Let’s hit the nail on the head early on a key claim that is already being widely circulated about the aged care sector. It’s one that is likely to continue to be spread despite the government’s efforts to get ahead of Four Corners tonight with a preemptive royal commission. And it’s completely wrong: this government did not cut $1.2 billion from aged care funding.
It’s pretty easy to check. In Labor’s last budget in 2013, residential care funding — as distinct from home or community or flexible care, the other categories of aged care funding — was $8.3 billion and forecast to rise to $10.1 billion in 2016-17. The 2017-18 budget shows how much funding the Abbott/Turnbull/Morrison/watch-this-space government actually spent on residential care in 2016-17: $10.9 billion. That is, the Coalition spend nearly $1 billion more than Labor forecast. And that rose to $11.4 billion in the year just ended.
This year’s budget papers annoyingly combine residential and home care numbers (a key strategy in aged care is keeping people out of residential care and in their own homes as long as possible), but the combined total still increases by another $800 million this year.
No cut. Of any kind. Zero. Zip. Nada.
The “cut” allegedly made by the Coalition was in the 2015 Mid Year Economic and Fiscal Outlook and the 2016 budget, which totaled $1.67 billion. The Parliamentary Library describes it here. That was a change to the Aged Care Funding Instrument (ACFI), which is the assessment tool used to determine which care category residents fall into and therefore how much subsidy the government provides for their care. It accounts for the bulk of residential aged care spending. Who makes the ACFI assessments on which subsidies are based? Residential care providers.
If you haven’t spotted the flaw in that system merely from the description of it, I have a Harbour Bridge-shaped nursing home to sell you. ACFI was being rorted by for-profit residential care providers by assessing people into more expensive categories than they needed to be. Moreover, they boasted about how much money they were making from it to investors. So the government stepped in and curbed the dramatic growth in ACFI funding. Ending rorting is not cutting funding.
Prior to 2016, aged care funding was a rare area of bipartisanship: the Gillard government had significantly altered aged care funding in the wake of the Productivity Commission’s 2011 report. Unusually, Tony Abbott declined to exploit the issue politically, in effect creating a unity ticket with Labor going into the 2013 election.
As Michael Pascoe noted in 2016, the entire model of aged care funding is problematic when it provides incentives for providers not to improve the condition of their clients but simply meet minimum standards. Sure, nearly everyone who enters a nursing home is not looking at recovery and departure back into independent or assisted living, but there are a wide range of conditions experienced by the elderly that affect quality of life and remaining longevity and which are not amenable to a funding model that pays providers more the sicker they get.
That is, whatever the crimes, misconduct and corporate evil practised by individuals, non-profit and for-profit providers in the sector, the real issues are likely to be systemic and structural in nature every bit as much as failures of quality regulation processes, workforce problems and individual training, accreditation and remuneration practices.
All of these issues have been repeatedly addressed by inquiries over the last 20 years. How a royal commission, especially one adopting a highly legalistic approach, will add to the accumulated wisdom of parliamentary committees, eminent-person reviews and regular bureaucratic monitoring isn’t at all clear. But the fact that Scott Morrison spent much of his media conference announcing a royal commission having to refute the funding cut lie doesn’t augur well for a return to bipartisanship.
Soon the ABC will not even have to make the program to get the govt to start a royal commission, just announce they intend to make a program about an issue. That will save everyone a lot of money and time.
It seems to me that one of the major underlying problems with aged care is that the government puts a bucket-load of money into it. Whether funding increased or decreased is not my point. The funding is enough to attract all manner of scumbags looking to make money – not to care well for our aged parents or grandparents, but to MAKE MONEY and they make it in abundance.
This happens any and every time a service is funded partially by government. Non-profits might be better, but probably not by enough. The for-profit sector exists to make a profit for owners and that means exploiting every trick-in-the-book to extort more funding (the obvious one was placing aged patients in higher-care categories to get more funding), but they will also use every toe-cutter strategy possible to reduce costs – poor quality food, less staff, more foreign staff who are not adequately trained and do not speak English well, if at all (this is, from feedback I get from friends and family who work in aged-care, an epidemic), not having an EN or RN on every shift, then cutting back shifts to reduce the costs of penalty loadings. This all happens and continues to hapen on a daily basis.
What happens in medicine/health care/aged care is the same as in every other sector – the vocational eduction sector, the pink batts (all manner of fly-by-nighters flooding into the insulation industry), the school hall debacle with massively over-priced halls and other structures, solar rebates where the suppliers just added the cost of government rebates to the price of systems, so the consumer thinks they are getting a price reduction, but in fact it is all going to the installer.
Government funding absent adequate regulatory systems involves no more than a massive wealth transfer from general revenue to business, greedy corporates and the medical profession without any commensurate improvements in service delivery and outcomes. It thus happens on a systemic basis in aged care.
Another thing is that there is no substitute for a real live person employed by the government making regular visits to check on how an aged care home is performing.
Governments (and other employers) regard staff as a cost rather than a resource and in aged care, as in childcare, hospitals and other human service delivery areas, they rely on a minutely detailed but often relatively meaningless set of specifications which the home has to report against but the answers to which can easily be fudged.
“Another thing is that there is no substitute for a real live person employed by the government making regular visits to check on how an aged care home is performing.”
Between regular and checks you need to add unannounced or unadvised – maybe both.
I was just now at a hydrotherapy session and a nurse and fellow patient who had worked in nursing homes remarked that the places she had worked in had always been forewarned of these visits. So out came the decent bed linen and towels and up went the meal sizes just in time for the visitor to observe.
Agree
MJM. Not excusing the flawed funding model for this industry, but you could look here to see what DOES happen re an audit regime. Unannounced visits ARE now made.
https://www.aacqa.gov.au/providers/residential-aged-care/copy_of_processes/review-audits/review-audits
The problem with this audit regime is that the auditors… the people who go into the field every day–and who check homes off against a series of set parameters–can make and record a case for a parameter or parameters (let’s say food quality, or general cleanliness) to have presented during their visit as ‘Not Met’, only to be overridden by an office-bound supervisor who can, in turn, be themselves overridden by an office-bound manager. There is huge potential for professional incompetence and outright corruption.
Don’t think for one minute that the so-called not for profit sector are not exactly the same. They are every bit as ruthless as the others in cutting back on food, staff and cleaners.
Correct Mary. In NSW recently the government resisted the requirement for a registered nurse to be on duty on all shifts in these places in spite of massive evidence that this would improve care, health outcomes and the need for hospital admissions. One of the arguments used was that the “not for profit” sector couldn’t afford it. I heard an MP actually say that people in aged care didn’t require trained staff to look after them. The patient staff ratio issue is massive problem. The NSW Nurses and Midwives Association have been running a campaign on this for some time.
“Government funding absent adequate regulatory systems involves no more than a massive wealth transfer from general revenue to business”
Ummhh, hate to be the one to tell you this ‘Ill fares the land’, but that is the motto and raison d’etre of the Liberal Party.
For the national party, replace the word business with farmers!
Could also read:
For the national party, replace the word business with miners!
What you say is generally correct, but it is not entirely because of government funding – just look at the criminal behaviour of banking directors and executives. The real problem is access to the funds of others by those who are inherently selfish and dishonest. This has been so ever since the South Sea Company was found in 1720 to be infected with corrupt directors and politicians (including the then king of England.
Nothing has changed since, except the audacity of those involved and the stupidity of politicians who keep pumping money in and caring nothing about the result.
If another enquiry is needed, it should be into the nature and character of those who run our governments and corporations.
The people at the top of the government do not know the answer to the question of why Malcolm Turnbull was deposed as prime minister.
When they don’t know the answer, they are going to lose the next election.
Thanks Bernard. Facts are facts. There’s been enough lying and scaremongering from both sides to last several lifetimes. One of these days an aspiring govt will elect to stay above the fray and make their case with the quality of their argument without resorting to fake facts, name calling or lying. I suppose pigs will fly first, but one can live in hope.
I look forward to seeing the matching “Frydenberg has his pants on fire, Labor did not and wasn’t even forecast to take government debt to $1 trillion” headline.
I’m not attacking you for truth-telling, but I am suggesting the media as a whole seems far far quicker to pounce on this things coming from the ALP (“MEDISCARE!”) then when the Coalition trots them out again and again and again (mining tax, carbon tax, negative gearing, debt, interest rates, crime rates etc.
I agree advising providers of intending visit by regulators is absolutely ridiculous I wonder who set that procedure in motion clearly a friend of the nursing home owners.
“It’s pretty easy to check. In Labor’s last budget in 2013, residential care funding — as distinct from home or community or flexible care, the other categories of aged care funding — was $8.3 billion and forecast to rise to $10.1 billion in 2016-17. The 2017-18 budget shows how much funding the Abbott/Turnbull/Morrison/watch-this-space government actually spent on residential care in 2016-17: $10.9 billion. That is, the Coalition spend nearly $1 billion more than Labor forecast. And that rose to $11.4 billion in the year just ended.”
Spending more then a forecast isn’t particularly relevant.
Similarly, spending on categories like this rises because of increasing population numbers and because of inflation. iI’s the sort of thing which lets every government claim to be spending more on health and education than the last one. What would be more interesting is spending in real terms- are they spending more or less per head after allowing for inflation?
Exactly, Arky!
Funny how the Saturday Paper’s Briefing this morning has an entirely different analysis of the ‘almost $2 billion dollar cut in aged care funding’ by this government…also from the Parliamentary Library article.
They can’t both be right…but Bernard seems to be continuing with his ‘Labor bad (& wrong), Coalition good (& correct).
I don’t accept this diatribe from Bernard as being the be all and end all on the discussion…and recommend people look at other points of view!
As I noted elsewhere, in 2016 Bernard was writing articles about Aged Care budget cuts-right here in Crikey. With his level of consistency, Keane will get that job with News Corpse that he has been gunning for.
https://uat.crikey.com.au/2016/05/03/aged-care-services-a-budget-casualty/