Aged Care: Royal Commission and Beyond

Services
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Perhaps my paragraphing should have been better. True it was not an enquiry into the conduct of the government directly, it is an illustration of an RC whose genesis was at least partially politically motivated that proved to turn up important information. I agree the format is imperfect but right now what else is there?

Perhaps there is a better way of checking on the activities of our fearless leaders? Maybe instead a standing independent body that does not dance to the beat the party in power. Maybe a FOI system that cannot be defeated so easily. Or real time disclosure of all donations. Or all of the above.

But getting back to aged care, do you think as an industry it is well run? Does government behaviour, including regulation, funding and compliance, have any impact on how well it is run? What if anything ought to be done to change it?

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Yes to stronger FOI. Yes to significantly lowering the disclosure threshold, tightening up the disclosure rules, and dramatically shortening the disclosure period. (I don’t advocate for real time disclosure, because I know all too well all the things that can go wrong with that. In other words, the marginal utility, to the voter in this case, of “real time” as compared with, say, “next business day” is often not there - bearing in mind that disclosure right now can be 6? 9? months after the election, which is a joke.)

I remain cautious and sceptical about that. Who appoints people to that body? (Are the appointees just party hacks looking for a nice gig after being booted out of parliament?) Who writes the legislation that controls that body? Who promulgates the regulations that apply to that body? Who if anyone controls that body?

A truly independent body probably does not exist in Australia and would be a significant departure from current governance culture.

I would leave that to the experts. I am not an aged care expert nor do I play one on TV.

You know what they say about opinions. Everyone has one … :wink:

Legislation and regulation certainly impacts on that. That is something that the government controls.

Funding very likely impacts on that. The government certainly is part of funding, but aged care is not funded exclusively by government. (So if, for example, we want to mandate minimum staff-to-resident ratios, we shouldn’t duck the issue that the basic daily fee should go up in order to pay for that.)

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It’s a useful suggestion. There are those of us who have immediate family in aged care, and of those some of us have the sole responsibility through Powers of Attorney. Many of those in aged care have limited ability to influence the system around them. There are also those in care whose reality has been altered by changes in the mind, and rely on others to give them purpose and keep them safe.

The current system if it has been designed and left to the experts is a miserable failure. While we are not experts, we can relate first hand both the benefits and failings relating to one resident. A wider reality is we have 3 near neighbours we know well enough to share tea and cakes, a beer or wine or … who have or recently had immediate family in the same facility. A shared experience.

If it’s up to the experts, either they are far from expert, or those they report to are deaf dumb and blind. It’s a personal opinion. That there are many aged care facilities found to be deficient, says little positive about how our government has designed and regulated the delivery of aged care services.

With the basic daily fee already taking 85% of a residents aged care pension, which part of the other 15% are you suggesting they give up?

The impact of this payment is, of course, that individuals in aged care may only have access to 15% of any aged pension (currently $9.45 per day or $132.32 per fortnight) to pay for incidentals, including clothing, unless they have access to other income or assets. Even individuals who do not qualify for a full or partial aged pension, and who make significant accommodation payments, can find themselves in a difficult position if in residential aged care for a significant time.

It seems a rather callous suggestion, as the 15% must also cover the cost of medications up to the level of the safety net, and any other small luxuries such as barista coffee, optical prescriptions, dentures and dental work, etc.

It seems even more callous a suggestion when the numbers of those in Aged Care Facilities at anytime total less than 200,000. Those who have the means are mostly outside of Aged Care facilities and supported by a family, limited government assistance or personal wealth. Those in Aged Care Facilities in many instances have limited means, with little alternative.

Perhaps for others offering support or constructive observations, it would be helpful to know who is able to speak from recent first hand experience.

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You may have read more into my comment than was warranted.

In the above scenario, 100% of it is coming from the government anyway. So the assumption is that one way or another the government would (continue to) foot the bill entirely. However that doesn’t apply to all aged care residents.

I was looking at the aged care system as a whole in saying that it is part-funded by the government but not funded exclusively by the government.

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We all have different levels of understanding.

The cost of aged care has a number of components. The basic daily fee is just one. The government is not funding 100% of the costs. The resident in addition to the basic daily fee is personally responsible for paying an Accommodation Cost, a portion of the Means Tested Care Fee and fees for any extra services. Extra services might include simply things such as streaming TV services (entertainment package), phone/internet, meal packages, etc.

Rather than repeat what is available elsewhere on line, two sources both of which cover the same ground.

https://www.agedcare101.com.au/aged-care/working-out-your-finances/the-main-costs-explained

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No matter what the topic Royal Commissions are a waste of time and money

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Maja

Today I’ve read the discussion about the RC and MAC. I read some pages of the Quality and Safety Commissiion’s recommendations, and had discussions with one member of the Commission, and a few MAC customers…

Briefly: we thought that the My Aged care as a name could be replaced by “Support and care for later adults”.

As far as we discussed, the Quality and Safety Commission’s report and recommedations are agreeable.

One of us related an example in connection with the Cabcharge card mentioned earlier in the present discussion… In this case the HCP as an alternative to Cabcharge card offered “Personal care” service for shopping, priced for $62.00 / hour and an additional $1,20 / kms on travelling. The shopping trip with the HCP would cost $150.00 in a distance of 15 km between the customer residence and the supermarket. The cost is for 2 hours. The taxi’s Cabcharge would be about $75.00 for the same distance.

The providers pay their emplpyees between $23 and $26.00 per hour. - The Age, 4. April. It is $100.00 difference!!! The question iss where does the money go?

The customer is legally blind, and can use a taxi subsidy. However the provider ruled, that the taxi subsidy and the Cabcharge card can not be used together, The question is: Why not.? The provider also ruled that it does not reimburse the taxi subsidy . expense from the HCP. It is disadvantages the customer who is legally blind and in the Later adults group.

So, if the RC, the ICAC, and other commissions and submissions and public inquiries are not listened to, as they are not - see the Aboriginal death in custody RC, what can people do to balance the excessive power and often abuse of the Later Aduts.

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Our only protection is at the ballot box. Government programs are designed and managed by those elected to government, not by an opposition.

It is nothing new for carefully crafted programs with nice names to have alternative priorities when examined beyond their headlined names.

While this may technically be OT it is more an extension of the topic in how governments can manipulate their programs by design or incompetence or amateurish drafting, and which it is in any case is left to partisans to argue. Reading this one is necessary as the headline alone would be misleading as to the background.

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To All Interested Participants of this Discussion,

I agrre with Phil T about the wording of political parties policies. Eg: the Green 200 policy to fund dentirstry as a MEDICARE item. Sounds very promising and enchanting, however the Green 200 should than exclude or regulate the GAP payments.

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The least point of argument will come from those with first hand experience of the deliverables. IE those living in aged care or with the aid of support services applicable to their needs. Evidenced based assessment might be another term for it. Although those responsible also have there own versions of self scoring. Oft used to tick the promises delivered box to the exclusion of the needs required. (Cynicism that promises are rarely met.)

With around 200,000 Aussies in Residential Aged Care and many more reliant on external support a significant number of the Choice membership and Community will have first hand experience. Similarly for the NDIS.

Is there an opportunity for Choice to look further at how well the respective systems - government interfaces - service or fail to serve the consumers dependent? It has taken a Royal Commission to show there are significant concerns with customers not getting the services they are paying for. For most consumers independence of advice is what Choice does well. Our experience of choosing an Aged Care Facility is there is advice. It’s predominantly provided by interested parties, none of whom have the benefit or experience of the paying customer.

Informally one might find some feedback on individual providers on FB groups, or in our instance word of mouth through several trusted members of the local community.

It’s worth some more thought as Googling a particular facility returns mostly higher priority marketing placed content. There are also number of specialist web resources that offer to list the top 10 rated in your area, independence possibly not assured.

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Support and care fir Later Adults and the National Disability Scheem customers

LGP and Origine: are they the same? Can they increase prices by 25 % without prior warnings? Eg.: a 45 kg gas cykinder was $105.00 three months ago, and it is now $138.00 The bill sent as an email attachment, which is NOT accessible. The email said: it is confidential, and NO REPLY. How does one know, that it is legitimate? And when inquiring about the bill on the phone, the response is coming from off shore. How does one know, if the bill is genuin? In addition to the problem was that the gas ran out after hours, so the person placing the order was charged with an additional $58.00, though the delivery day for the area coincided with the ordered cylinder’s delivery. The delivery was cancelled the next day as a second bottle still was working. Nevertheless the delivery arrived and the driver said, that while the order was on his list at early morning, it disappered in the next hour, and he wanted to find out whether the cylinder was needed or not. A week later another delivery truck arrived! wanting to replies an empty cylinders. However the two cylinders were full. The email with the invoice was adressed to the person’s first name, as Dear Xyz.

Using Cabchage card and TUSS - Taxi users subsidy scheeme… One of the taxi driver though I gave the Cabcharge card given to me by the MAC provider charged my personal bank account and not the Cabcharge! The possible link for him could have been that the TUSS covered 50% of the trip, and the other 50% was charged from my bank. Though I understand that there is competition between taxi companies and aged care providers, I do not understand how a taxi driver can exploit the situation and access my bank account.
Is this one of the way to compensate the investors for their loss as the Guardian article suggests?

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For those looking for details on the current status of a Residential Aged Care facility, the following site provides links to weekly updates.

There are detailed lists for each state showing the weekly status for each facility - the weekly number of residents and staff with Covid and the number of resident deaths with Covid for each facility.

‘COVID-19 outbreaks in Australian residential aged care facilities | Australian Government Department of Health

From the latest update - 14th April 2022.
1,107 deaths have been recorded in aged care facilities since the start of 2022. Approx 350 deaths every month. The total since the start of the pandemic is 2,024 deaths.

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For any one concerned about family in Residential Aged Care the weekly reports may help. Individual care providers vary in what information they release publicly and to family. In particular the total number of residents and staff currently affected or deaths may not be shared directly. Some facilities are more communicative than others.

Looking at the national reporting there are currently aged care facilities with up to 50 residents currently with Covid, and some reporting more than 5 deaths for the week.

An open question is whether without the Royal Commission we would be as well informed about how Aged Care is responding to Covid as we are today?

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After the RC it seems the game has adopted different ‘uniforms’ but not much in substance. Following historical norms business has been important to governments of all persuasions that have been reticent to make and hold them accountable. Another example of window dressing that suits?

Facilities that do not meet minimum standards can still be 5-star and advertise accordingly?

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For those with family or a friend in Aged Care the lived reality. From our past experiences the surprise is it is still not surprising.

P.S.
A personal comment is to not rush and respond to the immediate pressures to make the decisions necessary. In home care options or 24x7 care facility. It can be a very stressful time for all including the one contemplating leaving their forever home. For some making an immediate decision takes priority because it’s the easy path to dealing with stress. It becomes someone else’s problem. There is no easy path to making the best decision as opposed to a convenient decision.

A suggestion:
Take time to visit the care facilities where there is more than one option, assuming that is how it must be. For which outcome be committed to visiting daily. Best if this is shared between friends/family where possible. We found developing positive relationships with the immediate staff can make a difference to how it is.

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