Online version of the 2012-13 Department of Health and Ageing Annual Report

Outcome 4: Aged Care and Population Ageing

Access to quality and affordable aged care and carer support services for older people, including through subsidies and grants, industry assistance, training and regulation of the aged care sector

Page last updated: 29 October 2013

Major Achievements

  • The Department progressed key elements of the aged care reforms through developing major legislative changes, which were passed by Parliament and became law on 28 June 2013.
  • Developed the My Aged Care website and national contact centre, starting from 1 July 2013, making it easier for consumers, their families and carers to access quality information on ageing and aged care.
  • The 2012-13 Aged Care Approvals Round marked a key step forward in the delivery of a significantly expanded and more consumer directed Home Care Packages Program.
  • Supported 486,000 people through the Commonwealth Home and Community Care program in its first year of operation following the transfer of full funding and operational responsibility from states and territories except in Western Australia and Victoria.
  • Supported appropriate and inclusive aged care through the release of the National Ageing and Aged Care Strategy for people from Culturally and Linguistically Diverse backgrounds and the National Lesbian, Gay, Bisexual, Transgender and Intersex Ageing and Aged Care Strategy.

Challenges

  • Ensuring benefits for both consumers and providers by enabling stakeholders, including consumer groups, provider peak bodies and groups representing aged care workers, to contribute to implementing changes in the aged care system and supporting them through program guidelines and communication.
  • Building an appropriately skilled and well-qualified workforce to deliver quality care to older Australians.
  • Ensuring the administration of the aged care regulatory framework appropriately accommodates changes in the aged care system, including introducing home care packages and consumer directed care.
  • Continuing to focus on building stronger connections between the health and aged care systems, promoting better practice and partnerships and providing for better palliative care and support in the aged care system.

Performance

This is a doughnut chart and a table that summarises the results for all deliverables and key performance indicators in outcome 4 during 2012-13. The results show that 58.7% were met compared with 81.3% in 2011-12, 32.6% were substantially met compared with 21.1% in 2011-12 and 8.7% were not met compared with 6.6% in 2011-12.

58.7% MET

32.6% SUBSTANTIALLY MET

8.7% NOT MET

Period Met Substantially met Not met
2012-13 58.7% 32.6% 8.7%
2011-12 81.3% 12.1% 6.6%

Programs contributing to Outcome 4

Trends

Figure 4.1 shows the increase in aged care funding since 2009-10.

Figure 4.1: Aged Care Funding Growth 2009-10 to 2012-13

The figure is a vertical stacked column chart and shows the increase in aged care funding since 2009-10 to 2012-13. The y-axis denotes the amount of funding (in millions). The x−axis denotes the financial years from 2009-10 to 2012-13. Each column is subdivided into five stacks showing contribution of funding towards Residential Care; Home Care; Information, Quality and Capacity Building; Basic Support at Home and Flexible and Short Term Aged Care.

Figure 4.2 shows the increase in the value of accommodation bonds, with the average bond balance more than $200,000 in 2011-12.

On 30 June 2012, approved providers held in excess of $13.1 billion in accommodation bonds on behalf of approximately 65,700 residents.

Figure 4.2: Trend in Aged Care Accommodation Bonds 2007-08 to 2011-12The chart shows five groups of clustered columns (three in each) representing the years from 2007-08 through to 2011-12 (denoted on the x-axis). Each cluster represents the three types of accommodation bonds which are: the number of bonds held; total value of bonds (100,000); and average bond balance. All the three have shown a steady increase over the years.

Outcome Strategy

Outcome 4 aims to ensure that older people receive a choice of high quality, accessible and affordable care, and that carers get the support they need to look after frail older people living at home. Through Outcome 4, the Government also aims to encourage older people to live active and independent lives. In 2012-13, the Department worked to achieve this Outcome by managing initiatives under the programs outlined below.

Program 4.1: Access and Information

Program 4.1 aims to provide equitable and timely access to aged care assessments and make it easier to find services through My Aged Care.

Provide equitable and timely access to aged care assessments

Through the Aged Care Assessment Program (ACAP), Aged Care Assessment Teams (ACATs) comprehensively assess the care needs of frail older people and determine their eligibility for Australian Government subsidised aged care services. These assessments assist frail older people to gain access to the most appropriate types of care and improve their health and wellbeing.

The Australian Government and all state and territory governments have agreed to continue to deliver ACAT services through to June 2014. The agreement provides for state and territory governments, as the managers of ACATs, to meet benchmarks that measure improvements to ACAT assessment services against key performance indicators.

Make it easier to find services – My Aged Care

The Department established a single entry point for aged care services. My Aged Care began operating on 1 July 2013 with the introduction of the My Aged Care website and a national contact centre.60 These services enable the general public, older people, their families and carers, service providers and health professionals to access quality information on ageing and aged care. My Aged Care helps people to navigate the aged care system and provides referrals for assessment and service provision via multiple channels. Over time, My Aged Care will implement a central client record, an assessment capability to identify needs based upon a national assessment framework, and a linking service to help vulnerable people with multiple needs.

In 2012-13, the Department worked with both the Aged Care Gateway Advisory Group (established under the auspice of the National Aged Care Alliance) and the Gateway Consultation Forum (comprising Commonwealth, state and territory governments and National Aged Care Alliance representatives) to design the services that were introduced on 1 July 2013. The Department will continue to work closely with these two external consultation groups in developing and introducing additional My Aged Care services.

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Program 4.2: Home Support

Program 4.2 aims to provide integrated aged care services to people in their homes and offer support to carers.

Provide integrated aged care services to people in their homes

From 1 July 2012, the Australian Government assumed full funding and operational responsibility for aged care. This included the transfer of aged care services provided under the Home and Community Care (HACC) program to the Commonwealth, except in Western Australia and Victoria where existing arrangements continued during 2012-13.

In 2012-13, the Department built working relationships with more than 1,200 aged care providers to deliver basic maintenance, support and care services, such as domestic assistance, personal care, meals and transport to older Australians. The Department put in place arrangements to ensure continuity of services in the transition period while the Commonwealth Home Support Program is being established.

Offer Support to Carers

The Department continues to support carers in their role through a number of initiatives including the National Respite for Carers Program, Commonwealth Respite and Carelink Centres, the National Carer Counselling Program and residential respite care.

In 2012-13, the National Respite for Carers Program provided funding to more than 570 respite services Australia-wide, as well as a network of 54 Commonwealth Respite and Carelink Centres.

Respite was delivered in a number of settings including in peoples’ homes, day centres and overnight cottage respite. In 2012-13, respite services were provided to 104,124 carers.

In 2012-13, the Department held an open funding round to expand the number of respite services funded in areas where limited respite was previously delivered. Funding was provided for 55 additional new or expanded respite services which will assist a further 2,500 carers in the 15 months from April 2013. These additional respite services will provide services to carers of frail older people to encourage them to remain living in their community.

Commonwealth Respite and Carelink Centres provide information about support services available for older people, people with a disability and their carers. They also link carers with community services in their area and assist carers with short-term and emergency respite. In 2012-13, the Commonwealth Respite and Carelink Centres provided respite and carer support for 74,124 carers.

In addition, residential respite provides short-term care in aged care homes to people who have been assessed as eligible and approved by an Aged Care Assessment Team to receive residential respite care. It can be used on a planned or emergency basis. In 2012-13, there were 63,796 admissions to residential respite care and more than 1.5 million residential respite days used.

The National Carer Counselling Program reduces carer stress, improves carer coping skills and helps to continue, wherever possible, the caring role through short-term emotional and psychological support services to carers. From 1 July 2012, an additional $1 million per annum was provided to Carers Australia to increase the availability of counselling for carers through this program, bringing the total funding in 2012-13 to more than $4.5 million.

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Program 4.3: Home care

Program 4.3 aims to provide more care at home, match funding to care needs and provide greater choice and control in access to care services and delivery.

More care at home

The Department recognises that older people have a strong preference to remain in their own homes for as long as possible. It continues to increase the availability of Home Care Packages which provide nursing care, personal care assistance, meals, transport, domestic assistance, home maintenance and social activities to older people in their own homes.

The Department invited aged care providers to apply for new Home Care Packages through the 2012-13 Aged Care Approvals Round (ACAR).

Matching funding to care needs

During 2012-13, the Department consulted closely with the National Aged Care Alliance (NACA), including the Home Care Packages Working Group, to develop the implementation arrangements for a new Home Care Packages Program.

This program began on 1 August 2013 replacing the Community Aged Care Packages, Extended Aged Care at Home and Extended Aged Care at Home Dementia packages. The objectives of the program are to assist people to remain living at home for as long as possible; and to enable consumers to have choice and flexibility in the way that care and support is provided at home.

A Home Care Package is a coordinated package of services tailored to meet a person’s specific care needs. The package is co-ordinated by a home care provider, with funding provided by the Australian Government. Under the program, there are four levels of packages.

Work continued on developing new supplements for veterans with a mental health condition associated with their service, and on improving the quality of care in Home Care Packages for consumers who have cognitive impairment such as dementia. These supplements took effect from 1 August 2013.

Work also began to implement the new income testing arrangements which will take effect in Home Care from 1 July 2014.

Greater choice and control

Consumer Directed Care (CDC) is a way of delivering services that allows consumers to have greater control over their own lives by allowing them to make choices about the types of care and services they access and the delivery of those services, including who will deliver the services and when.

In the Home Care Packages Program, CDC is used to provide home care services which offers greater flexibility and choice to consumers. All new Home Care Packages allocated to providers through the 2012-13 ACAR will be delivered on a CDC basis.

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Program 4.4: Residential and flexible care

Program 4.4 aims to improve fairness and sustainability in residential care, provide culturally appropriate care and provide funding to other service models.

Improving fairness and sustainability

During 2012-13, the Department began implementation work on stronger means testing for residential aged care to take effect from 1 July 2014 to promote fairness in the aged care system by supporting people with limited means to have access to the care they require.

In addition, changes were made to the Aged Care Funding Instrument that is used to determine care subsidies in residential care to better match funding levels to the care needs of residents. Work continued on developing new payment supplements for veterans with a mental health condition associated with their service, and to improve the quality of care in aged care homes for residents who have severe behavioural and psychological symptoms of dementia and other conditions. These supplements take effect from 1 August 2013.

The ACAR is an annual application process that enables prospective and existing approved providers to apply for new Australian Government funded aged care places and financial assistance in the form of a capital grant or a zero real interest loan. In 2012-13, an ACAR was conducted where applicants could apply for new residential aged care places, new Home Care Packages, $51 million in capital grants, and more than $150 million in zero real interest loans.

The Department allocated 15 capital grants totalling $51 million to residential aged care services to improve building quality and standards, and to build accommodation for people with special requirements. These include people in rural, regional and remote Australia, Aboriginal and Torres Strait Islander communities, people from culturally and linguistically diverse backgrounds, people living in areas of need, older people who are homeless or at risk of becoming homeless and concessional, assisted or supported residents. The Department offered 33 zero real interest loans totalling $156.4 million.

Provide culturally appropriate care

The Australian Government is committed to delivering aged care that is appropriate for all older people regardless of race, culture, language, gender, economic circumstances or geographic location.

The Department supports the delivery of culturally appropriate aged care services to older Indigenous Australians, particularly those in rural and remote areas, through the National Aboriginal and Torres Strait Islander Flexible Aged Care Program. A total of 29 services are currently funded under the program. In addition, development continues for two new flexible services in the Northern Territory at Mutitjulu (Central Australia) and in East Arnhem Land.

Other service models

In 2012-13, the Department continued to provide funding for 4,000 flexible care places through the Transition Care Program. The Transition Care Program is a joint initiative between the Australian Government and all state and territory governments. It helps older people leaving hospital to improve their health and wellbeing, while assisting them and their family or carers to make long-term care arrangements, if necessary. In many cases, this resulted in older people returning to their own homes rather than entering residential care prematurely.

In 2012-13, the Australian Government provided $92.4 million to state and territory governments under the National Partnership Agreement on Financial Assistance for Long Stay Older Patients. This funding recognises that there are some older people in public hospitals who have finished acute and post-acute care and have remained in hospital longer than would otherwise be necessary, while they secure an appropriate aged care place.

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Program 4.5: Workforce and quality

Program 4.5 aims to ensure the availability of a skilled workforce, empower consumers and promote quality in aged care.

Ensuring availability of a skilled workforce

In 2012-13, the Department implemented the first stage of an aged care workforce strategy. Two initiatives were commenced – the Aged Care Workforce Supplement and the Aged Care Workforce Development Plan.

In addition, the Department continues to help delivery of workforce programs through the Aged Care Workforce Fund. This provides funding for training, education and support for the aged care workforce, brings together the aged care, training and research sectors and provides training for Aboriginal and Torres Strait Islander aged care workers to deliver culturally appropriate care.

In 2012-13, funding was provided to support:

  • approximately 11,000 aged care workers to study nationally accredited short courses, including dementia short courses, and palliative care and medication assistance skill sets;
  • the delivery of more than 4,500 Certificate III and IV aged care qualifications;
  • 31 Aged Care Nurse Practitioner projects to develop, test and evaluate a range of models in the aged care sector;
  • 16 Teaching and Research Aged Care Service models and the Aged Care Nursing Clinical Placements and Graduate Nurse Placements, which promote partnerships among aged care and education providers;
  • approximately 15,000 aged care employees to undertake further studies through education and training incentives and aged care nursing scholarships; and
  • more than 800 people enrolled in accredited training courses. These promote culturally appropriate training in rural and very remote communities to improve recruitment and retention of local Aboriginal and Torres Strait Islander aged care workers.

Empowering Consumers

The Department continues to strengthen the handling of aged care complaints through the Aged Care Complaints Scheme. A recent audit of the scheme by the Australian National Audit Office (ANAO) found that consumers were generally positive about the scheme’s enhanced focus on people receiving care and more timely resolutions of complaints. The Department agreed with the ANAO’s two recommendations to improve access to the scheme for isolated care recipients and to get more value from customer satisfaction surveys.

The Department has implemented measures to address these recommendations, such as providing information about the scheme to public guardians, advocacy groups and people involved with the Community Visitors Scheme (CVS). These groups are important touch points to reach care recipients who may be socially isolated. To improve the value of customer feedback about aged care complaints processes, in 2012-13, the feedback questionnaire, and how it is disseminated, was reviewed to increase response rates.

The Department continues to fund the national CVS which provides companionship to socially or culturally isolated people living in Australian Government-subsidised aged care homes.

In 2013, the CVS was expanded to include group visits within residential aged care, as well as visits to people receiving Home Care Packages. An open competitive funding round was held in early 2013 to allocate these places to successful applicants.

Promoting Quality

The Department has helped aged care providers understand their responsibilities under the Aged Care Act 1997. This includes continuing to monitor the increased protections for accommodation bonds, monitoring approved provider Aged Care Funding Instrument (ACFI) claims, and developing national aged care quality indicators for residential aged care. This will inform consumers and their families about the quality of residential aged care services and help providers to deliver them.

While strengthening evidence requirements and regulatory powers for the ACFI, a focus on educating approved providers has been maintained, including talking with industry through education sessions. The review program also supported approved providers to understand their obligations through the review process and has started exercising broader regulatory powers in response to repeated failure to correctly apply the ACFI.

Under the Aged Care Complaints Scheme, the Department focused on influencing industry to encourage better practice in complaints management. This was achieved through engaging and consulting with industry, service providers and their staff regarding effective complaints management. The scheme has also produced resources for industry and communicated with aged care providers in the community following the introduction of Commonwealth HACC complaints from 1 July 2012. Strengthened powers were also developed for the Aged Care Commissioner starting from 1 August 2013, giving the Commissioner the capacity to direct the scheme to undertake a new complaints resolution process and take the views of the Commissioner into account.

Program 4.6: Ageing and service improvement

Program 4.6 aims to provide support for people living with dementia and to meet the needs of a diverse community, creating better links to the health system.

Support for people living with dementia

The Aged Care Service Improvement and Healthy Ageing Grants Fund provides a large, flexible funding pool for initiatives that strengthen the capacity of the health and aged care sectors to deliver high quality aged care and promote healthy ageing, including initiatives to support people with dementia.

During 2012-13, the Department implemented initiatives to improve care for people with dementia. Support and care for people with dementia, their families and carers has increased through expanding the Dementia Behaviour Management Advisory Service into the acute and primary care settings.

Support was provided for people with Younger Onset Dementia who now have access to specialist key workers, who provide individualised support and advice, through Alzheimer’s Australia. Alzheimer’s Australia has continued to deliver the National Dementia Support program with exceptional services being provided in all areas. For example, more than 7,500 people received support through counselling, support groups and early intervention.

The Australian Commission for Safety and Quality in Health Care started work on improving the standards of care for people with dementia in hospitals. Hospital environments will be examined under this initiative with specialised consultants being made available nationally to provide advice.

Support for a diverse community

In 2012-13, through the Aged Care Service Improvement and Healthy Ageing Grants Fund, the Department supported a number of projects that were aimed at meeting the needs of older people from diverse communities. Activities such as staff training and information dissemination projects are supporting people from a range of special needs groups including people from culturally and linguistically diverse (CALD) backgrounds and people from the lesbian, gay, bisexual, transgender and intersex (LGBTI) community.

In 2012-13, the Department began funding a multi-year project to deliver LGBTI sensitivity training for all aged care workers nationally.

In December 2012, the Australian Government released two National Ageing and Aged Care Strategies: The National Ageing and Aged Care Strategy for people from Culturally and Linguistically Diverse backgrounds and the National Lesbian, Gay, Bisexual, Transgender and Intersex Ageing and Aged Care Strategy. These strategies have been developed to inform how the Government supports the aged care sector to deliver care that is appropriate and inclusive.

Better links to the health system

The Department continues to focus on building stronger connections between the health and aged care systems. In 2012-13, activities to strengthen the interface between the health and aged care systems were begun. These included promoting better practice and partnerships and providing for better palliative care and support in the aged care system.

Outcome 4 – Financial Resource Summary

Program (A) Budget Estimate 2012-13
$’000
(B) Actual 2012-13
$’000
Variation (Column B minus Column A)
$’000
Program 4.1: Access and Information 1
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 123,319 121,681 ( 1,638)
Departmental Expenses
Departmental Appropriation 2 13,409 12,313 ( 1,096)
Expenses not requiring appropriation in the current year 3 365 597 232
Total for Program 4.1 137,093 134,591 ( 2,502)
Program 4.2: Home Support1
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 1,385,773 1,373,339 ( 12,434)
Departmental Expenses
Departmental Appropriation 2 29,740 29,505 ( 235)
Expenses not requiring appropriation in the current year 3 874 1,432 558
Total for Program 4.2 1,416,387 1,404,276 ( 12,111)
Program 4.3: Home Care 1
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) - - -
Special appropriations
Aged Care Act 1997 - Community Care Subsidies 595,586 598,855 3,269
Aged Care Act 1997 - Flexible Care Subsidies 548,573 557,710 9,137
Departmental Expenses
Departmental Appropriation 2 15,833 15,709 ( 124)
Expenses not requiring appropriation in the current year 3 1,827 2,996 1,169
Total for Program 4.3 1,161,819 1,175,270 13,451
Program 4.4: Residential and Flexible Care 1
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 4 85,803 67,349 ( 18,454)
Zero real interest loans
- appropriation 147,995 73,915 ( 74,080)
- expense adjustment 5 ( 93,666) ( 51,547) 42,119
Special appropriations
Aged Care Act 1997 - Flexible Care Subsidies 351,335 354,180 2,845
Aged Care Act 1997 - Residential Care Subsidies 7,814,208 7,883,111 68,903
Aged Care (Bond Security) Act 2006 5,000 - ( 5,000)
Departmental Expenses
Departmental Appropriation 2 34,018 33,753 ( 265)
Expenses not requiring appropriation in the current year 3 2,362 3,868 1,506
Total for Program 4.4 8,347,055 8,364,629 17,574
Program 4.5: Workforce and Quality
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 151,562 145,164 ( 6,398)
Departmental Expenses
Departmental Appropriation 2 99,486 98,691 ( 795)
Expenses not requiring appropriation in the current year 3 2,926 4,811 1,885
Total for Program 4.5 253,974 248,666 ( 5,308)
Program 4.6: Ageing and Service Improvement
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 96,504 86,605 ( 9,899)
Special appropriations
National Health Act 1953 - Continence Aids Program 63,326 62,047 ( 1,279)
Departmental Expenses
Departmental Appropriation 2 22,465 22,290 ( 175)
Expenses not requiring appropriation in the current year 3 2,022 3,315 1,293
Total for Program 4.6 184,317 174,257 ( 10,060)
Outcome 4 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1) 1,990,956 1,868,053 ( 122,903)
- expense adjustment 5 ( 93,666) ( 51,547) 42,119
Special appropriations 9,378,028 9,455,903 77,875
Departmental Expenses
Departmental Appropriation 2 214,951 212,261 ( 2,690)
Expenses not requiring appropriation in the current year 3 10,376 17,019 6,643
Total expenses for Outcome 4 11,500,645 11,501,689 1,044
Average Staffing Level (Number) 1,407 1,410 3
  1. This program includes National Partnerships paid to state and territory governments by the Treasury as part of the Federal Financial Relations (FFR) Framework.
  2. Departmental appropriation combines 'Ordinary annual services (Appropriation Bill 1)' and 'Revenue from independent sources (s31)'.
  3. 'Expenses not requiring appropriation in the budget year' is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses - please refer to the departmental financial statements for further information.
  4. Ordinary annual services (Bill 1) against program 4.4 excludes amounts appropriated in Bill 1 for Zero Real Interest Loans as this funding is not accounted for as an expense.
  5. Payments under the Zero Real Interest Loans program are a loan to aged care providers and not accounted for as an expense. The concessional loan discount is the expense and represents the difference between an estimate of the market rate of interest, and that recovered under the loan agreement, over the life of the loan. This adjustment recognises the difference between the appropriation and the concessional loan discount expense.

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