Instead of transformation, the new Aged Care Act risks a two-tier system where older Australians pay more, get less, and taxpayers still foot the blowout bill.
It’s been four years since the Royal Commission into Aged Care and a recently released report is warning the new Aged Care Act could cost taxpayers more and strip away rights, despite being described by the Department of Health, Disability and Ageing as “rights-based”.
In contrast, the Inspector-General of Aged Care Natalie Siegel-Brown says, with older Australians being forced to pay co-payments, the new Act might set up a scenario in which people can’t afford their own care.
Ms Siegel-Brown released her Progress Report Implementation of the Recommendations of the Royal Commission into Aged Care Quality and Safety in May, however it was tabled in Parliament on Thursday.
She said while there has been a large number of Royal Commission recommendations implemented in the new Aged Care Act, they’re not necessarily ones that could really transform the system.
“Many of the recommendations that would truly bring the objectives of the new Act to life remain outstanding. And the implementation of others appears to be more peripheral or completed in a rush,” the report said.
“As at 1 January 2025, the statutory timeframe for this report, the required sector ‘transformation’ had not been achieved.
“Much of the reform agenda has been made up of disparate and sometimes disconnected changes that target specific issues rather than delivering systemic change,” she continued.
The Inspector-General is concerned that the lack of those transformative changes could potentially push people who’d prefer to age at home prematurely into residential aged care.
Of particular concern is the government’s decision to make co-payments part of the new Support at Home system. Older people with means will have to contribute to their own non-clinical care and services both in home and residential care.
“It must be said that co-payments are contrary to the Royal Commission’s intent,” Inspector General Siegel-Brown said.
“While the Inspector-General understands the reality of the budget constraints, she holds genuine fears that the manner of implementing co-payments may set up a scenario where vulnerable older Australians will forego care: either because they cannot afford it or because they are worried about the cost,” the report continued.
“The Inspector-General shares the fears of stakeholders that the manner in which co-payments and other aspects of the reforms have been structured, could potentially both prejudice equity of access to care and create inadvertent cost blow in other areas.”
One of those stakeholders is Professor Kathy Eagar. In her submission to the Community Affairs References Committee on Aged Care Service Delivery, Professor Eagar wrote that she had no problem with older people paying for aged care if they have the resources.
“But, in my opinion the proposed SAH consumer co-payments model is badly designed
and should be rejected. Consumer co-payments should be linked to the person’s capacity
to pay and not the quantum of service they require to live safely in the community,” she wrote.
Other concerns outlined in the Inspector General’s report include the mainstreaming of Aboriginal Community-Controlled services.
“The process is widely feared to undermine the provision of culturally appropriate care and threatens to decrease – rather than encourage – Aboriginal Community-Controlled care provision,” the report said.
“The process of mainstreaming runs counter to these recommendations. The Inspector-General holds further concerns that action in this area has not been consistent with the National Agreement on Closing the Gap, to which the Australian Government is a signatory.
“There is an urgent need to pause and reorient the current approach,” she said.
Inspector General Siegel-Brown also commented on the waiting lists for home care.
She said although the government hadn’t delivered a universal entitlement to aged care, “there has been action to provide more timely access to in-home care through additional funding to expand the number of Home Care Packages”.
She said that her office continued to hear about substantial delays in access to care.
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“Extended delays also call into question the effectiveness of government actions to date, and public confidence that the aged care system can meet older peoples’ needs and aspirations,” she said.
She is not alone on this, with Health Minister Mark Butler backflipping on his previous decision not to release new Home Care Packages until 1 November. This week, he agreed to release 20,000 new packages after losing a vote on an amendment to the Aged Care and Other Legislation Amendment Bill.
“Providers have said over the last little while, including in the Senate inquiry, very recently, that they are able to provide these packages if we put them into the market. Now, I guess now they have got that opportunity,” Mr Butler said.
Greens spokesperson for older people Senator Penny Allman-Payne said the government needed to be more transparent about how the new aged care system will impact older Australians.
“This is a shocking wake-up call for supporters of the new Act. This report has warned of a two-tiered system, where aged care increasingly becomes about the care you can afford rather than the care you need.
“I am scared stiff for older people under this new system,” Senator Allman-Payne said.
The Older Persons Advocacy Network (OPAN) welcomed the report but said it highlighted how much needs to be done before the new Aged Care Act commences on 1 November.
OPAN South Australian member, Aged Rights Advisory Service CEO Carolanne Barkla said:
“There are several challenges and risks that need to be addressed before we reach this milestone, and this is a useful report card for government and industry stakeholders to measure aged care delivery against.
“Aged care providers support some of the most vulnerable people in the community and it is imperative that care is delivered within the prism of rights, dignity and respect.
“This report sends a clear message – there is a lot more work to be done to better support providers, residents and older people”.