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Delving into the detail

NIMAC’s concerns revolve around the proposed regulatory reforms and the form they will take, writes Pam Bridges.

Like many others we read the draft report from the Productivity Commission with interest. Attempting to absorb the information in this very large document is certainly a challenge, but we commend the commissioners on their work, recommendations and explanatory notes.

The principles as outlined in recommendation 4.1 are fully supported by our organisation. However, the reforms around the funding of the cost of care and the fees and charges (bonds and retentions) are very complex with potentially far reaching effects and we suspect the devil will be in the detail. It is not clear what the net result will be for service providers and for consumers at this stage.

NIMAC would support the removal of the high-low care distinction for facilities, but we are unsure of replacing the ACAR with an open market scheme. We believe more work needs to be done in this area for the effects – positive and negative – to become clearer.

The proposed Australian Seniors Gateway seems, at first glance, to be just another iteration of a number of past projects , such as Care Link and Access Points. The concerning issue here is the proposed development of the Aged Care Needs Assessment Instrument (ACNAI) which, if one was a cynic, appears to be another name for ACATs. The concerns that the industry generally has with the way in which the ACATs carry out assessments in some areas, where subjectivity has replaced objectivity, and the disparity between ACAT assessments and ACFI assessments is ongoing.

The recommendations around workforce issues propose development of minimal nursing staff levels. This could include the licensing of personal carers, expanding their role and upskilling. Whilst NIMAC would support any initiatives to upskill our workforce, there has been considerable funding allocated to this cause over the past few years and unfortunately, once trained many of these workers choose to work in the acute and other sectors because of the lack of wage parity offered in aged care.

Staffing ratios do not get over the problems of an available pool of candidates to take up positions, wages that are competitive and changing dependency levels of resident in residential facilities.

The proposed Australian Aged Care Regulation Commission, although at first glance commendable, is another area where the devil will be in the detail. A lot more work needs to be done around the tools that will be used to assess quality and compliance within residential and community services. The regulatory processes also need to be spelt out in more detail, particularly in regard to whether this body will embrace a risk-based approach to compliance and enforcement.

Obviously the danger with new entities is that the existing personnel within current departments might be transferred ‘holus bolus’ to the new commission. To do this has the potential to have disastrous consequences. It would just transfer old ways of doing things and learned behaviours to a newly titled department. NIMAC would support this proposal with reservations around the implementation and ongoing functioning processes.

We would most definitely encourage the Department to conduct a review of the existing legislative reporting requirements to establish if, having been in place for some years, they are actually achieving something positive for residents, clients, consumers and service providers.

In summary, NIMAC’s concerns revolve around regulatory reforms and the form they will take to ensure that they value-add to the already stressed aged care sector. The detailed work around fees and charges, open markets and an Australian Pensioner Bond Scheme will become clearer as modeling is carried out. The one thing that is patently obvious is that the aged care sector cannot afford to slip any further back with regards to financial viability. To do so would mean that the aged care sector as we know it will cease to exist.

Pam Bridges is president of Nurses in Management Aged Care (NIMAC)

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