Budget 2021: what they said

The most significant budget for a generation was handed down this week. After years of debate about how we should go about caring for our elders, now and into the future, this budget was to be the answer.

Much like the release of the final report of the Royal Commission into Aged Care Quality and Safety, the government's response was somewhat anti-climactic. 

Aged care was of course mentioned in the treasurer's budget speech, but the official government response to the royal commission was released quietly on the health department website to no great fanfare. 

The figures announced in the budget for the sector have left some commentators unexcited, so what do the main players in the aged care sphere think of the package which, in the words of Aged Care Minister Greg Hunt, will "ensure senior Australians have access to high quality and safe care services, are empowered to have more control and choice in their care arrangements and are treated with dignity and respect"?

Older Persons Advocacy Network (OPAN)

“This is a win for reducing elder abuse, improving the aged care experience and keeping older Australians connected to their communities,” said OPAN ceo Craig Gear.

OPAN says the $94 million additional investment in aged care advocacy will keep older people living independently in their own homes for longer and prevent abuse. This brings the total funds provided to support the National Aged Care Advocacy Program (NACAP) to more than $145m over four years.

“We celebrate the government’s commitment to this transformation of aged care, including a new Aged Care Act that has the older person at its core, delivers high quality care that matches their needs, and prioritises their human rights, by 2023,” Gear said.

“However, the human rights enshrined within the new Aged Care Act must be accessible to older people and enforceable.

“Older people’s voices can contribute to initiatives such as an Inspector General of Aged Care and advisory roles such as a Council of Elders, which is what older people have been calling for."

Council on the Ageing (COTA)

COTA Australia chief executive Ian Yates said the budget boost is a serious and meaningful response to the royal commission.  

“Aged care reform needs proper oversight to get the job done. The new Aged Care Act in particular, along with the oversight mechanisms of an Inspector General, an Independent Pricing Authority, a National Aged Care Advisory Council and the Council of Elders, sets us on exactly the right path. We look forward to working with Government on the implementation of these important measures.

“We welcome the Government’s initial investment of $7.1 Billion into the daily care of older Australians living in residential aged care. Importantly this investment will be complemented by increased transparency around staffing and public funding and will ensure all aged care homes have a minimum staff time per resident. However, each of these measures needs to be stronger than announced and we will continue to argue for mandatory full transparency about staffing numbers and mix, finances including third party entity payments, quality measures and resident and family feedback. The Australian public deserves to know how their funding of aged care is being spent," Yates said.

"In addition, the Government will by 2024 finally implement its 2018 ‘in principle’ commitment to put the funding for residential aged care in the hands of consumers by abolishing bed licences and the Aged Care Approval Round (ACAR)."

The unions

Carolyn Smith, Aged Care Director of the United Workers Union said the budget gives the illusion of action on aged care but fails to address fundamental issues facing the sector.

“In residential care, when you look at the promise of care time for older Australians, it’s being introduced with the lightest feather of regulatory enforcement: an obligation to report care time minutes in July 2022.

“The aged care sector knows what this is about: no-strings-attached funding for providers and no clear expectation that money will be meaningfully tied to care for older Australians.

“In home care clearing the waiting list over two years simply means older Australians will continue to die on the waiting list.

“Scott Morrison has broken his promise for a comprehensive response to the aged care crisis by rejecting the Royal Commission’s recommendation that the home care wait list be cleared by the end of the year."

Smith said that the $17.7 billion a year over five years – or $3.5 billion a year – paled in comparison to the $50 billion in funding needs indicated by the Royal Commission and others over the same period.

“In its final report the Royal Commission found Federal Government funding in 2018–19 was $9.8 billion lower annually than it should be if aged care had been appropriately funded,” Smith said.

“The funding shortfall is leading to horrendous human costs in aged care, with older Australians left unsafe and vulnerable, and workers left physically and emotionally exhausted."

The Australian Nursing and Midwifery Federation is similarly unmoved by the government's package. It welcomes the measures ensuring providers must disclose care minutes as well as the new aged care act, but said that this alone is not enough.

“We question which generation will actually see the benefits of any action the government is taking to fix aged care. This budget falls well short of what residents, their families and the community wanted to fix this broken system,” ANMF federal secretary Annie Butler said.

"We’ve always said, if you don’t fix staffing, you can’t fix the aged care system. So the announcement of 200 minutes of minimum care per resident is a step in the right direction, but why wait until 2023? Critically, it does not include any requirement for a registered nurse to be on site at aged care facilities.

"Without mandated minimum staffing levels and skills mix guaranteed to meet the care needs of residents, elderly Australians and their families will continue to suffer."

The Australian Aged Care Collaboration (AACC)

The AACC's Patricia Sparrow said that after 20 government reviews in 20 years, this budget, and the government’s response to the Royal Commission’s recommendations, finally addressed many of the challenges facing aged care.

“Australia now spends half of what comparable countries do on aged care, and while this investment won’t close that funding gap entirely, it will provide structural relief in many critical areas.”

While the AACC's Sean Rooney said that with more home care packages, financial relief for providers and more care minutes per day, the government has taken significant steps toward meaningful reform.

"It also deals with major reform including a new Aged Care Inspector General, the creation of a new independent pricing mechanism and revised quality standards through an expanded Australian commission on Safety, Quality and Health Care," Rooney said.

“What this means is we are on the pathway to realising a transformed aged care system, that is resourced and enabled to meet the needs of a growing number of older Australians.”

Professor Lee-Fay Low, University of Sydney

Professor in Ageing and Health Lee-Fay Low says the funding injection means that ultimately more people will get care and better levels of care. But Low is concerned that key areas of the royal commission report have been missed out.

"There will be a new aged care act. However other structural reforms recommended by the Aged Care Royal Commission around care integration, and changing the system’s focus to supporting social participation, are not mentioned in this budget," she said.

"The budget includes the establishment of an independent pricing authority and greater funding for the Aged Care Quality and Safety Commission. However, other governance arrangements suggested by the Royal Commission such as a Cabinet Minister and Department for Aged Care and Independent Aged Care Safety and Quality Authority have not been included.

"I am concerned that the budget announcements are not addressing most of the structural issues in aged care. This seems like we are spending money to refurbish a badly designed boat, rather than investing in the design of a new ship."

Dementia Australia

Dementia Australia Chair, Professor Graeme Samuel, believes the $229.4 million allocated in this budget to dementia will transform the care people recieve.

“The government has responded through a transformational investment. We acknowledge the commitment made by the Prime Minister, the Treasurer, the Ministers for Health and Aged Care, Senior Australians and Aged Care Services.”

Marcus Riley, director of the Global Ageing Network and chairman of BallyCara

Riley agrees that the steps the government has taken are positive, although he argues that questions remain on several issues, such as long-term funding.

"Certainty for the long term is needed rather than band-aid measures via temporary supplements, supply – guaranteed access for people needing services as there was no commitment to a needs-based system, quality – which must be driven across the system in addition to compliance.  

"The main gaps from the budget announcements include addressing wage rates, which is fundamental to ensuring a sustainable aged care workforce, and a demonstrated commitment to fostering a wellbeing approach inclusive of preventative and restorative initiatives for people using services."

Richard Ainley, PricewaterhouseCoopers Australia Healthcare Partner

The shift of license allocation from providers to consumers is a significant and potentially transformational change to the residential aged care market, according to Richard Ainley, emphasising consumer choice and challenging providers to step up their care.

"Introduction of minimum care delivery commitments (including nursing) could improve care and experiences but will challenge providers to rethink current operating models and look to digital solutions to streamline and improve care delivery while competition for workforce intensifies," he said.

"If transformation of the aged care system is to be achieved, budget commitments and the reform pillars are only the beginning. Whether older Australians – and our aged care system – are any better off, depends on how these new commitments are translated into action and sustained change. Government, providers and the community will need to work in partnership to make the most of this not-to-be-missed opportunity."

Your Side aged care 

Your Side chief executive Danielle Ballantine said the government investment is welcome, but must be used to increase wages and bolster a shrinking workforce.

"There is a serious workforce issue – the number of people who will require care in the next 20 years is enormous. Paying for it and recruiting a workforce to deliver it will be a big challenge. On some estimates Australia will need 900,000 to 1 million extra care workers by 2050 – about 4 times what we have now. We need government and the sector to work together to solve this problem, and the taxpayer to be willing to fund it," she said.

"Aged care workers are some of the lowest paid workers in our entire workforce, for work that is demanding, rewarding and skilled. Without increasing wages to above “fast food level rates” at around $21 per hour, we simply won’t get the quality lift in care that we all want to see. So it’s really welcome that the government has allocated $17.7 billion to aged care but we must make sure it’s not tied up in red tape and regulation, and some of it goes to increasing wages."

The Royal Australasian College of Physicians (RACP)

“The fact is, the Royal Commission identified a $9.8b annual shortfall existing in aged care. Now we’re looking at approximately an average of $3.4b additional per year, for five years," said RACP spokesperson and President of the Australian and New Zealand Society for Geriatric Medicine, Dr John Maddison.

“Once you take out the $6.5 billion for Home Care Packages, it may not leave enough to address the issues in residential aged care which are significant.

“It’s a good start but it’s unlikely this is going to be enough to meet the current annual shortfall and address the Royal Commission’s 148 recommendations.

"Our entire healthcare system needs to shift to more easily integrate into aged care so that people living in aged care residences can access healthcare services and lead a better quality of life.”

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