After a royal commission that cost $92 million, many of us expected genuine aged care reform. Unfortunately, Labor’s so-called “generational” reforms to aged care fail to address fundamental systemic issues.
In her damning report on the progress of the recommendations of the royal commission, the aged care inspector general, Natalie Siegel-Brown, cuts through Labor’s spin. She states: “Despite the volume and pace of reform, a number of actions that would have seeded transformational change have not yet been delivered, some actions are not actively being considered, and indeed the manner of implementation in some areas may bring about unintended consequences.”
After rejecting the recommendation to finance the aged care system through an aged care levy, the Labor government convened yet another taskforce in 2023. It was Aged Care Taskforce, not the Royal Commission, that recommended a funding model in which people should make a co-contribution to their care costs based on their ability to pay. In fact, co-payments are contrary to the recommendations of the Royal Commission that called for guaranteed access to aged care based on assessed need.
The new co-contribution funding model is primarily focussed on a medical not social model of care. Activities such as nursing care, wound management, physiotherapy, and medication assistance, remains fully funded by the new Support at Home Program.
In contrast, services supporting daily living and independence, such as domestic and gardening help, showering and lifestyle activities are subject to co-payments. The out-of-pocket costs for domestic and gardening services will range from 17.5 per cent for full pensioners to 80 per cent for self-funded retirees.
While exceptions will be made for people who satisfy hardship provisions, the process of making the application with Services Australia will be difficult for some older, vulnerable people.
Co-payments will undoubtedly undermine some basic rights for those least able to afford care. The cost of a shower, for example, will range from five per cent for full pensioners to 50 per cent for self-funded retirees. If an older person cannot afford the co-payment for a shower, they may need to skip it. This not only has implications for a person’s hygiene but also their dignity.
The aged care inspector general described charging fees for services that support social and community engagement as “inconsistent with the [new aged care] act’s approach to high quality care, particularly the importance of individuals participating in meaningful and respectful activities”.
The government has celebrated the passage of its new Aged Care Act 2024. This is undoubtedly an important reform. However, it fails to take the leap from a provider-focused system to one that genuinely places the rights of older people front and centre.
Although the new Aged Care Act includes a Statement of Rights that outlines the rights older people will have when accessing aged care services, these rights are not legally enforceable. When a right is breached, the only recourse will be to make a complaint.
Thankfully, older people have the right to “live without abuse and neglect”. However, other important rights have not been included in the new aged care act, including the right to freedom from restraints. Despite the royal commission identifying an urgent need to respond to the significant over-reliance on chemical restraint in aged care homes, the new aged care act does not restrict the prescription of psychotropic medication or adequately address the use of restraints.
Most importantly, the Labor government has chosen not to implement the Royal Commission’s call for a demand-driven system providing universal access to aged care based on assessed need. The rights-based framework established under the new aged care act does not give an older person an entitlement to receive care. It only gives an older person an entitlement to an assessment.
As an aged care advocate for over a decade, I had hoped that the Royal Commission would ensure that stories about an aged care crisis were behind us. Instead, here we are again with recent media headlines declaring yet another “Aged Care Crisis”. Why has the Labor government failed to deliver a new aged care act that genuinely enshrines the rights of older people who use aged care services – either residential or in-home care?
Kathy Eagar offers a possible explanation: “The current government appears captured by the aged care sector itself and by a small group of Canberra public servants.”