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Monday, 17 September 2012
Page: 7055


Senator SIEWERT (Western AustraliaAustralian Greens Whip) (16:07): The provision of aged-care services in Australia has been in a steadily expanding crisis in that it has been getting worse for a significant period of time. That is nowhere more so than in my home state of Western Australia, where we have been at the leading edge of that crisis, with plain evidence of the consistent failure of providers to take up the beds offered in the aged-care approvals rounds over the last couple of financial years. The providers in Western Australia are also probably the most vocal around Australia about their concerns with the changes to the Aged Care Financial Instrument.

Along with a number of other people, the Greens cautiously welcomed the reforms that were announced on 20 April this year, I think it was, and we supported them in principle. However, the devil is of course in the detail, and once you start looking through them you see that there are some issues. While changes to the ACFI were mooted at the time, I really do disagree with Senator Brown that there was a lot of consultation around the changes. There was not. They came as a shock. The actual changes were announced very shortly before the beginning of the current financial year, which is one of the many things that providers are very critical of.

I have heard from a number of my constituents in Western Australia who work in aged care and—because I also hold the aged-care portfolio for the Greens—from providers all around Australia, expressing their concerns. They are particularly concerned about the potential impacts on the providers of services for supported and concessional places, Indigenous services, regional services and services to members of the CALD community.

We have asked a series of questions on notice about the ACFI changes, because at the moment we simply do not know. While I can sort of understand where Senator Fierravanti-Wells is coming from on this, it is too early to know, and that is the point. We know there are a lot of changes being made as part of aged-care reform. They are very necessary changes but, in my opinion, they do not go far enough, and we are going to have to go further if we want to have a system that provides high-quality, affordable care. However, today I will focus on the Aged Care Financial Instrument changes.

What the government have said but are not able to significantly back up is that there has been a lot of rorting of the system, with lots of fallacious claims, and the funding for the Aged Care Financial Instrument is being spent too quickly. When the changes to the ACFI were made, the number of claims went up considerably. One of the questions I asked was: what evidence is there of the increase in claims? The government came back with the response that in 2010-11, of the services that were reviewed—because there is an ACFI review program—66 per cent were subject to one or more downgrades of their ACFI claims under section 29-1 of the Aged Care Act; and, in the financial year 2011-12, which had not yet ended when I asked the question, 61 per cent of the program had been subject to one or more downgrades. In that instance, the government are not claiming that there was rorting but that there may have been mistakes made in calculations and so on. When I asked how much those downgrades were worth in terms of savings, the government were not able to tell me. They said:

Residential aged care subsidy funding is calculated on a daily basis and this rate can change a number of times. Attempts to calculate savings would place an unreasonably high demand on resources.

They are saying that there is overclaiming going on under ACFI, so what I want to know is how much they are saving from having addressed that process. If they did the assessment process properly, do they actually need to change the instrument or simply make sure that the claims are accurate? Because that money is being used to provide care to people.

The bottom line here is the standard of care that is being provided in our aged-care facilities—and we know that our aged-care providers are not being paid enough to look after their residents. Talk to any provider in this country; they will all tell you that there needs to more funding provided to support those receiving care, particularly at the high-care end. What is happening because of the changes that were made by the previous government is that people are no longer going into low care but staying in their own homes, which is in fact what they prefer, and only going into high care at the end-of-care stage. That means they are there for shorter periods but the demands on the high-care services are much higher. So it seems to me that we are in the situation where the government cannot say how much is being saved following the downgrading of those claims. What we need to know is: are the items that are being claimed in fact the items that the government changed?

I understand that the government, in response to concerns raised by providers, have said that they are monitoring this. Isn't that the key point? That is why I am saying that this debate has been brought on too early: we do not know what impact the changes to the Aged Care Funding Instrument items are going to have on the provision of care. I know there is a lot of concern that one effect will be less time spent with people on day-to-day living activities. One of the criticisms you constantly hear from providers is that they just do not have enough resources or time to put into helping residents with day-to-day living activities, when those activities are what give their days meaning and joy.

We believe there are a number of principles by which we should be measuring the funding model and for which the government needs to have regard when it is monitoring the changes to ACFI: that is, the time staff can spend with an older person under their care has to be maintained—it cannot go down; that support for daily living activities is retained to enable a life of dignity and maximum independence; and, that the changes which target inefficiencies or rorting—and there is a difference there, a very clear difference—are consistent with the original intent of the ACFI tool and in fact do not create new barriers to delivery of quality care. We also need to make sure that the changes balance up saving for long-term reform against the risk of sustainability of services during the reform transition process.

Some providers are saying that we are in danger of going under because these changes are having such an impact on our services. I understand quite tight monitoring is going on and it needs to be happening rapidly because there is a potential that we will start losing some of the providers out of the system, the very thing the government has acted to address, so that residents in our ageing population are getting high-quality and accessible care. Also, one of the major criticisms of the system is that providers are not building beds and are becoming increasingly non-viable. We need to make sure that aged care providers have confidence in the minimum level of funding they are going to get, so that they can plan properly and participate in the reform process. Also, if they are not confident, they are not going to participate in subsequent rounds of ACAR funding.

It is absolutely critical that we get this process right. The Greens are watching this process very carefully, in particular the changes to ACFI. If the government have made a mistake and have not finessed the ACFI carefully enough, they will need to be big enough to acknowledge that adjustments will need to be made or people will be missing out on care and providers will be going out the back door. My state will be leading that withdrawal because Western Australian providers are the most likely to be non-viable in the near future. This needs to be fixed and careful monitoring needs to be in place so that we will have an aged care system into the future. (Time expired)