more people. Because MND does affect a relatively small number of people, so it’s not that much funding to do it. But if you put everybody with a dementia diagnosis to the front of the queue, what does that do to the queue? It means that being at the front of the queue doesn’t get you seen any quicker because there are so many people there.
Advocates for people with dementia, that’s their concern, and I support that. There is an issue there.
Then you’ve got the residential accommodation review, where the issue with that is it’s definitely recognised that something needs to be done, but it hasn’t recognised the scale of the problem.
It’s great to see additional funding for supported residents. We’ve been saying this for years, and really pointedly in the last 12 months, that the gap between a private-paying resident and a government-funded supported resident is so big.
Have those announcements in the budget had any noticeable improvement on the appetite to build aged care beds?
The $30 that you get for new beds, and that was backdated to 1 November last year, has helped – and I’ve spoken to a number of providers who have said that has helped them get a business case across the line.
And we know that there are maybe a few thousand beds across the country that have been almost able to be built based on their business case and how the financials stack up. This will definitely tip those into the viable column.
There are also a lot of providers saying they think it will help build homes where the land is already owned by the provider, but we’re quite concerned that it won’t be enough to build the home and buy the land.
That’s much more dependent on local property and land prices, so it won’t be as much of a challenge in a MMM5 area [small rural towns] where land prices are very cheap. Although construction costs will generally be much higher there. But it’s going to make it more difficult if you’re in MMM1 areas [metropolitan areas] where the land itself is now much more expensive than it was five or 10 years ago.
So, it’s a nuanced view, and until people start to do the real numbers on a specific site, it’s quite difficult to know, but we definitely think there will be beds built as a result of the $30.
We are still concerned at just how many homes are in the red. Ultimately, even if you can make your business case for a new home line up on its own, if 50 per cent of your other homes are losing money, you’re still not going to build. You’ve got to make sure your organisation is sustainable and viable before you take on new debt, take on new risk. It’s not just can we get the building to add up or the build costs to add up, if the rest of your organisation is losing money on every bed every day, you’re still not going to build.
How are department and provider preparations going for the 1 October system changes to how personal care is classified?
My understanding is they are relatively simple changes, and largely at the software vendor end, and I don’t hear any issues with us being ready by 1 October. Nobody has raised anything about us being ready technically on 1 October. We’ve heard lots of concerns about why they didn’t come in sooner, but I don’t have any sense that there’s an issue that will stop us being able to implement it on 1 October.
What are you hearing from providers at your recent conference?
There are definitely providers with a sense of optimism. I worry that there’s still a lot of burnout and there are still a lot of people who are very confused by the changes [for] providers and there are still lots of teething issues.
We’re still getting hundreds of calls a week from our members to our support line to deal with transitional issues with Services Australia, issues around implementing the policies software, vendor issues. So that hasn’t died down. We thought it would have died down by now, but we’re still having to put a lot of our own resources into answering those questions and escalating things.
We’ve still got good engagement with Services Australia and the department to progress those issues, and I think Services Australia have been overwhelmed by this as well. We have to remember everybody experienced these reforms, it wasn’t just providers or older people or government, it was all of us.
They’re as responsive as they can be to the things that we raise, but there’s a lot of stress still for providers because there are so many of these operational issues that we’re still having to get fixed. But despite all of that, I am seeing a growing number of providers who have some optimism that this will get better. But there are still a lot of providers who do not feel that at all.
What’s needed to turn that around for the ones that aren’t feeling optimistic?
That’s a million- or trillion-dollar question, for us, for Ageing Australia, in terms of us supporting our members, it’s about fixing those issues that are causing friction, something like the MBS assignment of benefits issue, that has taken huge amounts of attention of provider leadership away from what they want to be working on to address this because they’re now having to persuade GPs to stay and try and explain the issues to government, and it is a complicated issue.
It’s things like that we need to fix. We need to focus on fixing those things, because for a lot of staff and providers, the lack of funding, yes, it’s a problem, but they’re spending a lot more time dealing with unpaid claims or compliance issues, or issues around a star rating outcome that they’re having to appeal because they don’t think it’s right.
That’s where we have to spend a lot of time. But we also need more positive signals coming out of the government around policy and funding, because a lot of the people who are pessimistic are looking at, we’ve got losses, we’ve had losses for five to seven years.
The new $5 probably won’t fill the gap, and it doesn’t come in until 1 March. Then in home care, we’ve still got all of the issues around pricing transparency and providers being accused of charging unreasonable prices, when all the evidence shows that is not the case.
Everything I’ve seen shows that providers have all bunched around a similar percentage increase. But we still see the Telegraph or the local tabloids in states printing every single example they can find of someone who says that they’re unhappy with their charges. That increases the feelings of being under attack. Providers are implementing a government policy, but they’re generally the ones that get blamed for that policy, even though they didn’t set it when an older person or their family is unhappy with the outcome.
The reality is we do see people have experiences in aged care that we would like them not to have. There are still people who have bad experiences, just like there are in every hospital in the country, just like there are for disability providers, just like there are for every human services sector.
The problem in aged care is there’s a pile-on every time there’s one example, and everybody goes back to the bad old days of thinking that aged care is a bad sector, and it just isn’t. But if you’re a provider or someone who works for a provider, that’s why people are burnt out, that’s why people don’t want to stay in the sector. We’ve got those two groups, the people who are seeing a silver lining, but there’s a large group that are not, and I don’t blame them.
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