This week’s aged care reform continues the tradition of federal governments tinkering at the edges of the heavily regulated and mostly taxpayer-funded sector, but putting off a major overhaul of its old-fashioned funding model.
Yesterday, Minister for Aged Care Ken Wyatt announced the merger of two federal bodies to create the independent Aged Care Quality and Safeguards Commission, which will also take over regulatory functions from the department when it begins operating from January 1, 2019.
The new commission will combine the functions of the current Aged Care Quality Agency (which only replaced the former Aged Care Standards and Accreditation Agency in 2014) and the even newer complaints commissioner established in 2016, together with aspects of legal compliance handled by the Department of Health via funding arrangements.
Along with the new agency, Wyatt promises “enhanced risk profiling of aged care providers, to determine the frequency and rigour of visits and to ensure failures are quickly identified and rectified by providers” and public ratings showing provider performance against quality standards. A new online “comparison tool” aims to make it easier to shop around.
He also announced, diplomatically, the “development of options, in consultation with the sector, for a Serious Incident Response Scheme to ensure the right systems are in place to identify an incident and prevent it from occurring again”. Providers reportedly welcome the merger but are wary of public ratings and a new flying squad.
A single independent regulator was among the many recommendations in the Productivity Commission’s 2011 blueprint for sweeping reform of the sector, which was extremely well received by both industry and consumer groups but has mostly been left on the shelf by successive governments.
It took a more recent inquiry into the federal regulatory regime, catalysed by revelations of horrific abuse at the Oakden Older Persons Mental Health Service in South Australia, for the idea to finally be taken up. Along with complaints and quality commissioners, that review recommended the commission employ a chief clinical adviser and a consumer commissioner. It is not clear if the new agency will follow this exact model.
“We recognise that the vast majority of providers give consistent, quality care to their residents. But, as we have seen, there can be failures,” the minister said. “We must ensure that disasters like Oakden are never repeated.”
“Our senior Australians have built the nation that we enjoy today. They have rightly earned the respect of the community and must be cared for with the dignity they deserve.”
The new reforms follow the introduction of “unannounced audits” in place of normal accreditation inspections, which immediately followed the recent regulatory review.
Wyatt’s opposite number, Julie Collins, said the latest reforms were welcome, but also too little and too late.
“Malcolm Turnbull must use the upcoming Budget to deliver genuine new investment in aged care to ensure older Australians are receiving high quality care,” Collins said in a statement, in which she also added that she believed “the majority of older Australians are treated with care and respect” in nursing homes.
“The Turnbull Government is still sitting on more than a dozen reviews and reports addressing the task of reforming aged care funding, workforce and quality of care,” the shadow minister added.
Problems at the Oakden facility run by the SA government came to light in early 2017 and it was soon ordered to be shut down, following a damning review by the state government’s chief psychiatrist, who then resigned a few months later.
There was also a review by the SA Independent Commissioner Against Corruption Bruce Lander, who called the facility “a disgrace” and said anyone in a position of authority in the public sector should read his report and reflect on the failures that led to serious mistreatment of people with dementia.
“I would hope this sort of horror could not be allowed to occur in any other facilities, given the critical issues raised,” said Wyatt in a speech last month shortly after Lander published his views on the matter. “This definitive report on the Oakden tragedy must stand as a grim beacon, for our current and future aged care obligations.”
While the government is changing the way it regulates aged care services, the funding is staying the same.
The centrally planned federal funding model that underpins the sector is not so young itself, and the federal government — whichever side is in power — will come under increasing pressure to move to some kind of market-based model as the years tick by. In that regard, the success or failure of the supposedly consumer-directed National Disability Insurance Scheme in coming years will be an influential factor.
Council on the Ageing Australia chief executive Ian Yates said the regulatory merger was a good idea, but urged the government “to go further and give consumers direct control over their aged care funding, as recommended by several inquiries and this government’s own aged care advisory body” in his response.
Yates also hopes the consumers will not be forgotten. “The atrocities at Oakden were only brought to light thanks to the tenacity and persistence of Oakden family members, demonstrating the importance of having strong consumer voices heard in aged care quality processes,” he said, “but we need to make it much easier, indeed normal practice, for consumers and families to be involved – that’s why we need the Consumer Commissioner’s role.”