Speech - Opening Address to the National Aged Care Conference 2012 - Living Longer, Living Better Adelaide 6 August 2012
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6 August 2012
Thank you Sally and thank you everyone for coming to Adelaide.
Before I go on though can I acknowledge Josie Agius, who gave us that beautifully warm but also funny Welcome to Country. Josie, like me, is from Port Adelaide. And today, is not a day where we feel particularly joyous after yesterday's drubbing by Great Western Sydney and all that it means for our club but Josie is a bit of an icon here in Adelaide and it was, as always, a Welcome to Country that blended the warmth and the seriousness of a Welcome to Country by the traditional owners - one of the real elders of the Kaurna people here in Adelaide - with some humour and some directions as to how you should behave and what you should see in Adelaide.
Thank you particularly for coming to my home town, not just because I was able to get up and watch Usain Bolt with my children this morning instead of being on a plane, but because we think this really is a beautiful city to spend a couple of days during a conference and also a city where some very significant innovations in the aged care sector have traditionally taken place, for reasons that I don't fully understand, but Adelaide has been a real centre of innovation here in aged care.
So, given the significant representation from the Adelaide aged care sector hopefully visitors to our city will be able to get some time to talk to some of those people as well.
This was initially planned as a conference around assessment but after the planning of the conference we released Living Longer. Living Better so we thought we'd take the opportunity of getting several hundred of you together, not only to talk about assessment but also to dig into the detail of the Living Longer Living Better policy and to speak again in some detail about it and the implementation milestones.
We have I think more than 1000 people registered for this conference, which is a wonderful achievement, and it's also streaming live over the internet.
It's now 12 months since the Productivity Commission was released by the Prime Minister and myself and it's been a very busy 12 months.
The Productivity Commission, as tends to happen with that body, gave us a very, very comprehensive, detailed and thoughtful report running to, I think, 750 pages or so, plus a couple of hundred pages of appendices.
They received hundreds and hundreds of submissions both in the draft phase and in the final phase of their inquiry and also conducted many, many public hearings as well.
At the same time the sector for some years now has come together under the rubric of the National Aged Care Alliance, NACA, and, in a way that many other sectors of society and the economy could copy, thrashed out their differences and been able to present to the Parliament, to the community, to the Productivity Commission and others, a very united view about the major building blocks of aged care reform.
I think this is a significant reason why we are more successful now about aged care reform than perhaps was the case 15 years ago.
After the release of those documents I conducted 35 or 40 different forums around the country, largely organised by COTA and Alzheimer's Australia where more than 4000 older Australians came and told me - I can tell you in usually very forthright terms, often very frank terms - what they wanted from an aged care system and the degree to which they thought they were getting it from the existing system.
Living Longer Living Better is a product of all three of those processes. Not one, in and of itself, but a combination of all three.
The view of the sector through NACA, the view of a very expert group of people through the Productivity Commission, having conducted such a comprehensive inquiry, and the capacity I, as the Minister with responsibility for taking this to Cabinet, was able to get from talking to more than 4000 older Australians directly.
The challenges that we had to confront in this policy are well understood and none of them are particularly new, even if some of them are getting more pronounced as the years go by.
There is a very significant unmet demand for care and support in the home.
Before this Budget there was not a single additional each package in the forward estimates in the Budget until 2018/2019. Home care is running at a very significant state of unmet demand.
There are significant work force pressures everywhere in Australia but particularly in some of the jurisdictions impacted most by the mining boom.
Employers tell me across the country they are finding it increasingly difficult to get good workers and if they get them, to keep them - largely because of very low pay.
For many years we've known of the problems associated with an overly regulated residential sector. This was really the reason for previous attempts at aged care reform back in the '90s and in the mid part of the last decade.
And we've heard very clearly that there are insufficient supports within the system for some of the real and growing challenges like the prevalence of dementia and the increasing diversity of our older population just to name a couple.
Dealing with some other areas of reform as I have, it is striking the degree to which those challenges are all broadly agreed by the sector; by experts, by service providers, by the workforce through their unions and most importantly by older Australians themselves and their families.
Living Longer. Living Better, I think, does deal with all of those challenges and it responds to the community’s expectations of what aged care should look like, not just in the next few years but the next couple of decades.
Older Australians said to us very clearly that they didn't want a system any more that was built around nursing homes. They wanted a system whose primary objective was to support them staying in their own home for as long as possible, and if possible for the remainder of their lives.
And that is why we're reconfiguring the HACC program and a range of other traditional Commonwealth programs to build a new home support program from 2015, to review the services within that program for the first time since the 1980s and to grow it very significantly, both in the next couple of years, and from 2015 by six per cent per annum in real terms.
It's why we're developing new levels of home care package, significantly increasing the number of home care packages by about two-thirds and making sure over time all of those home care packages become consumer directed care packages, built around the needs and the preferences of the consumer rather than the needs and the convenience of the provider.
Older Australians also told us, as did their families, that they want a much easier way into the system. I had a person come up to me at a forum who told me she'd been working in the sector for 25 years. She told me she thought that she knew the aged care sector back to front, knew everything about it until she had to find a bed for her mum. And for the life of her she couldn't find the information that she thought she and her family needed to make the best possible choice for their mother.
Now, if a person like that can't find the information she and her family need, what hope does someone who's never dealt with the aged care sector before have, particularly if they have language and cultural barriers.
That's why we picked up the Gateway proposal - a proposal initiated largely by COTA and developed over time in its two reports by the Productivity Commission.
Older Australians, employers, trade unions and everyone else with any passing acquaintance with the aged care sector told us we need to do better in attracting and retaining a good quality dedicated workforce. We have 300,000 dedicated people working in aged care today. We're going to need almost a million over the coming few decades.
It's hard to come to grips with this idea but in a few decades one in twenty workers in Australia will be an aged care worker. And if we don't improve wages, if we don't improve conditions and if we don't improve some of the management practices that are also core to the idea of retaining a good workforce, we're simply not going to get there.
And that is why we adopted a proposal largely put to us by NACA in its latest blueprint to put $1.2 billion into a Workforce Compact to provide bridging arrangements while we work on longer term solutions to find fair and competitive wage rates for aged care workers.
We also heard very clearly from the 300,000 or so Australians living with dementia and their families that supports for them are profoundly inadequate; supports in home care, supports in residential care, supports in primary care and in hospitals.
Alzheimer's Australia's Fight Dementia Campaign has lifted the profile of this condition very significantly. The package that we released a few months ago includes around $270 million of new initiatives to fight dementia.
Later this morning we're hearing from the President of Alzheimer's Australia, Ita Buttrose, about the Fight Dementia Campaign but can I say, as an early step, that this Friday Minister for Health Tanya Plibersek and I are taking a proposal to a meeting of state, territory and Commonwealth health ministers that dementia be added to the list of the existing eight national health priorities to become the ninth.
In more forceful terms than I expected, older Australians also told us that a critical part of being able to age well is to have the confidence that you will also be able to die well, die in circumstances and at a location of your choosing, among the people you love, among the things that you cherish.
In Newcastle, I heard this very starkly when a retired steelworker stepped up to the front of a crowd of about 150 or 200 people and ripped open his shirt to show me his "do no resuscitate" tattoo.
This happened in Darwin too, by a woman in a rather flimsier shirt who was able to be convinced that I was going to take at her word that she had such a tattoo and she didn't have to show it to me. She told me she had a tattoo on her back in case she collapsed face down that said please turn over.
Again, I took her at her word.
I had other people come up to me at forums and talk about older Australians getting little DNR tattoos on their chest.
There must be an easier way for people to feel some confidence that they are communicating their wishes clearly to their family and to their clinicians and, most importantly, that they have confidence that those wishes are going to be respected.
That's why I'm particularly proud of the elements in the package that seek to ramp up our capacity to deliver an advanced care planning system to older Australians particularly, and our capacity to deliver palliative care beyond the hospital system; in aged care facilities and in home settings where the vast majority of people actually want to die.
We were told also that the aged care system needs to do better to cater for the increasing diversity of older Australians; the cultural and the linguistic diversity of older Australians and also the sexual diversity of older Australians, frankly a topic that for too long has been taboo.
That's why we've accepted recommendations from the Productivity Commission to put together discrete, particular aged care strategies for those two populations groups, Culturally and Linguistically Diverse (CALD) Australians and LGBTI Australians, by the end of the year so that those strategies feed into the design and the development of the implementation of the rest of our package.
And we've heard for many, many years now that the residential sector needs to be freed up, to deliver the quantity, the quality and the diversity of care that we need now and we're going to need even more into the future.
Since 2008, we've increased the accommodation supplement by almost 40 per cent and under this package from July 2014 it will increase again by around two-thirds, for significant refurbishments and new builds that happen after 20 April this year.
From 1 July 2014 the last remnants of the old distinction between high care and low care will be removed to allow a single system of accommodation charging for non-supported residents for the first time. Providers will be able to offer additional services and additional amenities for the first time to those residents who choose to take those up.
And both residents and providers will have confidence that the accommodation charge that they are receiving or paying, depending on their perspective, will for the first time reflect a reasonable return on the investment that the provider is making.
Older Australians did tell us clearly, though, that they did not want more means testing of their family home or their principal residence. So we did not accept the Productivity Commission recommendation to change existing arrangements around the means testing of the family home.
They told us also that they want a genuine choice about whether or not they pay their accommodation charge in a lump sum or as a periodic payment and so we provided them with that choice.
Many of those questions, particularly around the redesign of the accommodation charging arrangements for residential care, will be developed over the coming few months by the Aged Care Financing Authority, the membership of which I announced last week.
The touchstone for me about those accommodation charges and for our policy is that providers will be able to receive and will be guaranteed by the Aged Care Financial Authority a reasonable return on their investment.
What a reasonable return is won’t be determined by me, it's going to be developed by the Aged Care Financing Authority based on draft operating guidelines that I'm releasing today and which will be finalised after consultation with the sector by 31 October this year.
For the first time, modelling about these issues, the modelling and the advice delivered by the Aged Care Financing Authority, will be public and transparent, published on the aged care website.
Broader reforms, beyond just the financing arrangements, will be monitored by the Aged Care Reform Implementation Council as was recommended by the Productivity Commission. I'm very pleased to say that Peter Shergold, one of Australia's leading public service and public policy figures, has agreed to chair the Reform Implementation Council and, as you know, is speaking to us in a very short while.
This is a very complex, multi-layered policy and it has many implementation challenges, but I'm confident that it has strong community support; not because of the work we did in writing it, but because of the clarity with which older Australians, their families and the sector more broadly told us what they thought the detail of this reform plan should be.
The only public research I've seen about the policy indicates strong support. Research done by EMC indicated that only seven per cent of people polled disapprove of this policy while 61 per cent approve.
More importantly, from my perspective, the target groups have even stronger levels of approval. People asked between the ages of 55 and 64 indicated their approval at 78 per cent. People over 65 indicated their approval at 71 per cent.
This is a package whose time has come. People who've been working in the sector for years have been wanting meaningful reform of aged care since at least the 1990s.
But This is not the final word on the matter. In five years' time there will need to be a very significant review to consider whether we are able to take even further steps to consider the entitlement model that the Productivity Commission and I know many of you want to see become the centrepiece of the aged care system in due course.
But for the moment there is a lot of work to do, just to get this implementation detail right.
Thank you very much for coming along today. I look forward to some very gentle questioning over the next 10 or 15 minutes.
For more information, contact the Minister’s Office on 02 6277 7280
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