NADIA MITSOPOULOS, HOST: I don’t reckon there’d be many of you who want Sam Rae’s job right now. He is the Aged Care Minister, and he’s got what feels like an impossible task, reforming a system to make it affordable, sustainable, and to meet the needs of an increasing ageing population, the likes of which Australia’s not seen before. And those reforms have not necessarily gone smoothly. Now, Sam Rae’s been in town as part of the federal government roadshow. He actually popped into the studio a little earlier this morning and had a chat to me.
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SAM RAE, MINISTER FOR AGED CARE AND SENIORS: Good morning.
HOST: Now, you’ll keep the Commonwealth Home Support Program which provides low-level support for people shopping, gardening, those kind of things, to keep seniors at home, rather than roll it into the new Support at Home scheme. Now, was that a direct result of the complaints you were getting about the cost and the fact that providers were pulling out?
RAE: No, Nadia, it's not. But we have 830,000 Australians who rely on the Commonwealth Home Support Program. It's the biggest part of our aged care system. And as you noted, it delivers those core supports for older people, often when they're entering the aged care system. We're talking things like Meals on Wheels, helping keep the house clean, transportation. And one of the really important ones that people don't often think about is community connectivity, making sure that people have opportunities to stay socially connected. We really value this program. We value what it means to older people, and we value the role that it plays within the broader aged care system.
And that's why Minister Butler and I last Thursday announced that the CHSP would remain a standalone program, that we'd extend the current contracts through to the middle of 2029, so that along with older people themselves and the sector, government would have the opportunity to redesign the future of CHSP and how it interacts with the rest of that aged care system.
HOST: What's the extra cost of keeping it?
RAE: We’ll announce the costs through the MYEFO process. That's the usual way that we do that. As you pointed out…
HOST: But it will cost more than you planned?
RAE: Well, we've got explosive growth in demand, Nadia. So disentangling the policy decisions from that demand growth is really challenging. Nevertheless, what we do know is that demand for CHSP services is very, very high. And in some parts of the country, services are already struggling to respond to that level of demand. We needed to get certainty about the future of the program, so that we can think about how we fund it and what the costs of funding it are.
This year the Federal Government will invest $47 billion in aged care, and within the next couple of years, that will go beyond $50 billion. This is one of the fastest growing expenditure items in the Federal Government's budget. We need to make sure that we're getting value for money for taxpayers, as well as delivering on our promise to older people, that they will be able to access safe, dignified and high quality aged care services.
HOST: And what about Support at Home? Because you are trying to keep people in their homes. What are the wait times at the moment?
RAE: So, the wait times have been coming down across the board for Support at Home. They differ depending on the priority allocation that people get. People who are classified as urgent priority, they always receive their packages of support under a month. Those that are classified as high, that's about 1 to 2 months. And then as you move up towards the standard priority, the wait time can be about 6 to 8 months depending on the availability of care within the system.
There's 2 sort of constraining factors here, Nadia. One of them is, of course, the financial considerations. The other one, though, that people don't talk about enough are the workforce constraints on the aged care system. It's a tough job. And for a long time, they've been underpaid. We've invested $18 billion over the last 4 years to bring workers' pay packets up to parity where they should have been paid in the first place. That's one step in the right direction.
HOST: So, given the challenge of getting the workers to help these people, what is the waitlist at the moment? How many are waiting for care at home and how much could that grow by?
RAE: The national priority system – I think that's what you're referring to here. That's the system that the Federal Government uses to understand who is waiting for some care or additional care to what they're already getting under the Support at Home system. That number is about 100,000 people at the moment.
However, I just want to make this point, Nadia. We are going to have waitlists because of the demand growth. My focus is actually not the waitlist, it's on the wait times. That is actually the impact on older people and their experience within the system. The waitlist itself is largely irrelevant to a grandparent or a mum or a dad who's awaiting care. What really matters to them is the time they have to wait from the point at which they're assessed and approved for a particular level of care and the point at which they receive it. So, our focus has been on driving those wait times down. That’s what we’re focusing on at the moment.
HOST: On 102.5 ABC Perth and WA, you’re listening to Sam Rae, who is the Aged Care Minister, who's been in Perth for a couple of days and has dropped by the studio. That brings me to your controversial algorithm. Now, families, assessors, clinicians, even some Labor colleagues, did tell Four Corners the system is failing and the algorithm needs to be scrapped and you need to start again. Is it time to accept defeat on that one?
RAE: Nadia, what you're referring to is called the Integrated Assessment Tool. It's part of the Single Assessment System, which was obviously a key recommendation of the Aged Care Royal Commission. And I just want to go back in history so we can explain to people how we got to the point that we're at...
HOST: We kind of do know the history. I guess what people are asking was the concern that you couldn't override the final decision. What changes will you make or would you scrap it?
RAE: Respectfully, Nadia, part of that history is relevant to where we're at now. Because under the old assessment system, older people weren't getting the care that they needed. Wait times were sometimes as high as 10 months just to get assessed for care. We had very significant error in terms of the quality of assessments that were occurring. And ultimately what that was leading to was a very unfair situation where older people weren’t getting assessed by the same criteria. We needed to implement a system in accordance with the Royal Commission recommendation that was fair, that was efficient, and that was accurate.
The way that the assessment works is the qualified assessor – this is a professional, highly trained assessor comes usually to the home. Some assessments are done over the phone, but most of them are done in the older person’s home, ideally with a support person, with the older person that's being assessed as well.
That subjective clinical data is entered into the Integrated Assessment Tool, and this is the part where people are a little bit confused and that is causing some anxiety. The Aged Care Rules, they are then applied in an automated process against that clinical data. Now, the reason that we have to do that is because everybody has to play by the same rules. If we want to have a fair system, if we want to have an accurate system, we need to make sure that everybody is being assessed under the same rules.
HOST: Okay, but the concern is that some people were left worse off.
RAE: I've made a number of changes already to the Integrated Assessment Tool and I will continue to make whatever changes that we determine are necessary to get the best outcomes for older people. And perhaps I can answer your question?
HOST: The review process?
RAE: You're quite right, we're running a rapid review process at the moment, a 3-month rapid review on the priority component of the Integrated Assessment Tool. There's a number of elements of the Integrated Assessment Tool and the new Single Assessment System that are working much better than the old assessment system. That's a good step in the right direction. However, there remains room for improvement. And I have been dissatisfied, and I've said this publicly over a period of time now, with the way the prioritisation mechanism works. So we're doing this 3-month rapid review, I'm awaiting those findings in the coming weeks.
We've made changes to the queuing rates within the NPS in order to make sure that people are getting their care sooner. We've introduced the MND priority pathway so that people who are living with Motor Neuron Disease are prioritised within the aged care system. I have flagged and announced publicly, looking at an escalation pathway that I would like to work across the Parliament with the other parties, particularly the Liberal-National Coalition, as the other party of government within the Parliament, an escalation pathway for the number of people, the very small number of people for whom the Integrated Assessment Tool doesn't fully capture their complex circumstances. I want to have this escalation pathway where they can have another process by which their care needs are more appropriately determined.
HOST: Okay. Can I look at residential aged care now? Australia needs 48,000 aged care beds over the next 5 years. That'll mean probably $26 billion worth of land and buildings alone, let alone dealing with the beds. That seems like it would be impossible to achieve. Is that right?
RAE: They're very, very big numbers, Nadia.
HOST: Huge numbers.
RAE: Very big numbers. We look at needing about 10,000 new beds a year of residential aged care coming online, just to break it down a little bit more. The last measured year, which is the financial year before last, we haven't got the verified numbers for the financial year just past yet. But that last verified number was about 800. So we are a long way short as a community and as an aged care sector of meeting that uptick in demand.
HOST: And then you look at, break it down again, you've got a 95% occupancy rates at the moment in residential aged care, but more than 60% of aged care homes operate a loss. So who would invest in aged care?
RAE: It's a very challenging question. The way the Government is approaching this is to work really closely with the sector across the country. There are different drivers for the investment challenge in different parts of the country. And here in Western Australia, one of those key drivers that is somewhat exacerbated as compared with the rest of the country is construction costs, for example. Every part of Australia has its own unique circumstances, so we need to look at each area and understand what is preventing the investment from the sector.
Over the last 4 years since we were elected, The Federal Government has invested more than a billion dollars in our Aged Care Capital Assistance Program. That's a grant-based program working with providers who have projects that we can bring beds online as quickly as possible. We've also been working very closely around some of the accommodation economics, respectively the earnings that providers can generate from their operations.
Here in Western Australia, we've invested $125 million just in the last few years in capital investments to unlock some of that non-government investment along the way. You might know that in the coming weeks, I'm also going to announce the outcome of our most recent capital assistance grants here in metropolitan Perth. It was 1 of 4 hotspots nationally that we identified that needed additional funding, and so we put aside another $115 million …
HOST: Do you know how many have applied for those grants?
RAE: We haven't made that as announcements yet, as you'd imagine, there's an appropriate process that's at arm's length and done by the department, so I don't want to predicate any of that. But we know that there is significant demand here.
We've been working really closely with the Western Australian Government as well, and I give them great kudos, they deserve it. They have been a really constructive partner in trying to work through some of these challenges. And I really commend the Premier and Minister McGurk, around some of the initiatives that they've taken. I particularly am watching very closely the rollout of their low-interest loan program within the aged care space. And I think the Time to Think beds program is a really significant development in terms of the way that we think about transitioning people from acute care into residential care. So I'm looking really closely at that as well.
HOST: That was Sam Rae, the Aged Care Minister.