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Wednesday, 18 September 1985
Page: 638


Senator GRIMES (Minister for Community Services) —by leave-From January 1984 a number of changes to arrangements for recurrently subsidising hostel care for aged and disabled people were introduced. Subsidies were restructured to relate assistance more closely to the extent to which hostel residents need and receive care services as well as accommodation.

The changes were primarily intended to speed the attainment of some of the Government's most important objectives for care of the aged. The new arrangements provided incentives to encourage hostels to cater predominantly for frail aged and disabled people. As well, the Government wanted to ensure that people who were financially disadvantaged had equal access to subsidised hostel accommodation and that short term respite care was available in hostels to enable people caring for aged or disabled friends and relatives within the general community to have a break.

Eligibility conditions for personal care subsidy were tightened and a new hostel care subsidy was introduced for provision of accommodation-related services for those residents who did not need personal care. As well, at least for all new hostel residents, eligibility for hostel care subsidy and personal care subsidy was made conditional upon assessment to determine that such care is needed. New assessment arrangements were therefore another element of the changes. Two new conditions of Commonwealth subsidy required that hostels include at least one financially disadvantaged person in every five new admissions and provide one respite care bed for every 50 hostel beds.

Given the sweeping nature of the changes I agreed to a review of the new arrangements from 1 July 1984 and invited representatives of the hostel proprietors and a consumer representative to join with Commonwealth officers in the task. Their report was completed in June 1985. I am pleased to report that the joint review found that even in the short time since the introduction of the new subsidy arrangements and its examination of their effectiveness, there is clear evidence that government objectives are being realised. For example, the Government's efforts to place greater emphasis on care services for the frail aged have been successful. Hostels are employing more staff, especially for personal care services. There is a clear indication that hostel residents are now increasingly those who really need supported accommodation-the frail aged. Furthermore, the requirement that one resident in five be financially disadvantaged is generally being met.

The joint review found that while the provision of respite care is becoming established this requirement has been waived by the Commonwealth in a large number of cases. There are other requirements, notably architectural ones, which have also been waived on a significant scale. A priority for my Department in future will be to reduce the total number of waivers outstanding to the minimum level possible. It is anticipated that only in exceptional circumstances will new waivers be granted in future. It is pleasing to note that the majority of hostels have not been adversely affected financially as a result of the changed subsidy arrangements. The review found that the average subsidy paid per bed has increased and, in fact, that 78 per cent of hostels are receiving more subsidy than previously. The review makes around 50 recommendations on matters such as the arrangements for agreement between the Commonwealth and hostels on services and standards, consultation with the hostel industry, residents' rights, rates and payments of subsidies, changes to assessment arrangements for establishing levels of care, and improved information services on hostels and the program in general. My response to individual recommendations of the review is detailed in the schedule attached to this statement which I will be seeking leave to have incorporated in Hansard. Recommendations on subsidy levels and the conversion of subsidy payments to a daily basis have already been approved for implementation in the Budget. My Department will be committing resources to implementation of these and a substantial number of other important recommendations made by the review. It is anticipated that this process will be complete by the end of 1986. Honourable senators will see from the schedule that some of the review's recommendations require further consideration. A number of these imply fundamental changes in the nature and direction of the hostels program and hence must be considered carefully in relation to other policy initiatives already in train-for example, the home and community care program. I regard the report as a very significant step in ensuring that the Government's commitment to the provision of appropriate facilities and services for aged and disabled people continues to be met and commend it to members of the Senate.

I seek leave to have incorporated in Hansard the schedule attached to the statement distributed, which details the response to each of the recommendations in the report of the Joint Review of Hostel Care Subsidies Arrangements.

Leave granted.

The schedule read as follows-

REPORT OF JOINT REVIEW OF HOSTEL CARE SUBSIDIES ARRANGEMENTS RESPONSE TO RECOMMENDATIONS

1. Policy recommendations

No.

Recommendation

Response

Comment

1

That the Commonwealth:

1(a)

replace the existing Hostel Care Subsidies Agreement by an expanded Gazette notice of services and standards to operate in conjunction with a Terms and Conditions Statement, as specified at Appendices G and H respectively.

Supported

The objective of this proposal is to simplify administration by setting out in the Gazette non-negotiable requirements as regards services and standards to operate and by negotiating a Terms and Conditions Statement at appropriate intervals with proprietors rather than annually. Implementation of the latter measure will proceed on the basis of negotiations with individual hostels for possible completion by the end of 1986. Existing agreements will be extended until these arrangements are in place.

1(b)

undertake adequate and timely consultations with organisations represented on the Joint Review prior to any significant future changes to hostel care subsidies arrangements other than those recommended in this report.

Supported

In situations such as the Budget context which require confidentiality the ideal expressed in the recommendation may not be possible.

1(c)

replace the present temporary absence provision by introducing a condition of subsidy, preferably consistent across all residential care programs, whereby a resident may be absent from the hostel for a total of (say) 28 days in each successive 12-month period without forfeiting payment of subsidy for that period of absence.

Supported

This provision is fully consistent with arrangements for nursing homes funded under the National Health Act.

2

That the Commonwealth:

2(a)

while recognising hostels' right to admit residents ineligible for subsidy, continue to encourage the provision of subsidised hostels predominantly as care facilities for frail aged and disabled people by relating its subsidies to the provision of care services and continue to seek to ensure that financially disadvantaged people have equal access to subsidised hostels.

Supported

This endorses current policy.

2(b)

consider funding separate hostels for younger disabled people under whichever program it considers most appropriate.

Supported

Current provisions under the Handicapped Persons Welfare Program (HPWP) are restrictive insofar as provision of residential accommodation is tied to other prescribed services. The Handicapped Programs Review Report recommended significant changes to arrangements for residential provision for those with disabilities, which address, among other things, this issue. Pending implementation of the Report's recommendations suitable projects for the younger disabled will continue to receive priority under the Aged or Disabled Persons Homes Act. Such proposals will generally be required to reflect the principles of the least restrictive alternative as identified by the Handicapped Programs Review.

3

That the Commonwealth:

3(a)

while continuing to provide grants to organisations operating existing separate care facilities for ambulant dementia sufferers, consider funding pilot programs, research, data collection and education on dementia and on appropriate forms of care for dementia sufferers.

To be further considered

The Government recognises the seriousness of the problem of dementia sufferers. It is for that reason that special grants are already available to assist hostels which accommodate those suffering from dementia. There is also provision for evaluation of such programs and the outcomes of that work will be used as a basis for urgent policy development in this important area. Further consideration needs to be given to the respective responsibilities of Commonwealth and State governments in relation to care of dementia sufferers.

3(b)

consider extending both recurrent funding (on a pilot or special grant basis) and capital funding to organisations establishing new separate care facilities for ambulant dementia sufferers, unless new arrangements for funding care for ambulant dementia sufferers may soon be incorporated within a more general restructuring of residential care funding arrangements.

To be further considered

See comment on Recommendation 3(a) above. See also Recommendation TR10(b).

4

That, as conditions of Commonwealth recurrent subsidy:

4(a)

Hostels enter into an agreement with each resident:

(i) whose form and substance are acceptable to a delegate of the Minister for Community Services,

(ii) that provides residents with security of tenure while the agreement remains in force,

(iii) that has indefinite term, subject to defined conditions under which the agreement would terminate and to certain clauses having effect for more limited periods or being expressed in conditional terms,

(iv) that provides for termination of the agreement, in defined circumstances, on the grounds of a resident's deteriorating health or of unacceptable behaviour by the resident,

(v) that specifies a mutually acceptable procedure for resolving disputes or grievances, and

(vi) that guarantees residents access to their personal file within the hostel's records.

Supported

This is intended to be implemented in conjunction with the proposed Terms and Conditions Statement for possible completion by the end of 1986. Timing and the exact nature of the response will depend on the outcome of discussions with industry and consumer groups. The broad intention is to set goals rather than to make detailed prescriptions concerning precise content and form in this area.

4 (b)

Hostels ensure that all residents have a genuine opportunity to form, or be represented on, a residents' council.

Supported

5

That consideration be given to establishing a new Commonwealth authority, along the lines suggested in Section 6.5, to which complaints and disputes concerning Commonwealth subsidised accommodation and services could be referred.

To be further considered

As the Joint Review Report acknowledged, the question of complaint and dispute resolution mechanisms goes wider than hostels and has been the subject also of recommendations in the Report of the House of Representatives Standing Committee on Expenditure `In a Home or at Home: Accommodation and Home Care for the Aged' and in a recent report by the Senate Select Committee on Private Hospitals and Nursing Homes `Private Nursing Homes in Australia'. A Task Force has been established by the Minister for Community Services and the Attorney-General, to examine the issues and consider possible options. An interim report covering all of the Department's programs will be provided by the Task Force for the two Ministers in November 1985.

6

That respite beds not be used for: trial periods before permanent residency; assessment; long day respite; care for residents of self-contained units within retirement villages who already receive support services from the institution; or convalescent or rehabilitative care (unless therapeutic services are available from outside agencies or within the institution).

Supported

This clarifies existing policy. Further consideration is being given to links with services provided under the Home and Community Care (HACC) Program and to encouraging hostels to undertake outreach programs.

7

That rural and remote hostels be required to meet the same terms and conditions of subsidy as apply to all hostels, but be similarly able, where circumstances warrant, to negotiate exemption from any relevant terms and conditions set out in the proposed Terms and Conditions Statement at Appendix H.

Supported

It is anticipated that only in exceptional cases would exemptions be granted.

8

That, to overcome the present pattern whereby transfer from a hostel to a nursing home is effectively irreversible, the Commonwealth consider development of assessment and funding arrangements that would permit introduction of an explicitly recognised transition period between hostel and nursing home care, as proposed in Section 9.4.

To be further considered

As the Joint Review acknowledges in para 9.35, this particular recommendation needs to be looked at in a broader context including the rate at which appropriate assessment processes and facilities become available. There would also be a requirement to address the issue of additional costs that would be incurred if beds were held for hostel residents during any transition period. It is recognised that any such arrangement should not limit appropriate admissions from the community.

9

That:

9 (a)

rates of HCS, PCS and RCS be reviewed annually and increases reflect movements in the overall costs of operating hostels, with some relative emphasis on increases in HCS.

To be further considered

Subsidy rates are reviewed regularly but on the basis that they are a contribution to the total cost of providing accommodation and care within hostels. The rate of Hostel Care Subsidy was increased from the equivalent of $1.60 per day to $1.80 per day in the 1985-86 Budget while the current rate of Personal Care Subsidy was retained.

9 (b)

payment of HCS, PCS and RCS be converted to a daily basis without reducing the total amount of Commonwealth recurrent subsidies for hostel care and without changing the 28-day basis for assessment arrangements.

Supported

The conversion to daily rates of payment was announced in the 1985-86 Budget and will be introduced from a date to be announced in early 1986.

9 (c)

to eliminate certain inequities while maintaining present protection for financially disadvantaged residents, present provisions on fees that financially disadvantaged residents may be charged be replaced by new provisions on permissible fee levels for all hostel residents (see also Technical Recommendation 9 (a)).

To be further considered

Recurrent subsidies paid under the hostels program are provided as a contribution to the costs incurred by hostels. They are not intended to meet those costs in full. Greater Commonwealth control over fee levels is not considered desirable in the light of this limited funding role. Further, the administration of permissible fee levels of the type suggested would prove difficult for both the Commonwealth and hostels.

9 (d)

consideration be given to making resident-funded not-for-profit hostels eligible for recurrent subsidies where they:

(i) meet the same terms and conditions of subsidy (including financial disadvantage and respite care provisions) as apply to all other subsidised hostels, or

(ii) like other hostels, have negotiated exemptions on an individual basis from normal terms and conditions of subsidy that they do not meet.

To be further considered

In a period of expenditure restraint the immediate Commonwealth goal must be to give priority to the provision of care for those less able to meet the cost of it themselves.

9 (e)

the Commonwealth move towards:

(i) consistent accounting requirements across all residential care programs based on audited, facility-level accounts that are prepared in accordance with generally accepted accounting practices and that draw upon the chart of accounts used in deficit-financed nursing homes, and

(ii) a requirement that hostels provide such audited accounts annually to the Commonwealth and to residents and give the Commonwealth access to supporting information.

To be further considered

The implementation of any new standards would take several years to implement and would be dependent upon discussions with the Professional Accounting Associations and the Voluntary Care Industry. Moreover, the introduction of the recommended requirements across all residential programs including nursing homes, would require a great deal of consideration and discussion. This proposal should also be examined in the context of the level and type of control the Commonwealth should have over the provision of hostel care.

9 (f)

the Commonwealth consider reviewing capital subsidy arrangements for hostels so as to enable a provision to be introduced into residents' agreements that a resident who decides to leave a hostel permanently within 6 months of entering it would be entitled to a refund of 90 per cent of any entry donation made.

To be further considered

This recommendation is consistent with the thrust of the Report for a clearer definition of residents rights. An assessment of the impact of Recommendation 9 (f) on the ability of organisations to raise capital funds and identification of possible administrative implications is required.

10

That:

10 (a)

residents of self-contained accommodation in retirement villages who do not receive care services from those institutions be given equal access to HACC-funded services.

To be further considered

In principle it is agreed that those in retirement villages should be treated equally with other members of the community in circumstances where they do not otherwise have access to care services. This is a matter which will need to be considered and discussed with State organisations delivering care services in the context of the development of HACC over the next year.

10 (b)

the priority of ``flexicare unit'' and similar proposals be evaluated relative to other aged care proposals requiring government funding.

To be further considered

The Joint Review acknowledged that this and similar proposals need to be considered in the broader context of the development of both residential care programs and home and community care programs.

TR1

That the Department of Community Services:

TR1 (a)

develop a manual aimed at residents, assessment authorities, review authorities, hostel operators, Departmental officers, hostel staff, and other interested people outlining the hostels program as a whole.

Supported

This is a major task which will require substantial resources. It will be undertaken in consultation with representatives of the hostel industry, consumer groups and other interested parties. It is recognised that the focus of any manual will vary according to its purpose and target audience,

TR1 (b)

ensure that hostel organisations and residents are informed of any significant future changes introduced in the hostels program.

Supported

TR2

That the Department of Community Services:

TR2 (a)

maintain separate statistics about patterns of usage of hostel accommodation and care needs among ethnic and Aboriginal residents.

To be further considered

The Department has recently commenced a consultancy to identify statistical and other information needs for program management.

TR2 (b)

both directly and indirectly, actively encourage hostels to have regard to any special needs (including dietary needs) of ethnic or Aboriginal residents.

Supported

TR3

That the following changes be made to the range and definitions of gazetted services:

TR3 (a)

Personal laundry be regarded as a personal (rather than hostel) care service, and be incorporated in the ``bathing, showering and personal hygiene'' service category.

To be further considered

To be considered in the context of possible changes to assessment arrangements. (See TR8 (a))

TR3 (b)

a separate ``treatment services'' category of personal care services be added, to include such treatments as ointments, dressings, eye drops, back rubs and urine tests.

To be further considered

To be considered in the context of possible changes to assessment arrangements. (See TR8 (a))

TR3 (c)

Two distinct ``emotional support services'' categories be defined which recognise different levels of care requirements, namely.

To be further considered

(i) provision of long-term emotional support where needed by an eligible person diagnosed as suffering from a form of dementia, or from a functional psychotic condition which requires long-term anti-psychotic medication, and

(ii) provision of emotional support, to meet needs of a kind which are usually reversible and short-term, to any eligible person who is diagnosed as requiring such support due to a mental condition other than those in (i) above, such as depression, grief, or other conditions causing confusion.

TR3 (d)

meals be required to be appropriate, of adequate quality, and served at reasonable times with reasonable serving arrangements.

Supported

TR3 (e)

hostels be required to adhere to relevant legislation and regulations on administration of medications.

Supported

TR4

That, in respect of the level of services and care provided, the terms and conditions of recurrent subsidy:

TR4 (a)

require hostels:

TR (a)4

(i) to provide, in each 28-day period, at least an average of 20 hours of hostel care staff time per resident plus at least an average of 12 hours of personal care staff time per PCS recipient.

Supported

TR4(a)

(ii) not to charge residents for community nursing and other outside services brought in by hostels to provide personal care services (as hostels already receive a subsidy for their provision).

Supported

TR4(a)

(iii) generally to provide in-house social programs free;

Supported

TR4(b)

not make it mandatory for hostels to employ nurses

Supported

This endorses current arrangements.

TR4(c)

provide that standard telephones shall not be regarded as on-call equipment.

Supported

This endorses the Department's current requirement in this regard.

TR5

That the Department of Community Services:

TR5(a)

encourage hostels to regard social programs and rehabilitation services as important and integral components of their overall care plans.

Supported

The recommendation as it relates to social programs is supported. The most effective approach to the provision of rehabilitative services needs to be considered in the context of the avail- ability of day care type services and community care services. The roles of professional therapists and personal care givers in hostels also need to be examined.

TR5(b)

develop educational measures to increase awareness among the medical community and the general population of the differences between hostels and nursing homes and of the objectives of the Commonwealth's hostels program.

Supported

This will be an important element in information and educational materials prepared by the Department covering the full range of services provided for the aged.

TR6

That the Department of Community Services:

TR6(a)

prepare a booklet for prospective hostel residents outlining:

(i) major features of hostel living,

(ii) care and accommodation services normally available (including respite care), and

(iii) things to look for when considering particular hostels.

Supported

This will be available in 1986.

TR6(b)

Continue to consult with representatives of service-providing and consumer-oriented organisations with a view to:

(i) developing a mutually agreed upon standard content for residents' agreements.

(ii) identifying alternative models for residents' councils, and

(iii) preparing guidelines on how residents' councils can be successfully established

Supported

TR6(c)

Regard either:

(i) a legal agreement, or

(ii) an exchange of letters between hostel and resident, or

(iii) a booklet describing the rights and obligations of hostel residents and management which is signed by both the resident and a representative of the hostel organisation

as acceptable forms for residents' agreements.

Supported

The Report specifies that agreements used should ``give rise to legally enforceable rights'' and should be acceptable, in form and content, to the Secretary of DCS.

TR6(d)

encourage hostel managements to provide for resident representation on any committees that are responsible for making day-to-day policy decisions affecting life within the hostel community.

Supported

TR7

That the Department of Community Services continues:

TR7(a)

to encourage the provision of respite beds on an evenly distributed regional basis.

To be further considered

This recommendation will be examined further with other options for improving access to respite care.

TR7(b)

to apply current time-occupancy limits for respite care residents.

Supported

This reflects current policy.

TR8

That:

TR8(a)

the current alphabetical system of assessing provision of personal care services be replaced by a numerical scoring system, as set out at Appendix K, and reduced recording requirements be introduced in respect of those residents eligible for PCS whose care requirements have remained constant for at least 6 months.

Supported

The change from an alphabetical to a numerical scoring system for assessing provision personal care services is supported in principle. It will be implemented subject to some minor modifications and the outcome of further considerations of TR3(a), (b), (c)(i) and (ii) and TR8(d)(i). The matter of reduced recording requirements will be examined in the above context.

TR8(b)

provision of personal care services on a daily basis be interpreted as requiring either actual assistance on a daily basis, or actual assistance on a regular basis in conjunction with close direct supervision on intervening days.

To be further considered

To be considered in the context of possible changes to assessment arrangements. (see TR8(a)).

TR8(c)

personal care assessment authorities be entitled to regard a report from a regional assessment team that a person needs daily personal care services as relevant evidence in determining eligibility for PCS for the current assessment period.

Supported

TR8(d)

in respect of assessment practices and criteria:

TR8(d)

(i) the status and care requirements of residents diagnosed as needing emotional support, to meet needs of a kind that are usually reversible or short-term, be reviewed by a medical practitioner on a 4-monthly basis.

To be further considered

To be considered in the context of possible changes to assessment arrangements (see TR8(a)).

TR8(d)

(ii) the Mini-Mental State examination be withdrawn as a standard against which to diagnose dementia for subsidy purposes.

To be further considered

TR8(d)

(iii) assessment of social support needs reflect whether a person is suffering an adverse effect from limited social contact.

To be further considered

TR8(d)

(iv) Assessment Form SR215, `Eligibility for Hostel Care Record', be amended to reflect the changes suggested in Subsection 9.3.3.

To be further considered

TR8(e)

the Secretary of the Department of Community Services be authorised to appoint a regional assessment team, where one is available and prepared to assume the function and where relevant State authorities are agreeable, as a hostel care assessment authority.

Supported

These arrangements are in place in most States and Territories

TR8(f)

to assist hostel managements to determine staffing needs and to satisfy Departmental auditing requirements, hostels be required to maintain comprehensive staffing rosters using a pro-forma staffing roster, to be developed by the Department of Community Services in consultation with industry representatives.

To be further considered

TR9(a)

the present provision on permissible fees for financially disadvantaged hostel residents be replaced by the following pair of provisions on permissible fees for all hostel residents:

* any hostel resident may be charged an amount equal to 85 per cent of the sum of the standard rate of pension and the maximum rate of supplementary assistance.

* however, residents may be charged a greater amount than this provided that no resident may be charged a greater amount which would leave him or her with less disposable weekly income than that available to a resident receiving the minimum amount of supplementary assistance.

To be further considered

See comment on Recommendations 9(c).

TR9(b)

all hostels be required to state their fee policies for current and potential residents.

Supported

TR9(c)

the `prescribed date' be amended from a date on which services are to be made available to an administrative date defining the end of a 28-day period:

(i) in respect of which subsidies are paid for services provided; and

(ii) which is the period in respect of which each hostel resident's need for services is assessed.

Supported

Point (i) is to be considered in the context of possible changes to the basis of assessment arrangements (see 9(b)).

TR9(d)

subject to an evaluation of experience with the direct credit method of payment recently introduced into the social security system, the Commonwealth consider changing the present hostel care subsidies payment system to payment by direct credit through electronic transfer of funds

Supported

While there are advantages in direct credit arrangements this change is not given high priority at this stage.

TR10

That:

TR10(a)

a flexi-unit scheme, involving co-located units linked to a conventional hostel building by covered ways, etc, be preferred on grounds of practicality to a proposal submitted for funding of `flexicare units' and that the presence of a stove in such units not preclude their being deemed hostel units.

To be further considered

TR10(b)

any overall review of residential care funding arrangements consider whether a general mechanism explicity for funding care for dementia sufferers (or a sub-group of them) would facilitate more appropriate such care.

To be further considered

Further consideration needs to be given to the respective responsibilities of Commonwealth and State governments in relation to the care of dementia sufferers. See comment on Recommendations 3(a) and (b).


Senator GRIMES —Printed copies of the report are available to all honourable senators. In the near future they will be sent to all hostels and associated organisations and groups to allow for the widest dissemination of the findings. I move:

That the Senate take note of the statement.