As far as the Productivity Commission's recommendations go, the Opposition and independent MPs aren't ruling anything in or out. Observers, meanwhile, are hopeful the need for reform will overcome the politics. Darragh O Keeffe reports.
The opposition has said it will not respond to the Productivity Commission's recommendations for reforming aged care until the government shows its hand. It criticised the government's response thus far - to engage in a series of community and industry consultations.
"Having a review of the review does not equate with action," said the opposition spokeswoman on ageing Concetta Fierravanti-Wells.
"Older Australians and the sector are no closer to knowing how structural reform will be introduced and how this will affect the care they receive and where they receive it."
When asked for the Coalition's view of the PC's recommendations, particularly around the user pays principles, Fierravanti-Wells said it would not respond until the government responds. "This is a report that the Government requested."
She said the Coalition would consider any legislation the government put forward, noting that as yet none has been presented to Parliament.
No scare campaign
"The Coalition will be constructive and will not engage in the disgraceful sort of scare campaign that Labor mounted against the Howard government on aged care in the late 1990s. The ball is in the Gillard government's court," Fierravanti-Wells said.
The Australian Greens said the PC's proposals were "worthy of close examination".
Greens spokeswoman on ageing Rachel Siewert said the report needed to be seen as the beginning of what should be very significant aged-care reform, "because there is absolutely no doubt that such reform is needed in Australia".
"If we continue to delay, I am concerned that our aged care system will descend further into crisis and an increasing number of aged care providers will become non-viable. I believe it is important for the government to act swiftly in order to ensure we can continue to guarantee quality care for people in both the short and long term," she said.
On the question of the user pays recommendations, Siewert said there was no doubt that more funding was needed to address growing need for aged care services.
"The PC report provides a number of alternative approaches that I believe are worthy of close examination. We need a system that provides an important element of choice but it is essential that we meet the needs of those that cannot afford to pay. We must ensure that the disadvantaged and vulnerable have access to good quality aged care. The key factor to effective aged care is ensuring that people are able to access the essential services they need," she said.
Asked if the Greens would support government moves to implement the reforms, Siewert said any legislation put forward by government would be given careful consideration "to ensure it delivered the very best outcome for the aged care sector and older Australians".
"Through my involvement with the Senate Community Affairs Committee I would also be involved in any inquiry into proposed legislation at the Senate committee stage," she added.
Meanwhile, key independent MPs whom the government would most likely look to for support to get legislation through Parliament said they were open-minded about the PC's proposals.
Andrew Wilkie, MP for Denison, said he was generally supportive of the recommendations but had to see legislation before deciding to support it or not.
"Older Australians deserve to live with dignity and independence in a home of their choice with access to the full range of support and care services they need. Those choosing to live at home must be given every reasonable assistance, including better funded payments for their carers, while government funding of aged care facilities must be increased significantly," Wilkie said.
He said the PC report included proposals to address the weaknesses and challenges in the aged care system and deliver higher quality care.
"I'm generally supportive of this blueprint, which includes the principle that people should be able to choose whether to receive care at home, and choose their approved provider. I'm also open-minded about the specific funding proposals in the PC report but need to see any government legislation before I decide whether or not I support it," he said.
Rob Oakeshott, MP for Lyne, said he was currently getting feedback from his constituency. "I'm road-testing all recommendations of the Productivity Commission's report with the community and with the minister, who was in Port Macquarie two weeks ago. The consultation continues on what is a really important area of national reform."
At the time of going to press, New England MP Tony Windsor, and the MP for Kennedy, Bob Katter, had not responded to a request for comment.
For its part, the government has been reaffirming its intention to reform aged care in this term.
Minister for Ageing Mark Butler told the recent Aged and Community Services Australia national conference that while the government was not yet in a position to endorse any of the PC's recommendations, it was important to note Prime Minister Julia Gillard hadn't ruled any of them out.
Reaffirming Gillard's intention to reform aged care, Butler said she had sent him on a "two track process of engagement" - first through a series of community forums with seniors run by the Council on the Ageing, and second through talks with the National Aged Care Alliance.
Observers are optimistic
Meanwhile, long-time industry observers say they are positive about the prospects of reform. Hal Kendig is optimistic and points to the historical imperative for change.
Since the Howard government was "beaten down" after its attempts to bring bonds into high care in 1997, funding of aged care has largely gone unchanged in the last 15 years, said Kendig, the director of the Ageing, Work, and Health Research Unit in the Faculty of Health Sciences at the University of Sydney.
"If anything was going to happen, a major strategy had to be developed. And with the Productivity Commission you have as heavy duty and as gold standard a policy making body as you could find in Australia."
Difficult to challenge PC view
He said the PC had produced a high quality report, "an excellent blueprint" that had actually anticipated the political complications. "It drives aged care in a more consumer led way... It recommends more funding into the sector by drawing very carefully on the older person's wealth. That argument is sound and I don't think either side of politics can challenge that view."
Kendig said he believes the timing of the PC's report is fortunate.
For a start, Labor needs some wins, he said. "Gillard came in saying aged care reform was one of her priorities and she was going to get it done in this term. And it seems there's real commitment there. I also think there's a view in caucus that aged care has been underdone and needs to be reformed."
Secondly, he says that given the COAG health agreement - Commonwealth takeover of HACC, Medicare Locals etc - there is now "an agreed policy context in terms of health".
"We can see how aged care might fit in with that," he said.
When asked about the challenge of getting aged care reforms through this Parliament, Kendig was again hopeful.
"The government has to get some runs on the board. And I think this is one that Gillard can realistically fight for. Tony Abbott probably realises he's getting closer to being in government and he might be starting to think about what will land on him when he gets there. It would probably be advantageous for him to have this issue settled and to show this is an area where he can come in and work with the government on reaching agreement."
Industry support helpful
For Jeremy Sammut, research fellow at the Centre for Independent Studies, the industry support for the PC report bodes well for the odds of reform happening. "Given the overwhelming support from both for-profit and not-for-profit providers, I would hope that we may get bipartisanship this time, and the Coalition won't do to the Gillard government what Labor did to it," Sammut said.
The type of reforms the PC has recommended have been supported by every review since the late 1990s - when bonds should have been introduced for 'high care' but for political opportunism, he said.
"This includes the Hogan report of the mid-2000s and the final report of the National Health and Hospitals Reform Commission. We constantly hear about need for continued structural reform of the economy, and that dealing with the challenges of ageing Australia requires difficult decisions. But this isn't a difficult decision," he said.
The current system is unsustainable and won't provide the quantity or quality of aged care demanding baby boomers will need and want. Without change, we will end up with a two-tiered system as the rich buy their way out of the crumbling government supported sector, he said. "It simply makes sense to use the capital people have acquired in their homes to support them at older ages. We can do this and still protect the nest eggs they wish to pass on to relatives."
However, Sammut expressed concern about one lobby in particular.
"I fear that greedy 'stakeholders' - the Seniors lobby, which is building its political profile as the political pull of ageing baby boomers increases - might sabotage the process by running a repeat of the scare campaigns of the late-1990s, which alarmed the elderly concerned about supposedly losing their homes. If this happens, then 'standing up for the elderly' might prove hard to resist for both the government and opposition, either of which might break ranks."
He said the reality was that the elderly have to realise that nothing is for free - not pensions, public hospitals, bulk billing or aged care.
"The federal government simply can't provide all the capital funding required to equip the high care sector to deal with the unprecedented impact of longevity."
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