Transcript – Reforming in-home aged care and regulation update

Transcript of the webinar on 31 August 2022, covering updates on reforms to in-home aged care, the new Aged Care Act and regulatory arrangements.

1:59:49

Presented by:

Moderator:

  • Michael Lye, Deputy Secretary, Ageing and Aged Care Group

Speakers:

  • The Honourable Anika Wells Minister for Aged Care and Minister for Sport
  • Dr Nick HartlandFirst Assistant Secretary, Home and Residential Division
  • Mel Metz Assistant Secretary, Legislative Reform Branch
  • Julia Atkinson Director, Support at Home Reform Branch
  • Gillian Shaw Assistant Secretary, Harmonisation and Regulatory Strategy Branch
  • Josh Maldon Assistant Secretary, Choice and Transparency Branch
  • Ros Bauer

[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Reforming in-home aged care and regulation update’, ‘Michael Lye’, ‘Deputy Secretary, Ageing and Aged Care Group’, ‘Dr Nick Hartland’, ‘First Assistant Secretary, Home and Residential Division’, ‘Mel Metz’, ‘Assistant Secretary, Legislative Reform Branch’, ‘Julia Atkinson’, ‘Director, Support at Home Branch’, ‘Gillian Shaw’, ‘Assistant Secretary, Harmonisation and Regulatory Strategy Branch’, ‘Josh Maldon’, ‘Assistant Secretary, Choice and Transparency Branch’, ‘agedcareengagement.health.gov.au’, ’31 August 2022’]

[The visuals during this webinar are of each speaker presenting in turn via video, with reference to the content of a PowerPoint presentation being played on screen, and Auslan interpreter signing on screen]

Michael Lye:

Good afternoon. Welcome to our Reforming In-Home Aged Care and Regulation Update webinar. I’m Michael Lye the Deputy Secretary for the Ageing and Aged Care Group in the Department of Health and Aged Care.

I’d like to start today by acknowledging the traditional owners and custodians of the lands on which we’re meeting wherever you may be today in Australia and I want to pay my respects to Elders past, present and emerging. I would also like to extend a very warm welcome and acknowledgment to any Aboriginal and Torres Strait Islander peoples who are joining us here on the webinar today.

I’m really pleased to see so many people attending the webinar. It’s great to see the level of interest in the new program and it demonstrates your commitment to engage and work with us as we seek views ahead of the final design of our new in-home aged care program to start in 2024. The Department is keen for your continued involvement in reform consultation and we are working hard to provide those channels for you to participate. The Ageing and Aged Care Engagement Hub provides all the current activities you can be involved with in the reforms to help drive change in aged care in Australia. We can provide that link if you’re not familiar with it already and other information at the end of this webinar. So please keep looking at the Hub, stay involved and keep engaging with us.

To begin today I’d like to play you a short video from the Minister for Aged Care and Minister for Sport the Honourable Anika Wells and she’ll be followed by Nick Hartland. Thanks.

[START VIDEO PLAYBACK]

The Honourable Anika Wells:

Good afternoon and welcome to the Department of Health and Aged Care’s Reforming In‑Home Aged Care and Regulation Update webinar. I’d like to acknowledge the Ngunnawal and Ngambri people who are the traditional owners of the land on which I’m speaking from today and pay my respects to their Elders and to all First Nations people taking part in this session. Thank you all for joining us today.

I’m not surprised by this level of interest. People resoundingly tell us that they want to stay home for as long as possible so it is imperative that reforms to in-home aged care bring genuine improvements for older Australians in both the short and long term.

The Royal Commission into aged care quality and safety report challenges us to create a better aged care service and a better standard of care for older Australians. The Albanese Labour Government is committed to meeting this challenge and delivering security, dignity, quality and humanity in care for every older Australian across our aged care system. When it comes to in‑home aged care there are three issues that come up again and again and again. Waiting times, excessive administration costs and insufficient access to support.

The In-Home Aged Care Reforms will ensure older Australians are able to access high quality aged care where and when they need it. More than one million Australians rely on aged care in the home today and throughout the pandemic people have depended on those services more than ever. Today you will hear from the Department on where they are up to on the reform journey, from the establishment of a new Aged Care Act to a new In-Home Aged Care Program through to progress on regulations and review of quality standards.

In July I announced the Government would return to the Royal Commission’s recommendation of delivering a reformed and improved In-Home Aged Care Program by July 1st 2024. We did this because we know that aged care reforms must be done once and they must be done well. We will use this extra time to listen and work with you, the people who access aged care and the people who deliver it, to address your concerns. That’s why activities like this webinar are crucial. Over the coming months the Department will be listening and engaging with older Australians, their families and carers, workers, their advocates, the providers to do everything that we can to achieve better in-home care.

Rest assured no one will be left behind or lose any services they currently have in place through the Commonwealth Home Support Program or through the Home Care Packages Program in this new timeline. If anything with more than $9.5 billion in funding this financial year going towards in‑home care and support older Australians should see real improvement before July 2024. An additional 40,000 home care packages will be available this financial year. We will increase goods, equipment and assistive technology funding this year by $25 million and expand access to the home care recipients most need. The new Aged Care act will be central to delivering on the Royal Commission’s vision of a simpler, fairer aged care system.

Though the task of reforming aged care will take years we have taken the initial steps by passing the Royal Commission Response Act. The Government has introduced a second piece of legislation to the Parliament, the Aged Care Amendment Implementing Care Reform Bill 2022. I note that first Act was the first Bill to go through the new Parliament, the very first one. That is the priority we place on aged care in this new Government. And it will build on the five elements of our aged care election commitments which include requiring a registered nurse on site and on duty 24 hours a day seven days a week in residential aged care, capping administrative charges and banning exit fees in home care and greater transparency.

With the return to the July 2024 timeframe we have a genuine opportunity to make the changes needed to help people remain independent at home as they age. I urge you to keep participating and engaging with us. I look forward to working with you on the reforms and talking to you again soon. Thank you.

[END VIDEO PLAYBACK]

Unidentified Female:

Nick sorry we can’t actually hear you.

Still don’t have you.

Sorry guys. We’ll just fix this technical issue.

Dr Nick Hartland:

Sorry. Operator error there. Excuse me. So let me start again. So thank you very much Minister Wells for that introduction and thank you to Michael for starting procedures. I’m Nick Hartland from the Home and Residential Division. I’ll be joined today by Mel Metz from the Legislative Reform Branch, Julia Atkinson from the Support at Home Branch, Gill Shaw from the Harmonisation and Regulatory Strategy Branch and Josh Maldon from the Choice and Transparency Branch and they’ll all introduce themselves in more detail when they give presentations to you.

We’re also welcoming our Auslan presenters here to assist us with today’s proceedings. If you like live captions there’s a link that the event reminder would have included that you can use to get those. Just before I throw to Mel who’ll be our first speaker just a couple of questions. As the slide shows the webinar will be recorded and uploaded on the Department’s website within a week. We will also be taking questions and we’re keen to hear questions because that gives us a good feel for the issues that the sector is worrying about. So you can ask a question of me or any of the panel members at the end of the webinar.

To ask a question what you would do is use the Q&A tab on the lower right hand corner of your screen. Just type it in and hit return. That will then be relayed to us. We will do our best to get through as many questions as possible but this is actually one of the largest webinars we’ve had so it’s very unlikely that we’ll be able to answer all of your questions today. So if your specific question isn’t answered please be understanding and we look forward to hearing from you.

So now just in part to make sure that we get as much time for questions as we can I’ll throw to Mel who will provide us an update on the Aged Care Act.

[Visual of slide with text saying ‘Legislation Reform’, ‘Mel Metz’, ‘Assistant Secretary, Legislative Reform Branch’, ‘1. New Aged Care Act – overview’, ‘2. Scope of the new Act’, ‘3. Current legislative amendments’, ‘4. Next steps’]

Mel Metz:

Thanks very much Nick and thanks everyone joining the webinar today for taking the time to join us for an update on aged care legislative reform. I have responsibility for the Aged Care Legislative Reform Program which includes both amendments to current legislation and delivering the new Aged Care Act. Today I’m going to talk you through four things. The rationale for why we’re developing a new Act, some of the foundational issues that we’re working on in relation to the new Act, our progress state on legislative reform and our broad schedule for developing the new Act.

So why is it that we’re developing a new Act? As many of you know a new Aged Care Act was the first recommendation of the Royal Commission. Recommendations 2 and 3 relate to the rights and principles to be included in the new Act. Commissioner Briggs said in her opening statement to the final report that a new Aged Care Act is needed which is based around the support and care needs of older people and their right to high quality and safe care. For too long legislation has focused on the funding requirements of aged care providers rather than the genuine care needs of older people.

In addition to the first three recommendations more than 50 of the 148 Royal Commission recommendations require supporting legislation to be implemented. Many of the other reforms are also going to indirectly rely on legislative changes or will be impacted by those changes. Some of the changes recommended by the Royal Commission are also very significant structural changes. That is they aren’t easily facilitated by amendments to the existing legislation. The design of a new in-home program and new regulatory model which Julia and Gill will speak to you about are both significant structural changes which would be difficult to facilitate within their current legislative framework. There are also cross-system issues that over time have been included in the legislation with one aspect of the system in mind. Some examples of this are information gathering powers, substituted decision making and representative arrangements and reporting requirements.

Starting from scratch with a new Act will allow us to streamline some of those cross-system issues which have arisen so that we can bring together one aged care system rather than the fragmented parts of the system that exist in the current legislative framework.

It’s also relevant that the current Aged Care Act has been amended by 67 different Bills since it commenced in 1997. Actually that’s now 68 given we’ve just had another Act passed through. Amendments since that time have responded to the policy issue of the day and the result is that we have quite piecemeal legislation. Some of my team describe it as Frankenstein legislation. Sometimes the definitions don’t match up across the principles and there are many different definitions of staff member and worker which is a good example of how the legislation has evolved over time.

Through the new Act we can address some of these technical issues that have arisen over time as well as the significant structural changes that are occurring within the aged care system. The Royal Commission’s observation that the current framework is about funding was correct. At the time the 1997 Act was introduced its primary intention was to fund nursing homes and that’s evident from the objects of the 1997 Act which start with ‘The objects of this Act are as follows – to provide for funding of aged care’. The new Act will still need to set out how aged care is funded but the primary focus of the legislation is going to shift to focus on providing aged care services to the people who need them.

It's also important to note that the new Act is going to replace both the Aged Care Act and the Aged Care Quality and Safety Commission Act. The Royal Commission wasn’t explicit about this but it can be implied from a number of the recommendations. All of the existing subordinate legislation is also going to need to be redrafted to fit into the new legislative framework and that’s currently over 900 pages of legislation.

The Royal Commission recommended a new person-centred rights-based Aged Care Act to underpin reforms and provide universal entitlement for older Australians to access aged care services they are assessed as needing as well as greater protection from mistreatment, neglect and harm. The intent is therefore for the new Act to provide a legal framework that formalises access for older Australians to an aged care system that is focused on their needs and delivers dignity, care and respect. A new model for support at home and new way of regulating providers will form part of the new Act. Many parts of the existing system will also be in the legislation, for example residential care. But you can expect to see a shift in emphasis. For anyone who’s ever taken the time to look at the current Aged Care Act approval of aged care providers is not going to be the first thing you see after all the technical and opening provisions of the Act as is currently the case.

This change of emphasis is more than just shifting and reorganising words. The goal of the change is to shift the focus of the system away from funding providers to instead focus on the following things. The rights of people accessing or seeking to access aged care, a single system entry point with clear eligibility requirements, a fair, culturally safe, single assessment framework, a range of aged care services including newly designed in-home care services, improved transparency and accountability and a new risk proportionate regulatory framework including improved quality standards to drive high quality and safe aged care, clear, streamlined provider obligations and a greater suite of tools and stronger powers for the aged care regulator.

The Act will describe all of these features of the system rather than just describing how money moves around. The Act will underpin systemic change to aged care in Australia but I think it’s important to recognise that not all change will be legislated. Cultural change driven by aged care providers, changing expectations of older Australians, improving systems and delivery and professionalisation of the workforce will all contribute to a better aged care system for the future.

While the new Act is being developed we’ve been working on amendments to the existing legislation to respond to some of the recommendations of the Royal Commission and the Minister touched on these in her opening statement. The Aged Care and Other Legislation Amendment Royal Commission Response Act of 2022 was introduced to Parliament on the 27th of July and it passed on the 2nd of August and it was the first piece of legislation to be passed by the new Government.

The Royal Commission Response Act implements nine time critical aged care measures including a series of reforms that respond to several recommendations of the final report of the Royal Commission. The measures introduced a new aged care subsidy calculation for residential aged care known as AN-ACC, provided a legislative basis for the star rating system which will provide information directly to people accessing care and their families about the relative performance of aged care providers. It introduces a sector wide code of conduct and banning order scheme to ban people who do the wrong thing from working in aged care. It extends the current scheme for reporting serious incidents to in-home aged care services including flexible care delivered in a home and community setting. It strengthens the governance requirements for approved providers, enhances information sharing between regulators in related sectors for example the NDIS and Veterans care. It increases financial and prudential oversight of approved providers, broadens the functions of the renamed Independent Health and Aged Care Pricing Authority to provide pricing and costing advice to Government on aged care and addresses issues with the informed consent arrangements with respect to the use of restrictive practices in residential aged care.

A second piece of interim legislation is the Implementing Care Reform Bill of 2022. It was also introduced to Parliament on the 27th of July and it includes three new measures which the Government committed to implement during the election. These include a responsibility for residential aged care homes to have a nurse on site and on duty at all times often referred to as 24/7 nursing, a power to set a cap on the amount of administration and management fees that home care providers are able to charge care recipients, and a mandatory reporting requirement to enable the Secretary of the Department to publish information about aged care services and approved providers including financial information.

The final slide provides an overview for our timeline for developing the new Act. We’re currently in the early stages of drafting the Bill for the new Act and we’ve been engaging with the Council of Elders and the National Aged Care Advisory Committee as well as other forums to consult and test components of the legislation. Our plan will then be to take an exposure draft of the Bill out for public consultation. Given the scale of the reforms involved with creating a new Act we see this consultation period as important not just to build confidence in the changes that are being made but to stress test the legislation before it’s introduced to Parliament and identify any issues with the way that it will operate. We can then take the time to address those issues during redrafting of the Bill prior to introducing it to Parliament.

By the time an exposure draft of the legislation is made public there shouldn’t be any surprises in the Bill. It’s really important to recognise that the consultation and engagement on various aspects of aged care reform will feed into the development of the underpinning legislation. Above all it will be important to ensure the legislation we’ve developed delivers on the promises of the Royal Commission’s final report and that we have a solid basis for an aged care system that meets the needs of older Australians. Thank you.

[Visual of slide with text saying ‘Thank you’, ‘For more information, please contact the Department of Health and Aged Care’, ‘Email: AgedCareLegislativeReform@Health.gov.au’, ‘agedcareengagement.health.gov.au’, ’31 August 2022’]

Dr Nick Hartland:

So thank you very much Mel. And Mel like all of the other speakers will be around to answer any questions you might have at the end of the session. I’d now like to introduce Julia Atkinson who will be providing an update today on reforming in-home aged care.

[Visual of slide with text saying ‘In-home aged care’, ‘Julia Atkinson’, ‘Director, Support at Home Reform Branch’, ‘1. Where are we up to?’, ‘2. Why reform in-home aged care?’, ‘3. What we consulted on in 2022’, ‘4. What we heard’, ‘5. What’s next’]

Julia Atkinson:

Thanks Nick. Hi everyone. I’m Julia. I’m the Director for Policy in the Support at Home Reform Branch at the Department and today I’m going to provide an update on where we’re at in the process of reforming in-home aged care. So I’ll talk about some of the reasons for the reforms, I’ll give a brief run through of the model that we’ve been consulting on, I’ll go through what we’ve heard in those consultations, and lastly I’ll give you a bit of a sense of where to from here.

So where are we up to? The Royal Commission released its report back in March 2021 and in January this year we published a paper that gave an overview of a proposed Support at Home Program. We ran a public webinar like this one back in March and since then the Department has been talking to a range of people about the proposed support at home model as well as running a small scale trial of a prototype assessment tool.

The Government has now deferred the start date for the new In-Home Aged Care Program to July 2024 and they’ve asked us to consult on changes to the model that was proposed back in January to address some of the feedback and concerns that we’ve heard to date.

So I’ll start by just touching on the why. Why are we looking at bringing these programs together and reforming the current arrangements? So firstly we need to improve access to services. There are wait times for home care packages. These are falling but there are still waits. And there are people who can’t access CHSP services in particular parts of the country very easily. As the population of older Australians grows we need to find sustainable ways to better meet the needs of the community. Part of that is making sure that the funds are used effectively to meet the needs of older Australians.

That brings me to the second point on the slide which is that we want to better align services to needs. Currently there are billions of dollars of unspent funds across CHSP and home care packages that are currently sitting not being used. At the same time we’ve got clients waiting for access to funding and services. We need to ensure that aged care assessments better align services to the needs of older Australians.

In this same vein we need to make sure funding is going to care. And so the reforms will aim to reduce unnecessary administration costs and fees. The reforms should also better support independence at home, for example by focusing more attention on the enabling and preventative support that people might need like goods and equipment and home modifications at the time that those supports can make the most impact.

Finally the reforms should result in a simpler aged care system for older Australians with better information and more transparency. New regulatory arrangements are being discussed today as well and these will aim to provide further assurance on quality and safety.

So as I mentioned in January the Department published an overview of Support at Home the program model which would replace Commonwealth Home Support Program and the Home Care Packages Program as well as short term restorative care. Before I go into some of the feedback that we’ve received on that proposed model I’ll do a very quick tour of what it was. So if you take a look at the slide running from left to right the model we proposed had a new assessment and classification system that would use validated assessment instruments. At the conclusion of the assessment older Australians would agree on a support plan with their assessor and this support plan would specify units of individual services per month. So for example you might see a support plan with eight hours of personal care, two hours of domestic assistance etcetera.

Services would be selected from an approved services list and clients would have some limited ability to swap services around within predetermined categories. People would be able to choose one provider or they might be able to choose multiple providers to deliver their services. Providers would then be paid in arrears based on the services they delivered at a subsidy rate set by Government. And there would be grants to support providers operating in thin markets.

Goods, equipment and assistive technology and home modifications would be delivered through a separate scheme. There would be flexibility for providers to allow temporary or minor increases in services for clients without the need for reassessment and when a client’s needs change significantly at that point they would be reassessed.

So that’s the whirlwind tour of the model that we consulted on.

So in terms of the consultations we ran a lot of meetings and workshops over several months and this slide here gives a little bit of a summary of that. So to talk through it starting from the top right and moving in a clockwise direction, so firstly we ran a small scale trial of the prototype assessment tool and we worked on this with Flinders University. That trial had two expert advisory groups providing advice to us. One focused specifically on Indigenous assessments and the other advisory group looked at the broader assessments across the community. The advisory groups included older Australians, assessors, allied healthcare workers and providers of aged care.

The trial assessed over 200 people and we started with video recorded assessments of actors before moving to aged care clients in the community.

So the second point on the slide was we conducted a survey on a draft service list. And we’ve got a paper summarising the response to that survey. It’s online as of today on the Department’s website so if you’re interested to read that please do take a look.

Thirdly we ran a series of workshops on care management specifically. These workshops included older Australians, service providers and peak bodies. And a paper summarising the codesign group’s proposals will be published on the Department’s website very soon and I’ll talk a little bit more about that later today.

So we also conducted multiple workshops on the proposed funding model with service providers, consumers and peak bodies. We’ve also been conducting visits with service providers to better understand how their business systems work and how they might work with our proposed payment arrangements. Most recently we held a series of codesign workshops on the new goods, equipment and assistive technology and home modifications scheme. These workshops were concluded last week and the team is in the process of pulling together some findings and insights.

In addition we’ve had a series of more targeted workshops and discussions with different consumer and provider groups such as transport, allied health providers, as well as many one on one meetings.

So what did we hear?

So we’ve grouped the feedback into six broad categories and I’ll go through each one of these in a bit more detail but just to summarise, the broad feedback that we heard was firstly the program structures we proposed need to be more flexible in order to respond to the changing needs of older people. This includes care management which can be needed unexpectedly and at points of change or crisis.

We also heard that some service types need more predictable funding than others. We learned that the assessment arrangements need more refinement and we have some work to do there.

We also heard that the proposed goods and equipment and assistive technology and home modifications scheme is broadly supported but we need more time to work through the details.

Lastly pretty much every older person we’ve spoken to has told us we need to do a better job of communicating what’s going on, what is going on and how does it impact on existing clients. And so that’s a core focus for us from hereon.

All right. So I’m going to dive into some more detail on each of these points.

So starting with flexibility. We heard that the approach we proposed is too rigid for older Australians. Our proposal allowed for only a limited swapping of services specified in a support plan with some capacity for temporary or minor top ups. But what we heard was that things can change week to week and people need to be able to adjust their services accordingly. So we’re now looking at options that give people more control over their services and that it can be more responsive to those changing needs.

In terms of the service list we conducted a survey earlier this year on the draft service list which was included in the paper we published in January. We received a lot of engagement on this so thank you. Overall we had 289 responses from older Australians, 342 from informal carers and over 1,100 from providers and professionals. What we heard was that respondents were generally happy with the inclusions on the service list however they recommended that the service categories be removed because they were confusing. We heard that services that older Australians thought were most important to them included cleaning, assistance with self-care, allied health, home maintenance and transport.

So care management. We got some really useful and constructive feedback on our proposed care management model. Our proposed model as a starting point suggested that care management should be funded separately as a monthly service in a support plan for complex clients. So participants in our care management workshops preferred – as a starting point before we get into anything else they didn’t like the term care manager. They preferred the term care partner as this terminology better recognises the role of older Australians in making decisions about their own care. So I’m going to refer to care managers as care partners from hereon out.

While there was strong support for regular check ins by a care partner there was a strong view that there will be times when more support is needed and times when less support is needed. So the model needs to enable people to get surge support and for that to drop off as their needs change.

We also heard that even those in receipt of fairly low level services who are quite independent may and may not regularly need to check in with a care partner, may occasionally need a surge of care partner support.

For more complex clients we heard that clinical expertise is seen as important although people felt there was some scope for a tiered approach and in some cases a client may benefit from the skills of a social worker more than a clinical nurse. So it’s all about tailoring to the needs of the client. Participants also recognised and emphasised that there are other skillsets such as knowledge of aged care, empathy, an ability to develop relationships. These are extremely important for the care partner role.

Finally these workshops talked about the accountabilities of care partners and we talked about what their accountabilities might be in the case where a person decides to have more than one provider deliver their care. What we heard was that technology to enable information sharing could be a really key enabler in this case.

All right. So on to funding. We had multiple discussions with service providers about the proposed funding model and that one being a mix of fee for service payments with in market grants. What we heard was that fee for service payments might be detrimental for particular service types and those included some specialist support services, for example vision advisory, dementia support, can tend to provide more one off or episodic care and that doesn’t fit neatly with a monthly recurrent support plan fee for service model.

We also heard from community transport services who commented that fee for service could have some unintended consequences for them. For example if a service needs to fill a bus in order to pay the bills people who are in out of the way locations might miss out. We also heard that group-based services like cottage respite and group social support can often have unpredictable client numbers week to week. This could make fee for service a bit hard to implement.

Lastly we heard from Indigenous service providers that a fee for service model might be a disincentive to attracting more Indigenous owned organisations into aged care and that flexibility is really important when working with Indigenous Elders who may be reluctant to reveal their aged care needs before they’ve established trust in their provider.

So across each of these areas that I’ve outlined we’re looking closely at whether a greater use of grants might be appropriate.

All right. Assessment. Improved assessment is a key element of these reforms. Following our small scale trial of the prototype assessment tool we have a range of follow up work to do. So firstly we need to make improvements to the tool itself. We need to make it more usable for assessors. We need to do some work on the look and feel of it. We’re going to reorder the questions. We want to improve the wording. We need to enable more pre-population of data. So we’ve got some really good feedback to help us with that.

Secondly we need to do more on developing guidance for assessors in areas like how to use the tool effectively, how to develop rapport with clients and how to ensure cultural safety for all clients undergoing an aged care assessment.

Thirdly the proposed new program will focus on improving early support for people to remain independent. So one area we really need to continue working on is when we want to refer someone for intensive allied health support how do we do that and how do we assess for it effectively, what is the process for allied health professionals to be a part of or advisors to an assessor, and what is the role of the assessor and the allied health professional in that process? We have further work to do on that.

So next the intention remains to have Indigenous specific assessment organisations and we’ll be doing further work with Indigenous stakeholders on the specific arrangements for these organisations. For example in the trial we looked at whether we could conduct an assessment over two visits where appropriate. So for example the first visit might include a yarning session to establish trust and rapport and then the second visit would get into the formal assessment. So we want to do more work in that space.

So finally we have a very important piece of work to validate the service levels assigned to each class. Service levels are currently based on a study of 2,500 clients which examined their characteristics and service usage in the current system. We want to do some further work looking at that and validating it and refining it.

So work to refine the prototype assessment tool and the assessment processes, that will continue this year and we hope to run another trial in 2023.

All right. I mentioned earlier that last week we ran some codesign sessions on goods, equipment and assistive technology and home modifications. So in essence the broad model being developed is that we would have a separately funded scheme for these supports to provide people with fast access to that equipment or home mod that they need rather than the current arrangement which often sees people saving up package funds before they can access these supports.

So we’ve had a lot of discussions with assessors and occupational therapists about that interaction. We want to make sure that we have the OT involved as much as they need to be but we need to make sure that that OT assessment doesn’t create a delay in access to support.

So some of the options that we talked about in our codesign workshops were how can we allow aged care assessors to safely assign low risk items, how can we support them to do that and to do more of it, how can we leverage technology to enable virtual assessments where appropriate, and how can we connect experts to aged care assessors using technology. Another thing we talked about was that the scheme would likely include a loans and refurbishment program. We’re looking at how we could enable automatic equipment upgrades as needed for people with progressive conditions like MND. We’re also looking at how we can ensure higher cost equipment is available for those older people with a disability who might not be eligible for the NDIS.

All right. So that’s the detailed feedback that we’ve had on the back of our paper but in addition to that feedback there are also a lot of other details and practicalities of the reforms that we need to continue to work through. So the Government’s decision to defer the introduction of the new program until July 2024, that provides us with more time to progress this work as well.

One of the things that we want to do more work on is that we know people who currently self‑manage their home care package are looking for some really clear, detailed information about how they might be enabled to self-manage under the new programs. So we’re looking at the moment at developing a bit of a detailed proposition of how we think that might work and our intent is to pull that together and then test it and refine it with older Australians and service providers in the coming months.

On the provider side we know that there are some really specific questions providers have around how payments might be made and how that would interact with their business systems and IT systems. And so we’ve been working with a small number of providers so far to increase our understanding of these systems issues but we want to expand that and we’re planning to run a broad survey shortly to continue with this work.

Obviously subsidy levels and consumer contributions are top of mind for older Australians and service providers and work is progressing in these areas as well.

There are a range of other details to be worked through with stakeholders as well as issues such as regulatory arrangements and we’ll hear a bit more about that from Gill Shaw in the next session of this webinar.

So where to from here? So over the next four months we’ve got a lot to do. We are planning to conduct another round of consultations looking at a revised approach, so taking the model that we put up in January, making some revisions based on what we’ve heard and going out and asking what do you think of this. And we also want to dive into some of the missing details as well. So following this webinar we would look to release a new consultation paper in September and we’ll be looking for submissions in response to that paper.

We also know that we owe existing aged care recipients a session on self-management and we’ve been promising that for a while so we’re going to aim to run a session on that in September as well.

We also want to test some proposed changes to the funding model. So we want to talk to service providers about this too and that’s another one that we’re going to try and fit in to September.

By October we’re hoping to be in a position to test some of the IT arrangements more broadly and we’re also talking to our state and territory network about running some local seminars across the country. Through November we will have seen submissions on the next paper and we’re hoping to be in a good position to run a series of targeted workshops talking about specific issues that are surfaced through that consultation. Then in December the plan would be to have another one of these public webinars and provide you all with an update.

So the current implementation date for 2024. We would expect Government to be looking at decisions about this program sometime mid-23. So that would give us about 12 months for transition and implementation and that’s when we would expect to start talking about that.

So before I close for today I want to reinforce a point made by Minister Wells when she announced the deferral of the program and again today in the video that she did for our webinar and that is that older Australians currently receiving aged care services will not lose existing services under these reforms.

Okay. Thank you for your time. That’s all from me. Thank you very much for your attention and for your continued engagement over the course of this work. So I will throw back to Nick.

[Visual of slide with text saying ‘Thank you’, ‘For more information, please contact the Department of Health and Aged Care’, ‘Email: SAH.implementation@health.gov.au’, ‘Website: www.health.gov.au/health-topics/aged-care/aged-care-reforms-and-reviews/reforming-in-home-aged-care’, ‘agedcareengagement.health.gov.au’, ’31 August 2022’]

Dr Nick Hartland:

Excellent. Thanks so much Julia. I’ll now introduce Gillian Shaw who will be providing an update on the development of the new regulatory model and the consultations associated with that.

[Visual of slide with text saying ‘A new model for regulating aged care’, ‘Gillian Shaw’, ‘Assistant Secretary, Harmonisation and Regulatory Strategy Branch’, ‘1. Why are we designing a new regulatory model?’, ‘2. How do we design the model and consult?’, ‘3. Where we are now in the process’, ‘4. Potential changes’]

Gillian Shaw:

Thank you Nick. And a big welcome to all of you joining us on the line today. It’s certainly great to see so many of you with us. So before I begin talking about my item for today I just wanted to touch on some of the language I’ll be using today and very conscious that sometimes we can begin to use quite bureaucratic or technical language. So I’m going to be very alert to that today and try and explain to you as much as I can so you all can have the same understanding.

So I am going to talk to you about a new model for how we may regulate aged care. And it’s really important that we take you through why we are designing a new approach, how we go about our task of design and how we’re going to consult on it. I want to talk about where we are now up to in the process and talk about potential changes.

So let’s touch on why we are designing a new way of regulating aged care. So as many of us have touched on already today the Royal Commission highlighted many things and in this space one of the findings was that ineffective regulation has contributed to high levels of substandard care in Australia’s aged care system. But as many of you would be aware regulation is one of the main mechanisms Governments use to protect the health and safety of the community and in this context in aged care the ultimate aim of regulation is to protect older Australians from harm.

A well-functioning aged care system needs to be supported by contemporary regulation to ensure services are high quality and safe. However the current regulatory framework does provide some constraints which Mel Metz touched on earlier today. So the current approach is currently one size fits all to regulation. For example the same obligations apply to home care providers regardless of the services they provide. We acknowledge that different services may pose different risks and the obligations should be commensurate with those levels of risk.

We’ve got a number of things up on the slide up there about the constraints of the current scheme and I’ll touch on a few more of those. So currently under legislation only corporations or state and territory governments can be approved aged care providers. It is also recognised that some aged care services need not be delivered by corporations but in fact could be delivered by individuals or sole traders. By opening the market to other suitable providers we believe it will offer more choice to older Australians in gaining access to the services and provide a more sustainable market going forward.

Another constraint of the current regulatory scheme is assessment against standards is the minimum requirement to ensure safety. Currently a provider’s assessment against standards is delivered through a pass or fail status which in our opinion does not provide the incentive to strive beyond the pass or fail and actually strive for excellence or innovation.

An important consideration in designing a new contemporary approach to regulation is seeking to align with other schemes. At the moment the current framework doesn’t allow legislative alignment or harmonisation between other care and support sectors, for example the National Disability Insurance Scheme or services that are provided to Veterans.

Designing a new regulatory model presents opportunities to improve the way aged care is regulated. A new regulatory model is needed to support and enable many of the reforms that you’ve heard about today and this includes what Mel Metz was talking about and fundamental will be the Aged Care Act and what will be underpinning that Act. Also what Julia spoke today. The new in-home care model needs to be supported by a new modern approach to regulation.

My colleague Josh Maldon will soon be talking to you about a new approach to aged care quality standards and this is also an important consideration as we design a new approach to regulation.

I just wanted to touch on our approach to consultation. And I apologise if this slide is a bit small to see but I just wanted to capture our staged approach. So we do have four stages. Stage one has already occurred. So this occurred through the concept paper that we released in February this year and that paper was really touching on high level concepts that we were thinking through about how we may approach a different way of regulating aged care.

We then held a webinar in March which some of you may have attended. Stage two. This is where we’re at right now. So we soon will release consultation paper number one and I was very pleased that the Minister approved this approach this week. So in the coming days we will release a consultation paper that we would really appreciate your views on. This paper outlines a high level picture of the new model and I’ll briefly talk about the content of this paper a little later in my presentation.

Stage three. This will be an important stage of our process where we’ll release what we call more in-depth elements that will form part of the new regulatory framework. So there will be separate consultation papers on those elements such as the registration process and other requirements an regulatory oversight that will apply to aged care providers under the new model.

And stage four will be a very important part of this process where we’ll touch on transition arrangements. So this is a significant change from the current arrangements and we do need to acknowledge the transition that will be required for providers and everyone in the system to move from the current scheme to the new one.

So we look forward to inviting your views to inform the new model through these stages of the consultation process. How you can engage in that will be through online submissions, webinars, workshops and surveys.

Now I wanted to give a brief overview of what you’ll find in consultation paper number one. It has several parts. Parts 1 to 3 are very much about the why that I’ve outlined for you today and how we are going about developing the new regulatory model.

Part 4 of the consultation paper talks about the four foundations of the new model and I’ll take you through those now. I’ll get you to change the slide please. Thank you. So there’s four foundations that are very much fundamental to our approach. So in the new model these are a rights-based approach which Mel talked about in her presentation about the new Aged Care Act. We want to have a person-centred approach to regulation where the needs, goals, values and preferences of older Australians are at the heart of the regulatory model. We want to take a risk‑based approach that is based on a risk proportionate approach and I’ll take you through what that means in a moment.

We also want to have a very important foundation of continuous quality improvement and an ongoing commitment to enhanced capability and quality in the aged care sector.

So as I touched on just before we are referring to a term that we call risk-based but also a risk proportionate approach. So I did want to pause for a moment and explain what we mean when we talk about risk proportionate. So you’ll see a chart here where we’re trying to illustrate what we mean. So it basically means the level of regulatory oversight is relative with the overall level of risk of harm to the individual.

So the slide here provides a useful guide to show what that means. So a really good example that I want to show you today is when we think about garden maintenance if you’re an older person living at home and you’ve sought support and you need gardening that will impose a slightly different risk of harm to you compared to clinical care that you may require in your home. So let’s say you’ve been discharged from hospital and you’ve arrived home. You might have clinical care provided to you by a nurse. So the risk of harm for that service is proportionately greater to that that you would have received when you had a gardener come in and maintain your garden for you.

So taking a risk proportionate approach has many benefits under a new regulatory scheme. It allows the regulator to focus on areas of high risk of harm. It supports providers to direct resources towards getting better quality outcomes for people, enabling innovation and continuous improvement of care. So through doing this approach we believe it will remove barriers to those services or providers who are lower risk and ultimately promoting greater consumer choice and service availability.

In the development of the model risk should be considered from different aspects and certainly we outline these in the slides above. And these include risks associated with care recipients, the nature or product of the service provided and the providers delivering the product or service and how it is delivered.

It is important to note that the risk proportionate approach does not mean there is a reduction in regulatory oversight or a lessening of protections for senior Australians.

It means using regulatory safeguards and tools proactively to prevent risk or harms from occurring, detect the presence or occurrence of a risk or harm and correct issues that present risks of harm or safety to older Australians.

I would like to clarify that the current regulatory framework has preventative, detective and correction functions as well however under the new model we want to make the framework and legislation more contemporary and that means more flexible for the regulator to respond and direct resources to those high risk areas as it deems appropriate to do so. We hope we’ll create a more agile and flexible arrangement for everyone in the aged care sector including the regulator. Next slide please.

So part four of the consultation paper talks about a concept of regulatory stewardship. So what we mean by stewardship is that we all have a role in taking care of our regulation. So this changes the shift a little bit because regulation is not only the responsibility of the regulator to implement but is everybody’s responsibility to help take care of regulation. So we really want to have that as an important message of the future in how we may approach regulation going forward. So it means everybody in the system has a role to play in the stewardship of our regulatory scheme.

So I’ve got some of those people on the slide there today and some of them will be in the audience today. So that includes older Australians, their families and carers, the Government, the regulator, the Department, providers and workers, peak bodies, advisory and interest groups. So under stewardship all stakeholders in aged care are the stewards of aged care regulation and play a key role in maintaining the health of regulation. This involves proactive ongoing maintenance and continued improvement in regulations in line with evolving best practice and innovation.

We believe a whole of system approach is applied which recognise that all parts of the aged care system are interconnected and all stakeholders would work together to proactively collaboratively work to achieve desired outcomes together.

Now I’m going to touch on some aspects that you’ll see in consultation paper number one. And I apologise if the slide up on the screen is not entirely clear but I’ll give you a good summary and then when the paper’s released hopefully you can go and have another look there. But part five of the paper touches on an overview of the regulatory model and really importantly highlights the aim, the objectives, the proposed regulatory tools and safeguards and foundations behind the thinking of the new regulatory framework. Ultimately the aim of the new regulatory model is to strengthen and enhance protections, rights and delivery of services provided to older Australians. This aim will also support the objectives of the new Aged Care Act that Mel Metz spoke about earlier today.

So that aim will be achieved through the following objectives. We want to achieve, strengthen and develop capability of our sector, safeguard older Australians, preventative and corrective actions and have efficient, effective and contemporary regulation.

So of course we want to see benefits come out of the new approach. So we believe there will be benefits for older Australians, their families and carers and support networks, that they will feel better supported and empowered through this new approach to regulation. For providers and services they will be high quality, safe and responsive. For workers this will mean they will be suitable and competent and supported in the care and services they provide. And for the regulator we will be able to direct regulatory effort in the best way to protect older Australians from harm.

So when you go to see the paper you’ll see that we outline four regulatory safeguards that will support the model. So this touches on registration, provider responsibilities, market oversight and engagement and capability building. Underneath these standard safeguards there are 13 regulatory tools which are shown in the picture here on the screen. The consultation paper and accompanying plain English summary guide will explain each of these tools.

I’d like to again clarify that the current regulatory model has most of these tools however under the new model we want to apply them in a more proactive and risk proportionate way to support not only compliance but also innovation, service excellence and continuous improvement.

Fundamental to the new approach under this scheme is that we are proposing that we have a registration model that will replace approved providers. We will work through the details of registration in the next stage of the consultation process.

So up on the slide here is a high level overview of how the regulatory tools will be used to manage risk so that older Australians receive high quality and safe care. So these will be applied across three stages. So of course we have the market entry stage and this is where entry requirements are placed on providers and workers through a registration process to provide Government subsidised aged care services. Then we have service delivery, the delivery of aged care services to older Australians and the safeguards applied to promote the delivery of high quality and safe care.

Then of course at the end of that process at any point in time we have the market exit, so the regulation of registered provider or worker when exiting the aged care sector including protocols and procedures that must be followed as part of that system. Market exit may be of choice or result of an enforcement action.

So part seven in the consultation paper will talk about the transition and outlines a number of transition principles. That is how we will transition from a current regulatory model to a new one ensuring care, business continuity and minimising unnecessary impact on all stakeholders. We will consider transition impacts through the staged design process as well as at the end of the process.

In essence that will be the key content outlined in consultation paper number one.

So I wanted to take this opportunity just to highlight for everyone that we are still working through the details of the proposed changes. We look forward to receiving your feedback and insights on our papers and particularly this first one and sharing more with you in subsequent consultation papers on specific topics over the coming months and early next year. To help us progress the policy development I invite you all to share your views with us on the regulatory model presented in the consultation paper number one. Please visit the Ageing and Aged Care Engagement Hub. Your input will help to inform policy development in the new model.

Thank you all today for your interest in hearing about the new model for regulating aged care. I look forward to answering your questions at the end of today’s session and also look forward to seeing you as part of our consultation processes as we move forward. Thank you very much. Thanks Nick.

[Visual of slide with text saying ‘Thank you’, ‘For more information, please contact the Department of Health and Aged Care’, ‘Email: AgedCareRegModel@health.gov.au’, ‘Website: www.health.gov.au/health-topics/aged-care/aged-care-reforms-and-reviews/design-of-a-new-regulatory-framework-for-aged-care’, ‘agedcareengagement.health.gov.au’, ‘31 August 2022’]

Dr Nick Hartland:

Great. Thanks Gillian. So our final speaker this afternoon is Josh Maldon who will be talking to us about aged care quality standards and after that we’ll have time to get into a question and answer session. Over to you Josh.

[Visual of slide with text saying ‘Quality Standards Review’, ‘Josh Maldon’, ‘Assistant Secretary, Choice and Transparency Branch’, ‘1. Royal Commission into Aged Care Quality and Safety’, ‘2. Quality Standards and Aged Care reform’, ‘3. Consultation to Date’, ‘4. Awareness Campaign’, ‘5. Public Consultation’, ‘6. Promotional materials’]

Josh Maldon:

Thanks Nick. And hello fabulous people. My name’s Josh Maldon and I’m an Assistant Secretary for the Choice and Transparency Branch of the Department of Health and Aged Care. I just want to say I’ve loved your continuing engagement throughout the webinar. You’ve had great questions. I love the energy and we’re going to bring it in strong.

Today what I wanted to talk to you about was to give you an overview of our review of the Aged Care Quality Standards which is just one of the key regulatory leaders of the broader framework Gill just discussed. My presentation’s going to include progress the Department’s made to address the recommendations specifically 19 to 21 of the Royal Commission into aged care quality and safety, the targeted consultation to date with stakeholders within the aged care sector including older Australians, providers, consumer and provider peak bodies and industry experts on opportunities to strengthen these, how these changes are shaping up from a home care perspective and the approach the Department will take to building awareness and promoting public consultation to make sure as many people can have their say.

So if we just go back to what the Royal Commission said, in relation to quality it said that aged care quality needs to be defined, understood, funded, delivered and be capable of being measured. And more broadly it said that the current data about the aged care system is fragmented and incomplete. This results in an inability to determine the extent of substandard care in aged care, a lack of information about service quality to inform consumer choice, provider quality improvement, Government risk-based regulation and also policy development.

In relation to quality standards it said that these are a powerful tool to maintain improved quality of care across the aged care sector however they don’t define quality or high quality aged care. They lack detail and objective measurements. And so they also said that particular focus needs to be given to a number of areas including governance, diversity, dementia, food and nutrition and clinical care. And to improve aged care quality the Royal Commission recommended a comprehensive approach to quality measurement and reporting with three linked elements. Indicators to measure quality, benchmarking for continuous improvement and a star rating system for comparing performance of providers. Importantly the Royal Commission said we need a philosophical shift to move towards an aged care system with older Australians at the centre where the voices of older Australians receiving care are heard to ensure the system is relevant and appropriate for the people it’s intended to support.

So as a first step to inform the urgent review the Department engaged KPMG to do an independent evaluation of the current quality standards to look at their clarity, relevance and the impact they’ve had on quality. It was a really comprehensive process which looked at national and international research and consultation with key stakeholders, again older Australians, providers and peak bodies. We had a total of 1,377 participants complete online surveys and we also had 323 stakeholders across 35 virtual focus groups.

Through the process the evaluation identified additional content was needed in the focus areas identified by the Royal Commission. And so it’s formed the basis of the Department’s review and development of the draft strengthened quality standards.

Importantly from a home care perspective feedback during the evaluation highlighted that many home care providers felt the current standards were too residential focused and not applicable with some of the home care provider service offerings. The KPMG evaluation report will be released in the coming days as part of building public awareness of the upcoming consultation.

So in terms of developing a draft set of quality standards the Department’s been working in collaboration with the Australian Commission on Safety and Quality in Health Care or the Health Commission who has responsibility for setting the clinical components of the standards which was transferred to them in 2021. They’ve also been working really collaboratively with the Aged Care Quality and Safety Commission, the Aged Care Quality Commission, who has responsibility for assessing aged care providers against the quality standards.

Additionally we’ve been engaging with key stakeholders to provider insights and feedback on how quality standards can be strengthened across particular areas. So for example this includes the Alliance of the Willing which is an initiative by the Maggie Beer Foundation on food and nutrition. It includes dieticians and other food expert representatives. We’ve been engaging with the Dementia Expert Reference Group and also a diversity working group.

Engagement with these groups has provided really in-depth and diverse feedback and identified opportunities to strengthen the current quality standards. From a home care perspective it identified the clarity of the expectations of this service setting is absolutely required. Key points of consensus more broadly from these engagements included the need for food, nutrition and the dining experience to be emphasised and protected through the standards as distinct from but alongside the clinical aspects of nutrition. Quality dementia care needs to be intrinsic to all standards and focus on the person not the diagnosis. And similarly diversity must be implicit throughout the standards. The aim of diversity is core business and relevant to every person impacting on everything we do.

Cultural safety should also be emphasised and person-centred care must consider older Australians rich and varied histories but also their life experiences which may include adverse events requiring trauma aware and healing informed care.

In addition we’ve been engaging with people through a sector reference group which includes representatives from a range of providers including CHSP and home care as well as NACCHO and remote and regional service providers, consumer reference groups with older people, consumer peak bodies and advocacy groups including OPAN and the National Aged Care Advisory Council and the Council of Elders.

We’ve been working really closely with the Health Commission and their clinical experts in revising and strengthening the clinical care standard and reviewing clinical issues across a range of things, so oral care, medication management, pressure injury prevention, wound management, continence care, falls prevention, mobility and infection control.

So what can I tell you about the main implications from the revised set of standards for in‑home care at this stage? You’ll know that currently the Aged Care Quality Standards apply to all providers of Commonwealth funded aged care regardless of the risk profile of the provider or the service type. And we’ve heard from you that having the same standards apply to all providers can lead to over-regulation of some providers and under-regulation of others. And so as you’ve just heard from my colleague Gill Shaw as part of the new aged care system Government’s exploring different options for regulating providers. And under that sort of an approach strengthening quality standards could be applied based on the type of services being delivered by a provider.

And I can’t show you the current draft standards just yet. Still need Government approval. But what I can tell you is that they’re comprised of seven standards and what we’re thinking is that all providers would be subject to standards one to four and then some providers would also be required to meet standards five to seven based on the types of services they’re delivering. Obviously Government has sent a really clear signal that they want a dedicated food and nutrition standard and obviously one will be clinical care.

So it’s not anticipated that the quality standards would apply to every aged care provider. In fact in line with other social care regulatory systems what we’re thinking is that providers delivering lower risk services such as gardening and outside maintenance may not be subject to quality standards. But as Gill discussed they would be subject to other regulatory requirements. And then providers of high risk services such as residential care or those providing clinical care, they may be subject to additional standards as relevant to those service types and specific to the risks involved.

To be really clear it’s not about lowering consumer protections or expectations. It’s about better targeting regulation in line with the actual risks to older Australians receiving care and services. It’s important to remember that the quality standards is one of a range of regulatory requirements used to drive provider performance and protect older people. So there will continue to be requirements contained in aged care legislation, checks on entry, incident management, response reporting under SIRS, worker registration and Code of Conduct, new quality indicators. I’d be expecting the star rating system at some point noting again that that would require a Government decision. And then of course other legislative requirements as Mel’s discussed in the development of a new Aged Care Act.

So in addition to looking at a way to provide greater specificity of expectation a review of standards has also been looked to progress Government’s commitment to harmonise regulation across aged care, disability and Veterans care and the revised architecture of the strengthened quality standards does provide a significant step closer to that harmonised state.

So what’s next? We’re preparing for public consultation, a process which will hopefully start in mid-September to test the revised content and structure of the standards. It will include a two week awareness building campaign which will launch very soon and include a variety of information to engage the public audience. It will call for action to participate in the Aged Care Quality Standards consultation. So this awareness campaign will include the release of the KPMG report and a fact sheet so that people can access the high level findings.

There will be a series of promotional videos for both providers and older Australians to engage stakeholders to register and participate in call to action activities such as the launch webinar, focus groups, surveys and submissions. There will be newsletters and fact sheets through various channels including stakeholder communication channels and consumer and provider peak bodies newsletters, certainly through Government agencies. We hope to have national major metro newspaper advertising to get to those people who aren’t digital and also a physical presence at aged care related conferences and expos where we can nationally and of course will be looking at all other opportunities through social media and radio and the like.

So again we hope to commence that six week public consultation around mid-September. The launch will begin with an overview webinar providing some information on the strengthened quality standards, information we provided on opportunities to register to engage with the consultation and provide feedback. Participants will be able to participate in the webinar by submitting questions exactly like this one and what we’ll do is we’ll answer those using a panel.

We’re going to have two public consultation papers which will describe the strengthened quality standards and they’ll talk about the process and the drivers for the change. One consultation paper will be an easier, shorter, read version with a more detailed one available for those wishing to have more information. Through the Aged Care Engagement Hub individuals can register for focus groups which align to their demographics or a specific focus area. The focus groups will be held online and be facilitated to provide opportunity to engage in robust discussion on identified subject matters and through a variety of modes including online surveys, the My Aged Care call centre, hard copy surveys, participants can also provide additional feedback and we’ll accept written submissions through the Engagement Hub as well.

So the Department’s worked to develop imagery and messaging to encourage stakeholders to have their say during the public consultation process. The messaging’s call to action is to encourage participation and have your say because quality aged care matters. It encourages everyone including older Australians to have their voices heard. The message goes on further to highlight that the Aged Care Quality Standards are more than just a document. The standards provide a shared understanding of what is expected in aged care, making quality everyone’s business.

So promotional imagery has been developed for each standard with each speaking to older Australians, providers and the workforce in aged care services. During the awareness and consultation period hard copy brochures, flyers, surveys and fact sheets will be available for the public to connect with various aged care conferences and expos. Representatives from the Department will be available to answer questions, assist with online activities and go through the fact sheets on quality standards.

Again as always the Aged Care Engagement Hub will provide information on registering for quality standards events including webinars, focus groups, national calendar events where Department booths will be present and access to notifications related to the launch of the public consultation period.

So the robust approach to consultation will provide multiple avenues of engagement for all Australians wishing to participate in the consultation period and again provide the Department with really clear insight into how to ensure the strengthened quality standards provides the framework to delivering high quality care to older Australians accessing all types of aged care services. So I really encourage everyone to participate in the public consultation and please have your say because quality aged care matters to all of us.

So thanks for your time today and back to you Nick.

[Visual of slide with text saying ‘Thank you’, ‘For more information, please contact the Department of Health and Aged Care’, ‘Email: QualityAgedCare@health.gov.au’, ‘Website: www.health.gov.au/health-topics/aged-care/aged-care-reforms-and-reviews/royal-commission-into-aged-care-quality-and-safety/review-of-the-aged-care-quality-standards, ‘agedcareengagement.health.gov.au’, ‘31 August 2022’]

Dr Nick Hartland:

Excellent. Thank you so much Josh. All right. So now we’ve got a question and answer session and we’ve been getting 205 questions into us so we’ll do our best as I said to get through as many as we can. And what I’ll do is I’ll read them out and if they’re easy I’ll answer them myself and if they’re not then I’ll ask one of our panellists to step in.

So the first question is:

Q:        Will the Bill include a charter of human rights for senior Australians?

So we might pass that one to Mel.

Mel Metz:

Thanks Nick. So we definitely intend to take a rights-based approach to the new Act. Subject to consultation our proposal is to include a statement of rights in the Act itself as the Royal Commission recommended in recommendation 2. We’re also thinking through the best way to implement rights in a meaningful way in the new Act. We think it needs to be more than just including a statement of rights that doesn’t link to any of the other parts of the legislation or the regulatory framework. So we’re really thinking through at the moment the best way to integrate rights into the Act but in short the answer to that is yes. Thanks Nick.

Dr Nick Hartland:

Thanks Mel. I think Julia you might be next up.

Q:        Can you please confirm which programs the new support at home reform will replace?

Julia Atkinson:

I thought you were going to take the easy ones Nick. Happy to take that one. Support at home is planned to replace the Commonwealth Home Support Program, so CHSP, the Home Care Packages Program, HCP, and Short Term Restorative Care, so STRC. So it’s to bring those three into one place.

Dr Nick Hartland:

Excellent. Thanks Julia. All right.

Q:        Can we expect ongoing audits against the current standards until 2024?

Josh is that one that you’d like to answer or Gillian?

Josh Maldon:

I can speak to that and Gill can come in. But at this stage the current policy and processes will apply whilst we’re looking at developing new models and the standards. They will be subject to Government decisions and implementation timeframes yet to be firmed up.

Dr Nick Hartland:

Q:        Are we going to see a shift in the new regulatory system from a punitive approach towards providers that are trying to do their best to deliver quality care in a reality of many challenges including workforce shortages to a regulatory model that works with providers in a positive way and productive way to help them improve, problem solve and to meet quality standards?

Gillian I think that might be one you might like to take?

Gillian Shaw:

Yeah. And I think it probably touches on Josh’s area as well but yes that’s certainly our intention and particularly behind that principle and foundation that we talked about, about quality improvement and moving beyond the pass or fail current system but creating one where we encourage moving beyond the pass. So I guess we don’t have the answers for that yet and we do hope through the consultation process you’ll help shape how we can achieve such a system. But certainly that it’s front of mind for us and we’re looking forward to shaping what that could look like Nick. Thank you.

Dr Nick Hartland:

All right. So there’s a question.

Q:        With the delay in the implementation of the support at home program what are the plans for the implementation for the single assessment workforce?

And I might make a couple of comments on that. So look people will know this has been an issue the Department’s been working on for some time and has been kind of rebuffed in the whole push and tumble of the political debate. Where we are at the moment is that Health Ministers are now starting to talk post the introduction of the new Government and that’s one of the issues that Health Ministers are raising with Minister Butler. Those conversations happen through pretty formal meetings when the Ministers get together. So what I think will happen is that there will be some discussions at very senior levels through those Health Ministers forums about states’ concerns about assessment processes and what matters to them and what they see as their role in the system, and out of that then I expect that Minister Butler will ask me and some of the other people that work on support at home to have some discussions with state officials about where we might take streamlined assessment.

But getting a better assessment service and one that works better for consumers is still very important to the Commonwealth but the first step is to let the Ministers have their discussion.

So anyway. And I did see that there are a number of questions about assessment. I hope that covers all of the assessment questions. All right.

Q:        Will the subordinate legislation be made public before any consultations on the main Bill?

I think Mel might want to have a crack at that one.

Mel Metz:

Thank you. So the way we work when we draft the legislation is we start with the primary legislation and then we move into the subordinate legislation. So it definitely won’t be public ahead of the Bill for the new Aged Care Act. And I mentioned in my presentation that there are 900 pages of subordinate legislation at the moment and we need to work through all of that and make sure it fits into the new framework. So my hope is that when we go public with the Bill for the new Act we can release some of the subordinate legislation but just given the volume of it and given a lot of it’s going to be rewriting existing stuff it’s likely that it will be released progressively possibly even while the Bill is before Parliament. So it will be over time, definitely not ahead of the Bill.

Dr Nick Hartland:

All right. Thanks. This one might be for Julia.

Q:        Will HCP care recipients lose any unspent funds being held when they transition to the Support at Home Program?

Julia Atkinson:

Thanks Nick. Good question. No. The intent is to retain all the current entitlements for clients who are currently in the program. So per the slide that I reiterated all current care recipients will retain their existing entitlements.

Dr Nick Hartland:

Thanks Julia. All right.

Q:        Currently there is no rating system for home care package providers to help us choose the right provider for our loved ones. Will there be a rating system where users can rate providers to help others similar to Google rating?

Josh I think that might be one you could have.

Josh Maldon:

Yeah. I’m happy to speak about that. So we are committed to delivering star ratings for residential aged care by December 2022. We would require decisions by Government to expand that across to home care but certainly from a broader policy perspective we are looking to create an end to end aged care system. But again that’s subject to decisions by Government.

Dr Nick Hartland:

Thanks Josh.

Q:        Will all providers need to be registered?

Gillian?

Gillian Shaw:

Yes is the answer. And I guess now we’re opening up the market that would include sole traders, so a physiotherapist who happens to decide to provide services in that way. Yes we will require all people to be registered to provide services.

Dr Nick Hartland:

This next question was also raised a couple of times and I was monitoring all the questions as they came through.

Q:        Will there be changes to the current arrangement of consumer contributions and income tested fees that consumers are required to pay?

I might have a crack at this and see if Julia wants to add anything. So look my perspective on this, we do have two different systems for CHSP and the Home Care Package Program, so there’s obviously an issue that we need to look at. But I think the perspective I would take on this is that we need to sort of settle the basic design of what we’re intending to do first and then think about what impact that has if any for the existing consumer contributions frameworks across those two programs. So that’s kind of where we are. I think that’s a longwinded way of effectively saying that yes we are yet to do some work on that but the priority for us is to get the kind of basic how is this going to work, what’s the model that the sector in the broad thinks is the best model for a future Support at Home Program and then you come to how does that work with consumer contributions.

Q:        What progress is being made to review the alignment of regulation across the carer support sectors and what work is planned to reconcile the significant system design issues around the interface between aged care and the primary and tertiary health sectors?

So Gillian you might like to start that but I’d be delighted to hear if you have an answer for the primary and tertiary health sectors. But after you get to the end of your answer then we’ll throw it open to the panel.

Gillian Shaw:

Thanks Nick. Certainly I think a strong I guess flavour of what we’re doing and certainly a principle is we’re very mindful of establishing a new regulatory scheme that aligns more appropriately with the NDIS where it should, recognising that in some situations that might not be appropriate but certainly there’s a principle there. We don’t want to create unintended consequences for providers and also for those accessing services where we’ve created a brand new scheme that really creates difficulties for service providers who we understand there’s 60% of service providers who do provide not only aged care services but also disability services. So certainly there’s a principle that we’re taking into account to modernise the way we regulate aged care and certainly working very closely with our NDIS regulator and DSS colleagues about how to progress that.

On the acute care – I think it was primary care interface wasn’t it Nick? Good question. Our relationship – also I think there’s a link here to how Veterans receive care as well and certainly very mindful of getting that alignment there. But in terms of primary care, no that’s not on our agenda just right now but we are mindful that that’s really important to take into consideration.

Dr Nick Hartland:

So I think on that there are some features of support at home that Julia was talking about in relation to care partners that should help join people to services they need outside of aged care. So there’s certainly some interest in that. There’s also quite a bit of interest – and the states have raised it but you’re interested too about that issue – about how does aged care and the hospital system work better together? The states are as people will probably appreciate very worried that there are a number of people in hospital beds that could be discharged but for access to a place that’s in a residential care facility or a spot in their home that suits their needs. So there’s work possibly done on that.

All right.

Q:        So there’s a lot of consultation that the Department is hoping to get stakeholders to engage with over a relatively short period of time. How will the Department account for stakeholder capacity to meet the call to participate?

So Julia do you want to start on this and then we’ll see. It certainly refers to all of us though I suspect.

Julia Atkinson:

Yeah. So I guess I’ll just start by saying it’s something that we kind of acknowledge and understand. It’s a lot of reform. We’re working really hard and we appreciate that you guys are as well. Some of the things that we’re trying to do to make this work – so we’re trying to put out into the public domain ahead of time what’s coming. So as much as we can put that schedule up on the Engagement Hub, make it really clear this is what we’re going to come to consult with you on at this time in this way. It’s not always possible to do that but where we can we do.

We also are looking to do more things like this where we connect up together so that we can hit a lot of people at the same time and talk about aspects of that system that are inter-related. So I guess that’s a couple of my reflections. Did other people want to add something as well?

Gillian Shaw:

I can insofar as I guess give people a level of comfort that all of us here in the Aged Care Group work really closely together so that we can lessen the burden I guess on all of you to be able to participate in the best ways that you can. Certainly how we’re going to roll out the consultation process on the new regulatory model is that we want to give you as much time as you possibly can following the release of consultation materials but also offer you different avenues in which you can choose to participate as well. I think that’s really important for you all, that you can choose to participate through a webinar or you can attend a workshop or you can provide a written submission. But make the range of opportunities available to you so you can pick and choose depending on your capacity to be able to do that. But yeah we’re very mindful of the load on you all and do work together as a team to make sure that we can coordinate that in the best way possible for you.

Dr Nick Hartland:

All right. So Mel this might be for you.

Q:        Will the new Aged Care Bill be more closely linked to the NDIS?

Mel Metz:

Yeah. That’s a good question and could be answered in a few different ways and Gill might want to add something to this. But in drafting the new Aged Care Act we’re definitely looking at how the NDIS scheme has been put together and looking for opportunities to align things where we can. Even with our interim amendments to legislation we’ve started doing some of that. So I very briefly touched on the new banning orders that came in under the Act that has just passed. The NDIS has a very similar scheme. We’re looking to the NDIS about how they regulate workers. So on a number of fronts we’re definitely looking to the NDIS to see how we can better align. And I’m sure Gill has a few things to say about that because there are definite benefits for aligning regulation for providers to operate across sectors.

Dr Nick Hartland:

Gill, nice segue.

Gillian Shaw:

Yeah. Thanks Nick. Thanks Mel. And what people will see particularly in the new registration model consultation paper that we’ll be releasing we’re certainly looking to potentially see some alignment with how the NDIS system works in terms of registering for a service type I guess because that really goes to that issue of how you then regulate in a risk proportionate way. So certainly looking at those opportunities. For example there could be a scenario where you could be mutually recognised within the aged care system if you meet a certain set of criteria for the regulator if you already meet that within the NDIS system. So we’re looking at things like that. Mel highlights a really important one. I think the fact we’ve got a Code of Conduct now that we’ll look to apply in very similar ways to what happens in the NDIS, that’s a really good example. And also Josh’s work on the Standards has also had regard to how the NDIS ones are framed. So yes certainly we would hope to mirror as much as possible how the NDIS framework works.

Dr Nick Hartland:

So on the design issues I mean there are some things that Julia and I have been looking closely at the NDIS in relation to for Support at Home. So we have looked closely at the idea of a plan which is sort of in our system but a much stronger element of the NDIS system and think there’s some benefits to thinking about some of the things they do there. The assessment approach won’t be quite the same though. And I can provide it in a second. And certainly things that the NDIS do well – I mean I hesitate to say well because usually when I say something well about the NDIS I get a list of kind of observations. But that scheme is set up much more around quick access to aids and equipment and that’s been an issue in aged care for some time in home care packages. People have to save for it. In CHSP there’s not the amount of provision that there should be and the Government’s made some announcements about that quite recently to increase access. So that early access to aids and equipment and capability building is a really important part of the reforms that Julia’s working on.

I think though having said all that that there will always be elements that aged care will look a bit different to NDIS. I mean maybe it’s a bit kind of obvious but the observation I kind of often make about this is that in NDIS there’s about 400,000 people in the scheme at any one time so it’s quite a targeted scheme. And in aged care we do 400,000 assessments every year. So aged care just has a volume issue that’s quite different to the NDIS so the administration that you build around it is always going to look a bit different. Anyway more work to be done on that.

All right. Maybe one for Julia. I’m not sure I fully understand this question. Anyway we’ll see if Julia does.

Q:        With clients not having their existing services decreased with the transfer to Support at Home how will the volume of care management be mapped over?

Julia Atkinson:

So I nodded in the sense that I know how I’m going to answer the question today which is I don’t know yet but it’s a really good question. And that’s one of the kinds of questions when I talked about that further detail and the practicalities issues that we need to kind of move in to in this next phase, that’s the kind of thing we need to think about. So now that we’re getting a bit of a firmer hold on where we’re going we can start to lay in what that transition will look like from one system to the next. So it’s a great question. I’ve written it down and we’ll take that away.

Dr Nick Hartland:

You saw it coming your way did you?

Julia Atkinson:

I did. Yes.

Dr Nick Hartland:

Okay. Well thanks. Thanks for that question. Sorry. That missed the screen so I can’t read out their name. Okay. Josh and Gillian this questioner has assigned this to you.

Q:        Would the level of regulation for a provider also be driven by scale, ie if you have a provider that only provides low risk services, eg gardening but they are large would you expect all standards to apply at a higher regulatory activity?

Gillian Shaw:

Josh do you want to have a go at that? I mean my response is certainly the scale of the type of provider is something that we are keen to hear from you on. It’s something that we have turned our minds to. For example if you are a sole trader in a small business and you’re operating in a low risk service the principle is in the risk proportionate approach we’re taking you would expect to see less I guess regulation imposed on you compared to a large scale provider who may be providing higher risk services. That’s as a principle but we certainly want to consult on that issue with all of you but a good question. But Josh do you have anything to add to that one?

Josh Maldon:

No. I agree with how you’ve answered it Gill and it’s something that certainly I think in the disability system that scale is something that’s considered and so hearing about what people think is the best way forward I think through consultation, is the way to go.

Dr Nick Hartland:

There’s a question.

Q:        Will there be any work on making it easier for consumers to select providers?

So I think maybe Josh first about quality indicators and information and then Julia we might ask you about consumer choice. It’s quite a complex question that when you peel it open.

Josh Maldon:

Yeah I can jump in and have a crack. I think that a lot of the measures Government has put into place is about increasing transparency both in the system and it goes down to a service level. It goes across a range of things such as quality indicators which we’re looking at in both residential and in the context of a new support at home system, how we make quality standards more measurable and show that through a star ratings system for residential aged care, and do we eventually expand it to home care. But what I would say to you is that a lot of the initiatives are aimed at identifying what good looks like and then being able to provide that to consumers in a meaningful way.

Dr Nick Hartland:

Julia?

Julia Atkinson:

Yeah sure. So the question of consumer choice of providers and it being quite challenging.

Dr Nick Hartland:

Lights have gone out on Julia.

Julia Atkinson:

So one of the things that we’ve been looking really closely at in the support at home model is how do we enable consumers to use more than one provider if that’s what they want to do. And not all consumers are going to want to do that. Some people will want to go to one provider and say ‘I want you to take care of everything for me’ and a lot of consumers do that today. But we do know that there’s a group of people who are really interested in being able to use more than one provider to provide different services. We haven’t quite worked through the practicalities of this yet but it’s something that we’re looking really closely at. And it kind of ties in to this question around self-management. So how can we enable that? There could be an ICT solution to this that we’re investigating but we still need to kind of do a bit more work on that feasibility and practicalities. But yeah being able to open up from you must go to one provider to deliver everything to well you could choose one provider to take care of your clinical services but you can get someone else to do your gardening, that could be a really good way to give clients more choice upfront.

Dr Nick Hartland:

Thank you very much. I think this is Gillian.

Q:        Does the new Act and framework apply to NATSIFAC funded community aged care services?

So whoever feels best - - -

Mel Metz:

I’m happy to take that.

Gillian Shaw:

Go on Mel. All yours.

Mel Metz:

Gill’s already answered. Yes is the short answer to the question. We are looking to incorporate the NATSIFAC program under the new Act to ensure the benefits of the important program continue and consumers can access it. But what we’d like to see in the new Act is a streamlined entry point to aged care but we also want to make sure that NATSIFAC program is covered by the regulatory framework that all the other parts of the aged care system are covered by and that people receiving services under that program can expect the same standards of care as the rest of the aged care system. I think that’s really important.

Dr Nick Hartland:

I think this is for Gillian. I’ll read out the question and it will explain why we’ve only got people that can’t answer all of it. So the general question.

Q:        Sorry I might have to leave early so I’ll ask now. One thing we’re struggling with with our GCP provider for my elderly mum is staff shortages. Would this cover long and short term sustainable training strategies to get more regular qualified carers and health workers? Now with sole traders being allowed to be providers, does this mean qualified people can start a carer business and provide that to customers?

So we don’t actually have the people that are the experts on labour force with us today unless I’m terribly mistaken but there is a lot of work going on in the Department and Ministers are very concerned about efforts to increase the supply of labour. Everybody understands that’s an issue.

Ros Bauer:

Nick it’s Ros Bauer here.

Dr Nick Hartland:

You’re here are you Ros? Step in.

Ros Bauer:

Look I’m not sure what the specific question is but I guess I’d like just to acknowledge that we’re very aware of the critical workforce shortages happening in aged care. But you’d only have to listen to news occasionally to hear that it’s happening across all industries and that there’s huge workforce issues happening everywhere. So there’s not an easy solution so I’m not saying that, but there are quite a number of things happening.

The first thing that the Government did when they came in was to provide a submission to the Fair Work Commission for the Fair Work value case. That was submitted on the 4th of August I think and this week hearings commenced in the Fair Work Commission. So that started with unions this week. I think the General Counsel or the Government will be hearing next week. So there’s a lot of work in that area and the Government has committed to support any decision that the Fair Work Commission comes up with.

So I think that’s one big part. The second thing is on the 17th of August the Minister ran an aged care workforce round table with about 20 providers, stakeholders, representatives of older people and unions and that will feed in to the Jobs and Skills Summit which starts tomorrow. So that’s going to be important to inform I guess future directions and I think will underline the importance of us here in Health and Aged Care working across a number of departments to see what levers we can facilitate to grow and skill our workforce. We’re very aware that the workforce is burnt out and that COVID over the last few years and still is now causing lots of pressure in the system.

I’d like to add however that because it’s a home care program we’re talking about we have also established a Home Care Workforce Support Program and I hope a number of you have come across that. There are consortium of providers in each state and territory and two focusing on rural and remote. That’s a consortium of providers to support aged care home care providers to increase their aged care workforce with wraparound supports, mentoring and the ability to skill existing workers as well as new workers.

To that end I’d like to put a plug in for a webinar that we are running. In fact it’s a series of three webinars we’re running. The first one is on the 14th of September and that will be entitled Attracting the Workforce. We’re doing that in conjunction with Department of Employment and Workforce Relations. So you’ll get some information on the programs that will support providers to get better workforce and in that webinar we’ll actually be providing more detail on the Home Care Workforce Support Program if you haven’t come across it. I must admit I’ve talked to a few providers and there’s been really positive feedback on that. DEWR will be able to talk about the employment programs, their regional employment facilitators and be talking about apprenticeships.

The other thing that we are working across Government is – and this will come out of the Jobs and Skills Summit as well – is international borders are now opening. We know that that has caused a lot of shortages in aged care and we are working across Government to look at streamlined pathways for migration.

So there are a number of initiatives that we are running so I would encourage providers to join in to our three series of webinars coming up September, October and November. Thanks Nick.

Dr Nick Hartland:

Excellent. Thanks very much Ros. Gillian there was an element of that question about sole traders being able to become part of the system. Do you want to just quickly - - -

Gillian Shaw:

Yeah. So I would envisage that a sole trader could be defined as a range of people who may choose to provide services. So I guess a carer who’s providing services could be but that level of detail is I guess yet to be decided. But a good question. And we do hope that through the sole trader model it will provide greater access to a range of service providers out there that go straight to the question that that person has raised. So great question.

Dr Nick Hartland:

So Jennifer asks:

Q:        Hi. Just wondering about plans for workforce, ie aged care assessment services and also concerns regarding vulnerable client assessment if there’s no face to face component.

So I kind of dealt in a very longwinded and possibly indirect way about streamlined assessment just a little while ago but the nuts and bolts of that is that we will be talking soon to assessment providers about how to get a better assessment system. Julia did you have any comment about the face to face assessment element?

Julie Atkinson:

Yeah sure. So as a starting point the preference is always face to face assessment and active assessment. That’s the best practice model. It’s not always possible. If we have lockdown requirements we have to find ways around that. But the starting point is face to face active assessment. I think this might come slightly from a clarifying point when I was talking about the goods and equipment codesign. One of the things we talked about with that codesign group was how can we use technology to help connect experts like OTs to assessors. And when we think about it the ideal is to have the OT in front of the person but if we’ve got someone in a highly rural or remote location and we can get an assessor out there but not an OT could we have the assessor for example in there with an iPad with the OT with them virtually. So that was kind of an idea. We’re looking at kind of innovative ways to get the best possible outcome in those assessments where it can be quite challenging.

Dr Nick Hartland:

Thanks Julia. Mel.

Q:        Is the new Act keeping the term ‘consumer’?

Mel Metz:

I’m so glad that that question has been asked actually. If it’s up to our Minister I would say definitely not. She’s not a fan of that term and tells us every time someone from the Department uses it. The Royal Commission was also pretty critical of the term ‘consumer’ which I guess it was a trend over time to use that, because they said that older people in the system aren’t genuinely consumers. Language and how we describe people in the new Act I think is something that we will have a real diversity of views on. My personal preference would be to use language in the legislation that is just talk about people as people because that’s what they are, and not use any specific term, older person, older Australian, consumer, care recipient. Those things have a variety of views. They speak to some people. Other people don’t like them. So my preference would be to use something that no one can kind of take offence to and that just describes exactly what we’re creating the system about.

Dr Nick Hartland:

Okay. Excellent. Thanks.

Sorry. Just lost track of where I am.

Q:        As a CHSP only provider (local government) do you have an ETA on extensions to service agreements through to June 2024?

So I think that’s probably me.

Yes we know we need to extend the CHSP contracts again. I think at this stage our thinking is that that wouldn’t involve as big a change as the last set of contract extensions which actually had some pretty significant reforms in them. Although to the extent that we could make the prices make more sense that’s something we should always be looking at. I don’t have a precise ETA but we do know that that’s a pretty major exercise and we’ll need to come to it pretty soon. So we’ll be able in good time to tell providers what’s happening and how we’re going to approach that extension.

Maybe one for Josh or Gillian.

Q:        Clinical governance is really confusing for CHSP providers who aren’t in a clinical setting. It’s hard to know what we’re supposed to do in terms of clinical governance frameworks. Can you provide an example document that would be applicable for CHSP providers?

Josh Maldon:

Hi Nick. Yeah I can answer that. That’s one we’re really hoping to get some feedback on during consultation. So that’s something we’ve certainly been discussing with the Health Commission is the difference of providing clinical care across residential versus the community settings. So that is something that we’ll specifically test and we welcome people’s feedback on it. Because the intent of what we want to do with the standards is have it better differentiate appropriate to particular service settings. So a great question and look forward to hearing people’s views on that.

Dr Nick Hartland:

Julia this might be one for you.

Q:        Do you foresee there will no longer be any block funding for any services?

Julia Atkinson:

I think that’s a pretty extreme way of putting it. No longer any. Hard to say definitively at this point. I would say that we’d foresee there’d be a lot less use of block funding and more targeted use of grants. That’s kind of what we’re looking at. I wouldn’t go never say never on never using block funding again in any circumstance and I guess what we’ve heard in our consultations around fee for service is that we do need to be looking at some other expansion of how we might use and deploy grants to back that up. But I think in general we would foresee a movement away from the level and scale of block funding that we’re currently using in the system. Would you agree Nick?

Dr Nick Hartland:

Yeah. Certainly we’re very aware of the need to examine how best to fund services with a high capital component that needs some funding certainty to be able to service that. So Julia in her previous presentation listed off a range of services. Certainly we understand that – and this is embedded in the AN-ACC – that there may need to be a different approach in remote areas to give provider certainty and for thin markets. So we’ll work through that. The heading block funding, will that mean block funding still exists? Well depending on your understanding of block funding the answer might be yes obviously. But it might also be a good idea to kind of look at the way in which we grant fund those services to make sure that they pick up actually the other benefits of the reform.

So yes we know we need to do some work and we know there is the issue around provider certainty. The sector that often feels a bit left out when I go through that kind of metrics of things that we’ve heard – I’ve said we’ve heard the need to look closely at rural and remote, the need to look at what we call thin markets, but providers that look after groups of consumers that are low numbers and are the cottage respite, transport and – sorry there’s one other one that now escapes me. Meals providers are also very worried. Sole meals providers are very worried and we know we need to talk to that sector about what funding arrangements are going to be like for them in the new system too. So they’re on the radar to work through those issues.

So Barbara asks:

Q:        If you’re already receiving a home care package will you need to be reassessed?

Julia?

Julia Atkinson:

So no. Our ingoing assumption on this is no. What we’d been looking at – and we need to work this as another one where we need to work through the practicalities and details – but looking at people currently in the system and mapping them in to the new backend of what we need to kind of deliver but doing it in such a way that doesn’t trigger a whole lot of reassessments. Because that’s not going to be very practical and it’s not going to be a good outcome necessarily for clients. And some people may choose to be reassessed but our ingoing assumption is no you wouldn’t need to be reassessed.

Dr Nick Hartland:

So Gillian this might be for you.

Q:        Will sole traders have to comply with all the legislative requirements companies do? So this is including leave, award minimums and provisions, superannuation, compulsory insurances and so forth.

Gillian Shaw:

I guess I could just talk about it from the perspective of I guess what will be required of them to ensure safety and quality matters are I guess appropriately dealt with. I guess going back to the comment before if a sole trader happens to be a physio and they want to provide a certain level of service then there will be obligations linked to that service provision which are more risk proportionate, I guess more aligned with the risk of that service that person is providing, which will be further worked through in our consultation paper. We’re not going to matters of corporations or business entities if you like under this framework. This is very much around making sure we’ve got the right safeguards in place. But that might be more a question I guess – sorry to throw Mel to this question, but in terms of our prudential regulation that’s certainly handled differently as part of this consultation process per se on our new regulatory model that I’m working on. But Mel is that something you can respond to at all?

Mel Metz:

So I probably can’t do it in a very good way but I’ll give it a go, noting that we’re nearly out of time. There is another team that’s working on prudential regulation and it will be something that the Commission starts doing and that there’s greater financial and prudential reporting. Precisely what those requirements are I’m not in a very good position to answer but I think we can take that away and include it in our frequently asked questions.

Dr Nick Hartland:

All right. So thank you Gillian, Josh, Mel, Julia and Ros for answering questions, for the presentations. So we’ll wrap up there. There was just one more question that I’ll deal with just offline before we close. There were a couple of questions about the SCHCADS Award which is a bit out of scope for this presentation but to the extent people are worrying still about the two hour minimum awards. So we have issued some guidance on that. The issue still gets discussed. So please look at our website for our guidance on what we think is the right approach there. But I won’t labour the point too much but just to make it really clear the two hour award minimum does not mean that you have to be two hours with the same client for that period. So it’s a minimum shift time in effect for a worker and a worker could see a number of clients within that time. So please use that to try and work through this SCHCADS change in a way that still supports consumers and still gives them value for money for their packages. We know it’s a transition issue and I don’t run a service but I appreciate the difficult of this. But it is important to keep the consumer in mind and to work through that change without assuming that a consumer has to have two hours in one time point.

So anyway having said that that concludes the time. Thank you all again for attending this session. Thank you for the questions. I hope you found this valuable and we certainly appreciate the questions you’ve asked. Thank you again to Minister Wells and Michael who joined us and thank you to the Auslan interpreters who have been working solidly for all of this time. Many people were asking about further consultation and that’s a really healthy thing for us. So please look at the website and subscribe to our newsletters and check out the new section on the aged care website and there’s an Engagement Hub that you can sign up. So there are lots of consultation opportunities. So if you were asking about consultation and you don’t do that we’ll wonder whether that was a serious question.

A recorded version of this webinar will be made available at health.gov.au. If you search for ‘Aged care webinars’ you’ll be able to find it. If you have any questions you can send them to SAH.implementation@health.gov.au. And having said all that as I said thank you for your attention. We’re very happy. This is the largest webinar we’ve ever done we think and hopefully we can beat that record the next time we come around. So thank you very much everyone.

[Closing visual of slide with text saying ‘Thank you’, ‘For more information, please contact the Department of Health and Aged Care’, ‘Email us: SAH.implementation@health.gov.au’, ‘Go to the Ageing and Aged Care Engagement Hub: www.agedcareengagement.health.gov.au’, ‘Visit the My Aged Care website www.myagedcare.gov.au or call 1800 200 422’, ‘agedcareengagement.health.gov.au’, ‘31 August 2022’]

[End of Transcript]

 

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The Australian Government extended the reforms to in-home aged care until July 2024. This webinar gives older Australians, their families and carers, and the aged care sector an update on the reforms. The update will include progress on a new Aged Care Act and regulatory arrangements.

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