We only learned of the Commonwealth Government’s plans to call for tenders for the operation of Aged Care Assessment Teams (ACATs) in January 2020. These would have effectively abolished the trusted, tried and tested system of advice and approval for admissions to residential care and home care packages.
The decision was announced amid the catastrophic bushfires of the summer, a time when it might have been thought that the reform would receive little if any public attention. Nonetheless, as reported in Aged Care Insite, the plans were widely criticised.
The geriatricians affected spoke out as did at least one Federal Liberal backbencher. So too did the Aged Care Royal Commissioner Tony Pagone.
Perhaps the most telling opposition came from the Ministers for Health of a number of states, from both Coalition and Labor governments.
Then, what Prime Minister Scott Morrison would surely call a miracle occurred. The Federal Government changed its mind.
The decision to put ACATs out for tender was overturned at the Council of Australian Government’s (COAG) Health Ministers meeting on 28 February. Buried towards the end of the communique from their meeting that day (following announcements on the COVID-19 virus, the response to bushfires and issues with the Commonwealth-State Health agreement), it was noted that:
“The Commonwealth has confirmed that it is not proceeding with the current tender process.”
Instead, the Commonwealth agreed to work with the states and territories to ensure a “consistent, uniform, efficient and integrated aged care assessment process that meets the needs of senior Australians and their families”.
Prior to the development of ACATs, Australia had the highest rate of admission of older people (that is, those then aged 65 and above) to residential care in the world. One of the key problems was that there was no source of independent advice possible. Nor was it required – simple approval by the matron in charge of a home was good enough for many years.
Later, medical approval was required, but this, if anything, seemed to make matters worse. Many GPs owned or part-owned private nursing homes and it was not surprising that they commonly referred many of their own older patients into their homes, ensuring that waiting lists grew, putting pressure on the government to increase the number of beds being funded.
The success of ACATs over the past 35 years is founded on volumes of evidence produced in regional and national demonstration trials that followed the work of famous Newcastle-based geriatician Dick Gibson and his colleagues, who pioneered a world-beating approach in which expert practitioners provided advice about the need to place individuals into residential care that was independent.
Subsequent research repeatedly demonstrated the value of the independence of the ACAT teams from the service provision system. Assessment helped reduce the rate of admission to ‘institutions’, providing confidence to those who wanted to remain at home and did not need the high level of resources required.
Since 2015, another level of assessment has been introduced. Access to the basic community care services funded through the CHSP programme now requires assessment by the RAS, or Regional Assessment Service. To my knowledge this new assessment hurdle has not been clearly demonstrated to be effective or even necessary. Certainly it is difficult to obtain accurate data on their operation or its outcomes.
One feature is clear – access to basic community care is now much more difficult. Not only is it confusing, there are time consuming waits of one to two months before assessment and often longer periods after it has taken place. The vast increase in waiting times for access to care packages coincides with the introduction of the RAS approach.
Could they be referring people away from the CHSP towards the HCP? It certainly looks like this is what is happening.
No wonder that one of the big themes to emerge from the current round of hearings at the Royal Commission is the call to open access to basic care – with many doors being opened, not just one.
Assessment, as it is currently implemented, is a one-off rationing process that takes place at the point of entry to the service system. Its great value, however, is as an ongoing advisory process that takes place on a regular, if possible daily basis, adjusting the assistance and care provided to the individual’s changing needs.
Such a process will often free up resources, as many people enter the aged care system with urgent needs, but gradually recover to an extent, sometimes regaining all their capabilities to remain independent. Without ongoing expert assessment, these resources can’t come free and the system quickly becomes clogged up with new referrals and long waiting lists.
The Commonwealth’s rethink of aged care assessment need not be seen as a backdown or retreat. It should be understood as an opportunity to open up a full rethink on the nature and conduct of assessment in aged care. That shouldn’t take a miracle. Just common sense.
Michael Fine is an Honorary Professor at Macquarie University.Do you have an idea for a story?
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