ALI MOORE, HOST: Sam Rae is the Minister for Aged Care and Seniors. Sam Rae, welcome to Drive.
SAM RAE, MINISTER FOR AGED CARE AND SENIORS: Thank you for having me, Ali.
MOORE: I know that you heard those two little examples that we gave you. How do you think the system is working?
RAE: Well, as we've said throughout this generational reform process, we want every Australian to be able to access safe, dignified and high-quality aged care. And of course, assessments are a critical component of making sure that people can get the care they need when they need it.
Unfortunately, under the old assessment system that was not the case. In fact, in some cases, people were waiting up to 10 months in order to get their aged care assessments. And by the time the old system wrapped up there was about $4 billion in unspent funds that were left sitting in people's accounts from over-allocation for some people. And the flip side to that, Ali, is that that's $4 billion that could have been spent on other people getting the care that they need. So, that's why this reform has been so important.
We need our assessment system to be fair, we need it to be efficient, and we need it to be accurate. Our wait times for assessments are now down under a month consistently. We're making sure that we're distributing the resources for aged care across all the people that need that care. And as I said, the fairness component is at the core of this to make sure that older people can get the care they need when they need it.
MOORE: How many complaints have you had about the Integrated Assessment Tool?
RAE: Well, there's an ongoing discussion but there's also a lot of misinformation about the Integrated Assessment Tool, Ali. The Integrated Assessment Tool has actually been in place since-
MOORE: Sorry, can I just, Minister, can I just interrupt? Can you just answer the question first, though? Have you had a lot of complaints? I mean, my understanding is you've had hundreds.
RAE: So, there's a process of review. Let me explain how it works, Ali, and we can get to the question that you're asking, I think, in the way that you mean to. The way the Integrated Assessment Tool works is, firstly, it's in place since 2024. And it's a very sophisticated process, it was developed based on data from 20,000 assessments, and it had a very strict and robust governance process in place.
What happens when you request an assessment is a qualified aged care assessor assesses you for your clinical needs and that's always a human being, and they input the data that they collect through that clinical assessment into the Integrated Assessment Tool. The part that is automated, and this is the part that people don't understand, is the automated application of the Aged Care Rules. And the rules have to be the same for everyone and they have to be applied equally to everyone - it's a critical part of making sure that the system is fair. Once that happens, there's then a delegate, an assessment delegate, who signs off on the classification and prioritisation of the person.
Now, to the point that you're asking, if someone is unhappy with the outcome of that, there's a process in place where they can request a review of their assessment. And we've had 800 requests for review out of 180,000 assessments - that's less than half a percent of the total number of assessments that have been completed since November, Ali.
MOORE: Just with that process of review, though. My understanding is you write, you ask for a review, and then I think there is three months, a three-month period to get an initial response. And the point that's been made to me is that people will be dead by the end of the three months. I mean, is that an appropriate process of review? I take your point, it's a small percentage, but that small percentage still represents a lot of people who are in a lot of pain. So, is three months an appropriate time period?
RAE: There's a 90-day maximum for completing that process, Ali. But as I said, we want people to get assessed more often so that we can adjust the care that they're receiving in order to meet their needs. When assessment times were out to 10 months, obviously that wasn't possible. We've now got assessments under a month.
So, people can be assessed pretty regularly and make sure that the care that they're afforded meets their needs at any point in time. In terms of that very small percentage, that half a percent that requests a review, those are completed within that 90-day window.
MOORE: So, when you get situations like Gaynor and her husband – and you heard what Gaynor said – essentially they did have 14 hours with a carer each week. And as you heard Gaynor say, she was unable to get her husband out of bed on her own, so that essentially covered getting him in and out of bed every day. It went through the new assessment tool and they've ended up with nine and a half hours a week, so there are days of the week where her husband simply can't be assisted to get out of bed. How is that good?
RAE: Well, firstly, I was really distressed to hear of Gaynor's distress and that Graham wasn't getting the care that he felt that he needed. And perhaps I'd ask of you that you pass along to us their details, because I'm happy to follow up on that directly. But one of the key principles of fairness within the system is that you can't go backwards. So, I'm not quite sure about what the specifics of that situation were and I'm happy to follow up on them. But a key principle of fairness in this is that once you are afforded a budget level within the home care system, it doesn't matter how many assessments you have you can't go backwards from there.
MOORE: So essentially, you're saying what's happened to Gaynor really couldn't have happened, because she had 14 hours and she ended up with nine and a half?
RAE: No, no. I don't want to reflect on- I'm not across the details of that situation.
MOORE: Well, I think the issue is the costs of increase. So, the budget may have stayed the same but she gets less for the same price because costs have gone up.
RAE: Well, that would be a different issue to what you've alluded to here - she hasn't been assessed for a lower budget then. But there have been price adjustments because we've put in place some consumer protections. So, under the old system-
MOORE: Well, that does amount to being assessed for lower care, doesn't it? I mean, maybe the budget hasn't changed, but you don't do it just on money. You do it on what that money buys.
RAE: No. Respectfully, Ali, that's not the case and that's not quite right. What we have done is under the previous system, up to about 35 per cent of people's care budgets were being spent on administrative costs rather than direct care for them. And then on top of that, there were also transportation costs being attributed for each block of care that was being delivered.
We’ve stripped out the transportation costs, they have to be included in the service price, and we've put a cap on the administrative costs at 10 per cent. So, there have been price adjustments on an individual service level but, overall, people should be able to purchase the same level of care through their packages.
MOORE: You're listening to Sam Rae, he's the Minister for Aged Care and Seniors. Sam Rae, can I just ask you about - and I understand your point about fairness, which is why you've introduced this Integrated Assessment Tool. But when you're talking about aged care, can any sort of assessment tool that's based on an algorithm, which is based- even if it's based on your rules and regulations, can it really be an accurate reflection of the situation? Every single older person has got different complexities, different requirements, lives in different circumstances.
RAE: You're very right about that, Ali. The Integrated Assessment Tool is based on the clinical assessment that the trained assessor conducts. Most of those happen face to face, there's a small number of them that happen via a Telehealth call where people are in rural and remote areas, always where it's in the older person's best interests.
But the critical component here is that the assessor does the assessment. They collect all of the clinical data. These very highly trained people. This is not a tick and run type exercise, it actually takes many hours to do. They enter it into the Integrated Assessment Tool, and then there is the application of the rules. And the rules have to be applied fairly to everybody, that’s the critical component here.
MOORE: But what happens if the assessor - who has seen the whites of the eye of the person they are assessing, have seen the situation around their home, have seen the home support that they've got - they put in one set of things and one set of recommendations and circumstances, and the algorithm spits out another - does that ever happen?
RAE: No. Again, I think there's some misunderstanding here, Ali. The clinical assessment is not subject to any automated process. The clinical assessment happens by the assessor. The automated component of the Integrated Assessment Tool is the application of the rules. So depending on the data that the clinical assessor…
MOORE: And that dictates how much money you get, correct?
RAE: Well, once the clinical data goes into the system the aged care rules, which have to apply equally and fairly to everyone, are applied to that data. Then there's a second person, the delegate, who then has to sign off on the allocation of funding.
MOORE: And has that delegate had anything to do with the person who's being assessed?
RAE: No, that is supposed to be a third party. So they go back through the clinical notes. They have access to all of the clinical data that the assessor has collected during the assessment process to make sure that all the inputs are accurately recorded in the system.
MOORE: Minister, I know I've got to let you go in a minute because I can hear the bells ringing in Parliament. But I do have a whole lot of texts of people very much along the lines of this- my 98-year-old mother has been assessed, terrific. We cannot get any provider to meet her assessed needs. And that is sort of a repeated story of different variations. So assessments are happening faster. What's happening with providers?
RAE: Assessments are happening faster. I suspect, obviously not having the detail of that specific case in front of me, but I suspect that concern might relate to the Commonwealth Home Support program as opposed to the Support at Home program. These are different levels of care and home supports that are provided through the Commonwealth system. And we do know that we've got such extraordinary demand within the system that it is putting providers under pressure. It's why we're working closely with providers to make sure that they can continue to expand their operations on the ground and we can continue to recruit the amazing human beings that provide this extraordinary care so that we can meet that growth in demand that comes from an ageing population.
MOORE: Now, I understand that you've actually made some changes, you've amended the way the system works to try and reduce wait times for packages - is that correct?
RAE: Well, I've always said, Ali, that if there are opportunities to improve the system for older people through the refinements, that we will absolutely take those opportunities.
Last week I made some relatively modest but very important changes to what's called the queue rate for some of the priority categories. And that means that people who are assessed, for example, as high priority can be moved through the system a little bit faster. We've always maintained that people who are assessed as urgent receive their packages within a single month. That will continue to happen, it will always happen. Now those people who are assessed as high priority, for example, will receive their package in just a little bit over a month but certainly under two months to try and get that level of care to people as soon as possible when they need it.
MOORE: And the case that I was speaking about earlier with Gaynor and her husband who has MND, and we spoke to MND Victoria. As part of your changes will you be putting MND patients in a higher priority? That is one of the things that MND Victoria want.
RAE: Well, as a part of the clinical assessment process, the assessor makes some decisions about what the needs are of that person, and they then fold into the prioritisation categorisation. So, we will continue to work with the assessors to make sure that they’re doing that in the right way, to make sure that we’re getting the best data into that system so the prioritisation can occur.
As I said, urgent people always receive their package within a month. We’re now making sure, as I said for example, that people who are assessed as high priority, that next level down, that they receive their packages within two months. So, we’ll continue to make sure that at every turn that where refinements can improve the outcomes for older people, we take those opportunities.
MOORE: Any plans to adjust the algorithm, or are you happy with the way the Integrated Assessment Tool is operating?
RAE: I think the Integrated Assessment Tool is doing a good job. It’s a much improved system. As I said, three principles - fairness, efficiency, and of course, accuracy. If there are opportunities through refinements, just like I did last week, to improve the experience for older people I will absolutely take them.
MOORE: Sam Rae, I really appreciate your generosity with your time this afternoon. Thank you.
RAE: Thank you, Ali. Take care.