New Aged Care Act and Support at Home program update

New Aged Care Act and Support at Home Program Update

Thursday, 14 December 2023



Presented by:

Moderator: Amy Laffan, First Assistant Secretary, Quality and Assurance Division

Speakers:

Mel Metz

Assistant Secretary, Legislative Reform Branch

Simon Christopher

Director, Harmonisation and Regulatory Strategy Branch

Ingrid Leonard

Assistant Secretary, Choice and Transparency Branch

Nick Morgan

Assistant Secretary, Support at Home Reform Branch

[Opening visual of slide with text saying ‘New Aged Care Act and Support at Home program update’, ‘The webinar will commence shortly’, image of QR code with text underneath saying ‘Scan here for webinar slides’, image of QR code with text underneath saying ‘Scan here for New Aged Care Act consultation page’, ‘Please check your audio settings if you cannot hear the presenter’]

[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 with an Auslan interpreter signing to the right of screen]

Amy Laffan:

Good afternoon and thank you for tuning in to today’s webinar about the new Aged Care Act and the Support at Home update. I believe we have over 8,000 people registered to join us today which is a fantastic interest so I thank you again for tuning in.

My name is Amy Laffan and I’m the First Assistant Secretary of the Quality Assurance Division in the Aged Care Group at the Department of Health and Aged Care. I’m joined today by Mel Metz, Assistant Secretary of the Legislative Reform Branch, Simon Christopher, Director of the Harmonisation and Regulatory Strategy Branch, Ingrid Leonard, Assistant Secretary, Choice and Transparency Branch, and Nick Morgan, Assistant Secretary, Support at Home Reform Branch.

I’d like to begin by acknowledging the traditional custodians of the lands on which we are virtually meeting today. We are based in Canberra on the lands of the Ngunnawal people and we recognise any other people and families with connection to the lands of the ACT. I wish to acknowledge and respect their continuing culture and the contribution they make to the life of this city and this region. I would also like to acknowledge any other Aboriginal and Torres Strait Islander people who may be attending today’s event.

Now before we start I’d like to let you know that we are recording this webinar so it can be shared for those who are unable to join us today. It will be available on the Department’s website in the coming days and you can also access the slides on our website now.

There will be a Q&A session at the end of the webinar. There is no option for attendees to turn on their video or microphone however you can lodge questions in the Slido box on the right hand side of your screen. We will attempt to respond to as many questions as possible at the end of the webinar. Questions submitted during the registration process have also been considered for this Q&A session.

This webinar will provide updates on the development of the new Aged Care Act, the new model for regulating aged care, the strengthened Aged Care Quality Standards and In Home Aged Care reforms including the new Support at Home Program. This webinar provides an opportunity to promote the second stage of public consultation on the new Aged Care Act. I am excited to say that the exposure draft of the Bill for the new Act has been published today. Today’s webinar marks the start of public consultation which is going to run through until mid-February next year. The release of the exposure draft provides an opportunity for aged care advocates, providers, workers, and most importantly older people and their supporters to tell us what they think about the draft Act. Mel will talk more about that and how you can get involved in the consultation shortly.

Today’s webinar will also provide context about how the new regulatory model for aged care and the Quality Standards for aged care are reflected in the new Act. And we’ll also hear from Nick Morgan about the In Home Aged Care reforms which will be the next significant phase of aged care reform after the new Act.

So I’d now like to introduce our first speaker Mel Metz, Assistant Secretary of the Legislative Reform Branch to talk to you about the new Aged Care Act.

Mel Metz:

[Visual of slide with text saying ‘Mel Metz’, ‘Assistant Secretary’, ‘Legislative Reform Branch’, ‘New Aged Care Act’, ‘Next Steps’]

Thanks Amy and hello everyone. I’d like to start by saying that I’m also very excited about the exposure draft of the Bill for the new Aged Care Act being published today. This marks the beginning of an important process. It’s time for you to tell us what we’ve got right and what we need to improve before we finalise the Bill and Minister Wells introduces it to Parliament next year.

As you know the Royal Commission handed down its report in March 2021 and the very first recommendation was to develop a new Aged Care Act. There was good reason for that. The Royal Commission said that the new Act will set the foundation of a new aged care system. They proposed a number of objects enshrining the rights of older people and new principles to provide high level guidance to participants in the system about what’s important. Many other Royal Commission recommendations, around 50 in total, also still need underpinning legislation in order to be implemented.

Since the Royal Commission handed down its report we’ve seen significant changes to aged care legislation. The first phases of reform have paved the way for a new Act. To remind you quickly of those changes on the 1st of July 2021 the Royal Commission response number one act came into effect. It introduced stronger controls over the use of restrictive practices such as chemical and physical restraints to ensure that they are a last resort. It enabled assurance reviews to make sure home care providers were using funding to deliver services to older Australians and it abolished the Aged Care Financing Authority paving the way for the Independent Health and Aged Care Pricing Authority.

Next on the 5th of August 2022 the second Royal Commission response act commenced. It responded to 17 recommendations of the Royal Commission. It introduced the new Australian National Aged Care Classification, AN-ACC funding model for residential aged care. It facilitated publication of star ratings to help people compare residential aged care services and decide which services best fit their needs. It introduced an enforceable Code of Conduct for aged care applying to approved providers, governing persons and workers. It extended the Serious Incident Response Scheme to home care and flexible care delivered in a home or community setting. It strengthened provider governance by placing new reporting requirements on providers and requiring clinical expertise on governing bodies. It made it easier to share information between regulators in the aged care, veterans care and disability support sectors. It increased financial and prudential oversight of the use of residential accommodation deposits and bonds. It established the Independent Health and Aged Care Pricing Authority to provide pricing advice to Government on aged care and revised the restrictive practices arrangements to address gaps in state and territory guardianship and consent laws.

On the 9th of November, just over 12 months ago now, the Implementing Care Reform Act received royal assent. It improved integrity and accountability in aged care by allowing publication of information reported by providers. It banned exit fees and allowed administration and management charges in the Home Care Packages Program to be capped. And very importantly it introduced the requirement for a registered nurse to be on site and on duty 24 hours a day seven days a week in every residential care home from the 1st of July 2023. All of these reforms have been adopted in the exposure draft of the Bill of the new Aged Care Act that’s been published today.

It's also worth noting that alongside these legislated initiatives a wage rise for aged care workers also took effect from the 30th of June 2023. Hearing from you about the exposure draft of the Bill for the new Act is the next significant phase in the pathway to a new Aged Care Act. This will be followed by introduction and passage of the Bill for the new Aged Care Act in 2024 and the new Support at Home Program commencing in 2025.

To help you engage in the consultation process I’ll now provide you with an overview of the exposure draft of the Bill. I’ll follow the order of the legislation and the consultation paper that accompanies it but I’m not going to read you every provision because there are 413 and I’m sure you would like to hear from the other speakers. Today I’m just going to signpost some important parts of the Bill for you. Chapter 1 of the Bill starts with the objects. These outline what the Act is trying to achieve. Objects can be used by the courts and others to interpret provisions of the legislation. I’ll allow you to read the proposed objects in your own time but I will make three points about what we heard during and actioned after the first round of consultations.

First of all feedback on the proposed objects was positive with broad support for placing the needs of older people at the centre of the new aged care system. Second we heard that you wanted a clear reference to the Statement of Rights in the objects which we have included. And third we heard that it was important to reference sustainable funding arrangements and the delivery of services by a diverse, trained and skilled workforce. So we have included those references.

The objects are followed by definitions which I won’t go through in detail however there are some special definitions called key concepts that are highlighted on the next couple of slides. These definitions are important because they’re either structurally critical or constitutionally significant. The new aged care service list is structurally important. It will for the first time make it clear to everyone in legislation what aged care services the Commonwealth funds. The service list sets us up to introduce Support at Home in 2025 and provides the basis for the new provider registration model which groups the services on the list into registration categories. We also define funded aged care service because this Act is going to be limited to services that are funded by the Federal Government. In other words services provided in the private market are not going to be covered by or regulated under this Act.

We’ve described two settings where aged care services can be delivered. A residential care home or a home or community setting. Definition of residential care home is particularly important because it provides a link to the Australian Constitution and the matters that the Federal Government is allowed to make laws about. The exposure draft also outlines who can deliver services. Funded aged care services can be delivered by registered providers. Aged care worker is defined and we have a new concept of associated provider. This recognises that registered providers will enter into sub-contracting arrangements and it makes it clear that where registered providers do so they remain accountable for the services that are being delivered.

We’ve elevated some of the most important features that deliver quality and safe care into the key concepts as well. These include concepts that you are probably already familiar with such as the concept of responsible person, suitability matters relating to responsible persons, the Aged Care Code of Conduct, the Aged Care Quality Standards, the meaning of reportable incident and restrictive practices requirements. We also have two new concepts which are relevant to civil penalties and the new duties. A significant failure and a systemic pattern of conduct.

And finally in line with what the Royal Commission recommended we have a definition of high quality care which will establish a shared understanding of what excellent care looks like. We changed this definition significantly based on what we heard in the first round of consultations. The definition now prioritises those matters that we have heard lead to excellent care outcomes and improved quality of life for older people.

The Statement of Rights and Principles immediately follow on from the definitions. The Statement of Rights focuses on what older people accessing or seeking access to funded aged care services can expect from registered providers. The principles on the other hand focus on the expected actions of the people or bodies who will perform functions or exercise powers under the new Act.

While there was strong support for the Statement of Rights and Principles in the first round of consultations we made several changes in response to your feedback. These changes are detailed in the consultation paper but I will mention a few. Significantly we organised both the Statement of Rights and the Principles into easy to understand headings. The Statement of Rights now includes references to intimate and sexual relationships, an individual’s spirituality, accessible complaints mechanisms, other methods of communicating noting they may be non‑verbal, and opportunities and assistance to stay connected to significant people and pets including through safe visitation.

We also heard your concerns that the principles were too passive. They now incorporate more active empowering language. We also know that enforceability of the Statement of Rights is very important to people. Section 21 in the exposure draft contains a clear expectation that registered providers must not act in a way that is incompatible with the Statement of Rights, taking into account the need to balance other competing or conflicting rights. This is supported by a registration condition outlined in Chapter 3 of the exposure draft. Section 92 for those who would like a reference. This condition requires registered providers to demonstrate through their delivery of aged care services that they understand the Statement of Rights, that they have practices in place to make sure they uphold these rights and provide older people with information about their rights. Where this isn’t the case a provider may be in breach which can lead to a number of regulatory responses.

We expect that in most cases a breach of rights will be resolved informally and directly with the provider. The Statement of Rights and the complaints and whistleblower frameworks that providers will have will provide the tools to facilitate early resolution. A person can also make a complaint to the Complaints Commissioner if they feel that their own or someone else’s rights have been breached. Depending on the nature of the breach this can lead to an agreed outcome or a response from the Aged Care Quality and Safety Commission.

The new Act will clarify the role of legally appointed supporters and representatives and their duties relating to supported decision making. This has been brought upfront in recognition of how important this cultural change, supporting people to make their own decisions is to providing choice, control and dignity to older people. People appointed as supporters will be able to receive documents and information and communicate information on behalf of an older person. Appointed representatives will be able to do these things too. They will also be able to make decisions on behalf of an older person where that person doesn’t have the ability to do so or that person wants the representative to make the decision for them.

The duties of supporters and representatives include acting honestly, diligently and in good faith, acting in a manner that promotes the will, preferences and personal, cultural and social wellbeing of an older person, and using best endeavours to maintain the ability of the older person to make their own decisions. There are additional duties for representatives when they act on behalf of an older person and in these circumstances the representative has to follow decision making principles to make sure the older person’s views, wishes and preferences are given effect. These principles are based on recommendations of the Australian Law Reform Commission and supported by a research report that was released by the Disability Royal Commission.

The administrative provisions about appointing, temporarily suspending and cancelling appointments of supporters and representatives are included in Chapter 8 of the exposure draft. We heard lots of feedback about supporters and representatives during the first consultation process. In response to what we heard people will be able to have multiple supporters or multiple representatives at the same time however they will only be able to have one of either a supporter or representative. In addition if someone is applying to be appointed as someone’s representative and they’re already appointed as a guardian or enduring power of attorney they must be appointed as a representative unless there is good reason for them not to be appointed. And an example of that would be where there is evidence of elder abuse. We also made an important change to talk about ability rather than capacity when referencing an older person and their decision making capability.

In line with our vision of legislation that follows the journey of an older person Chapter 2 outlines entry into the aged care system. It covers eligibility, classification, prioritisation and place allocation. This Chapter also provides important links to the Australian Constitution and the external affairs power. That’s section 49 for those of you that would like a reference. The initial eligibility test is set out in section 40. In summary a person must be aged 65 or over and have care needs or be aged between 50 and 64 and be an Aboriginal or Torres Strait Islander person or homeless or at risk of homelessness. This younger group will also need to have been informed of alternative options that are available to meet their needs and make it clear that they’ve considered those options and that it’s still their will and preference to receive aged care before the age of 65.

Participating in a needs assessment is the next important step which is covered in sections 43 and 44. Importantly there must be a conversation between the needs assessor and the older person about what the assessment has identified in terms of appropriate funded aged care services that may assist the person to maintain independence, the person’s preferences and goals, the next steps in the application process and how the assessment outcome will be communicated to them. This Chapter also provides for reassessments which might happen on the papers or through a full new assessment, classification which for Home Care Packages will occur at the same time as assessment and for residential aged care will occur once the person enters a residential aged care home, prioritisation which addresses the urgency of care for an individual and place allocation. Because places in the aged care system will now be allocated directly to an individual in both the residential care setting and in the home and community setting.

The prioritisation and place allocation provisions are not included in the exposure draft but the consultation paper outlines how they’re intended to operate. Likewise the draft does not currently provide for emergency entry into the aged care system before a needs assessment is undertaken but these will all be included in the Bill that the Minister introduces into Parliament in 2024.

I won’t spend too much time on Chapter 3 because Simon is going to talk to you about the new regulatory model and Ingrid will talk to you about the strengthened Aged Care Quality Standards. Chapters 3, 5 and 6 together establish a stronger aged care regulator. The most important aspects I’ll highlight for you in Chapter 3 are the new registration processes for aged care providers, the conditions on registration, the obligations on providers, workers and responsible persons, and the new duties and availability of compensation. Under the new system all aged care providers will need to be registered. That registration is subject to a number of conditions. And section 88 creates a general requirement for providers to comply with conditions with two levels of civil penalties where they fail to do so. Conduct that breaches a condition attracts up to 250 penalty units and conduct that involves a significant failure or systemic pattern of conduct, those key concepts that I spoke about earlier, attracts up to 500 penalty units.

The Aged Care Quality and Safety Commissioner is able to impose specific conditions and the other conditions that apply to all providers include complying with the Code of Conduct, meeting worker screening requirements, the rights and principles related condition that I mentioned earlier, requirements relating to protecting personal information and record keeping, requirements relating to fees and payments, incident management or SIRS, complaints and whistleblower requirements. Some conditions will only apply to some registration categories where they are most relevant. Those conditions are the strengthened Aged Care Quality Standards, meeting financial and prudential requirements, continuous improvement requirements, membership of governing bodies, advisory body requirements, delivery of service requirements, restrictive practices requirements and requirements around ceasing delivery of services.

This Chapter also outlines provider obligations. Breaching a provider obligation may attract a civil penalty, may constitute a criminal offence or may lead to some of the regulatory responses that I’ll talk through shortly. Provider obligations cover general compliance with laws, reporting information to the Commissioner, Complaints Commissioner, Inspector-General, System Governor or Pricing Authority, reporting changes in circumstances, suitability of responsible persons reporting, a general cooperation requirement so that registered providers cooperate with people performing functions under the Act, the requirements relating to registered nursing for residential care homes and the protection of personal information. This is also where the Code of Conduct requirements for workers and responsible persons appear.

We’ve included new duties on registered providers, responsible persons and platform providers. These provisions need to be drafted carefully to be able to respond to the most serious of behaviours and at the same time take into account the dignity of risk of older people and reasonable actions of providers that might result in adverse outcomes. We think we’ve got the balance right but we would like to hear from you about how we’ve drafted these duties. Breaching these duties will be a criminal offence and where that’s proven the Commissioner or an individual can seek compensation through the courts. We consulted on these duties earlier this year and as a result we have not included a duty on aged care workers. We agree that state and territory requirements and banning orders are sufficient to respond to workers who do the wrong thing.

I’ll briefly mention Chapter 4 which covers funding, means testing, subsidies and payment and fee arrangements. We’re not consulting on this Chapter at this time because these matters are under active consideration by the Aged Care Taskforce. There is an overview in the consultation paper and keep an eye on the Aged Care Engagement Hub for more information about the work of the Taskforce.

I’m now going to skip ahead to Chapter 6 which covers regulatory mechanisms because these powers are important in strengthening the role of the Aged Care Quality and Safety Commission. This Chapter picks up and modifies the Regulatory Powers (Standard Provisions) Act. That legislation sets the standard for the powers of Commonwealth regulators and includes monitoring and investigation powers, the power to seek civil penalty orders, the ability to issue infringement notices, enter into enforceable undertakings and seek injunctions. In addition there’s a new power for Commission officers to enter premises without warrant or consent where the Commissioner authorises that action because there is a serious risk to a person’s life, health or wellbeing. This is a strong power that was recommended by the Royal Commission.

Going back now to Chapter 5 this Chapter outlines the role and functions of the System Governor and the Aged Care Quality and Safety Commission. The System Governor is the Secretary of the Department of Health and Aged Care. This adopts the language used by the Royal Commission. Outlining the role of a Department is not a common feature of legislation but we think it sets important direction for the future and is consistent with public sector stewardship. It’s worth noting that the System Governor will be required to publish Coroner’s reports. This is in line with a recommendation of the Royal Commission. This Chapter also establishes the Aged Care Quality and Safety Commission, the Commissioner and the Commission’s functions, the ability to make financial and prudential standards, also establishes a strengthened Aged Care Quality and Safety Advisory Council and recognises in law the role of the Aged Care Complaints Commissioner.

Chapter 7 creates limits on recording, using and disclosing information that is obtained or generated in relation to the Act. This information referred to as protected information includes personal information within the meaning of the Privacy Act and information that could reasonably be expected to prejudice the financial interests of a provider if it is disclosed. This represents a change from the current Act that protects any information about an approved provider, an approach that was criticised by the Royal Commission. We will also be removing the broad FOI protections that were criticised by the Royal Commission.

We’ve also included a new whistleblower framework. These new arrangements are a critical part of the new Act given the Royal Commission’s findings that fear of reprisal can deter people and workers from making complaints. Taking into account feedback we received any person will be able to be a whistleblower and will be protected if they make a disclosure to a broad range of people including the Commissioner or a member of the staff of the Commission, the System Governor or an official of the Department, a registered provider, their responsible person or an aged care worker or a police officer.

The disclosure can be made orally or in writing but the person making the disclosure must have reasonable grounds to suspect that a person or entity may have contravened the Act. In response to feedback a whistleblower no longer needs to provide their name to be offered protection ensuring that potential whistleblowers feel safe to make disclosures. Disclosures also don’t need to be made in good faith removing additional barriers for prospective whistleblowers. The whistleblower just needs to have reasonable grounds to make a disclosure. Where these requirements are met whistleblowers will be protected from civil, criminal and administrative liability as well as contractual or other remedies. The new Act prohibits victimisation where a person makes a whistleblower complaint.

And then the Act finishes off with miscellaneous provisions in Chapter 8 which I won’t take you through this afternoon. These provisions are important because they do the administrative and mechanical work of the Bill however they aren’t the stars of the show so I’ll leave you to consider those in your own time.

I hope that that’s provided you with a useful overview of the exposure draft. I’d encourage you to read the consultation paper or the summary version and please read the legislation if you are so inclined. If you find the whole 325 pages a bit daunting I encourage you to start with the simplified outlines at the start of each Chapter which provide a really useful overview.

So what’s next? The exposure draft was released today and the consultations will now run over an extended period until the 16th of February 2024. The extended consultation notes the period of time within which we’re engaging with you. As with our previous consultation we invite you to lodge a submission or complete a survey. Please also register to attend one of the workshops and information sessions which we are planning in capital cities and regional locations across Australia from mid-January through to mid-February. Keep an eye on our consultation page for the scheduled dates and times.

I’d also just like to say thank you finally to all of you who have participated in the consultation to date. Members of the Council of Elders and National Aged Care Advisory Council, the Expert Advisory Panel, consumer and sector reference groups and the Diversity Consultative Committee have all been particularly generous with their time and expertise. We got so much valuable feedback and insight from our first consultations because so many people and organisations took the time to participate. We’re very grateful for that and hope that you continue to engage so that we can get this important legislation right. Further information is available on the Aged Care Engagement Hub. Back to you Amy.

Amy Laffan:

Thanks Mel. Certainly exciting times ahead. So now I’d like to introduce you to our next presenter Simon Christopher who’ll talk to you about the new regulatory framework. Over to you Simon.

Simon Christopher:

[Visual of slide with text saying ‘Simon Christopher’, ‘Director’, ‘Harmonisation and Regulatory Strategy Branch’, ‘Provider registration categories’, ‘Transition and deeming arrangements’]

Thanks Amy and hello everyone. I’m a director in the Harmonisation and Regulatory Strategy Branch in the Department. Our Branch has spoken with many of you in previous webinars about the new model for regulating aged care which will be part of the new Aged Care Act.

Today’s update on the regulatory model focuses on the proposed registration categories post public consultation for providers and the deeming process that we’ll use to move providers from the current regulatory model to the future model.

The new regulatory model will deliver cultural change to rebuild trust and confidence in the aged care sector. It aims to move the sector to a rights-based and person-centred approach that incentivises continuous quality improvement. These qualities are fundamental to high quality care. The new regulatory strategy requires all providers to be registered into a registration category based on the services they deliver. Registration categories enable obligations to be streamlined and targeted. This approach safeguards older people by enabling the Aged Care Quality and Safety Commission to focus its regulatory effort on what matters.

Since May this year we’ve consulted extensively on six proposed registration categories grouped on service characteristics and associated service risks and provider obligations for providers of both residential and home care services.

You’ll see the six categories we consulted on in this slide noting that the higher the category number the greater the risks associated with that care. Category one talks to home and community services, category two assistive technology and home modifications, category three social support services, category four clinical and specialised supports, category five home or community based respite, and then finally category six permanent residential care.

Through the consultation process we received a lot of feedback that we have incorporated into the revised proposed categories. These changes are outlined on the next slide.

This slide reflects those final proposed categories that will be operationalised as a legislative instrument of the new Aged Care Act. The main differences from what we went to consultation on and to what we’re proposing today are really categories three, four and five. And considering the feedback we received we made the following revisions. Category three is now called advisory services, previously called social support, and includes specialised supports, care management and assistance with care and housing. This will include services such as specialised continence, dementia support, hearing and vision supports and assisting older people who may be homeless.

Category four is now called personal and social care in the home and community including respite which was previously clinical and specialised supports. This will include personal care services such as showering and toileting and transition care when someone may be recovering from an injury and needs support to return to their activities of daily living. Personal care and allied health will both remain in registration category four and be subject to the Quality Standards. This reflects extensive consultation feedback and consideration of the intimate nature and risks associated to those types of services.

Category five is now called nursing and complex care management, previously home or community-based respite, and incorporates nursing or clinical care and complex care management where a person may require more specific nursing care at home such as managing wounds or administering medications for example.

Nursing has been separated from category four services and put into category five to reflect consultation feedback relating to the clinical governance expectations for nursing being different to those of allied health providers.

This change also reflects nursing’s unique risks and the need for complex clinical care to keep older people safe and well especially in their home. Care management was originally in category four but has been split into basic care management in category three and complex care management in category five. Category six encompasses services through residential care as it was before. These nuanced approaches to provider registration categories will ensure older people with complex needs get the specialist services they require and that older people with less complex needs can still access the quality care they need through services that are appropriately regulated.

Many providers rightly need to understand the impact of transitioning to the new model, in particular what deeming will mean for their business and for delivery of care. Essentially providers who are currently an approved, active aged care provider and receiving Government funding to deliver aged care services will be deemed into the new model. This means if you’re an active approved aged care provider now you’ll be registered as a provider when the new model comes into effect. We may need to ask for some additional information to ensure your registration details are correct and that you are registered into the correct category. However if you’re not an approved provider or an active provider of Government funded aged care services now or before the 30th of June 2024 and are seeking to provide these services to older people the registration process will apply to you under the new model.

The proposed registration categories will give you a good indication of whether the Aged Care Quality Standards will apply to you in the new model depending on your service types.

Information about what this will mean for providers in each category and what you can expect as part of the deeming process will be available in the new year and we will provide updates on this expected process as soon as we can.

Some of you have contributed you thoughts, experiences and advice as part of the public consultation process on the new regulatory model. I’d like to take this opportunity to thank everyone who’s participated in this important piece of work which will help us rebuild trust and confidence in the aged care system for the future. We have prepared a summary report on the consultation process which will soon be published on the Department’s website. The summary report will provide some detailed information on the process itself and the findings from the consultation overall. I encourage you to read through the summary report when it is available. Thank you for your time. I’m happy to take any questions in the Q&A session at the end of the webinar. I’ll now hand across to my colleague Ingrid Leonard who will provide an update on the strengthened Quality Standards. Thank you.

Ingrid Leonard:

[Visual of slide with text saying ‘Ingrid Leonard’, ‘Assistant Secretary’, ‘Choice and Transparency Branch’, ‘The strengthened Aged Care Quality Standards’]

Hi everyone. For those who haven’t met me before my name is Ingrid Leonard. I’m the Assistant Secretary of the Choice and Transparency Branch in the Department of Health and Aged Care. I oversee an important program of quality improvement reforms including star ratings for residential aged care, the National Aged Care Mandatory Quality Indicator Program, residents’ experience survey, food and nutrition, care statements as well as the Aged Care Quality Standards.

Today I’m pleased to give you an update on the strengthened Standards as we work towards implementing them next year.

I will begin by providing you with a brief background on the journey to strengthen the Standards and our work to translate them into legislation as part of the new Aged Care Act. I’ll then share our plans for next steps as we move towards implementation.

A final draft strengthened Quality Standards which were published on the Department’s website today have been developed following an extensive consultation process which commenced in 2021 with the sector, industry experts, older people, their families and carers. This in-depth consultation has helped to ensure that the final standards are robust and reflect our agreed vision for safe and quality aged care. The voices of older people were central in the development of the Standards. The opportunity to hear from older people themselves about their experiences and insights of aged care has been incredibly valuable in informing what the Standards should look like moving forward.

All of the feedback we received through consultation has informed further revisions of the draft Standards.

The next step in the process was to test how they would work in practice. So a pilot of the draft strengthened Standards was undertaken by the Aged Care Quality and Safety Commission with 40 residential and home care providers across different geographic locations, sizes and service types. And the pilot ran from April to October this year. The outcomes of the pilot identified areas that required further refining to improve the usability, auditability and clarity of the strengthened Standards.

We have since refined parts of the Standards to make them clearer, simplify the language and reduce unnecessary duplication of content and intent.

We’ve also been busy drafting the Standards into legislation under the new Aged Care Act. As you know the new Act has been designed to focus on the delivery of quality aged care services and on the safety, health and wellbeing and quality of life of older people.

Through the process of translating the strengthened Standards into law we’ve made some additional amendments to make sure they align with legislative requirements, for example clearly defining the link between the standards and the new Statement of Rights.

As the drafting process continues additional wording adjustments may be needed to ensure consistency with language in the legislation however we do not expect that this will impact the intent of the final Standards.

Now that Government has approved the final draft of the Standards and as I mentioned at the start we have published them on the Department’s website today, you can visit our website at health.gov.au and search Quality Standards. We will continue to work closely with our colleague Mel Metz and her team to finalise the standards in the draft legislation.

The Aged Care Quality and Safety Commission is developing guidance material for providers to support implementation. As part of this they are working very closely with the Australian Commission on Safety and Quality in Healthcare who are responsible for the development of the Clinical Care Standard, Standard 5, as well as us here at the Department.

We anticipate the guidance to be released for public consultation in the new year and I would encourage you to monitor the Aged Care Quality and Safety Commission’s website for updates on this. You can visit their website agedcarequality.gov.au and search Stronger Standards.

Our next step is to concentrate on working with the Commission to make sure that the sector and older people, their families and carers have access to the information they need to understand the changes and support implementation of the Standards into practice.

Thank you very much for your time today and I look forward to working with you and supporting the sector over the next couple of months as we implement the strengthened Quality Standards.

Amy Laffan:

Thanks so much Ingrid. Now to introduce our final speaker for today. Welcome Nick.

Nick Morgan:

[Visual of slide with text saying ‘Nick Morgan’, ‘Assistant Secretary’, ‘Support at Home Reform Branch’]

Thanks Amy. Good afternoon everyone. I’m Nick Morgan. I look after the Support at Home Reform Branch here in the Department.

Today I’m going to talk through the recent announcement to stage Support at Home and I’ll also provide a program overview and give an update on the program design. I’ll then conclude with some next steps.

Before I go to the staging of the reforms I just wanted to remind people that the objective of Support at Home remains to better support older people to stay independent in their homes through access to high quality services when and where they need them and a program that’s efficient and sustainable and which adds social value through things like volunteering in the community and a program that responds as people’s needs change without being overly complicated.

So while Support at Home will now be implemented in two stages the end state remains, and that is to have a single program for in home aged care that brings the Commonwealth Home Support Program, Home Care Packages and short term restorative care together making it simpler for older people. We want to have a greater emphasis on independence through upfront supports like handrails and allied health to keep people active. There would be budgets for all clients aligned to the new classifications, and reasonable prices and client fees set by Government.

So with that end state in mind we are now going to stage implementation as announced by the Government on the 28th of November. As outlined in this slide the single assessment system is still scheduled to commence from July 2024, then from July 2025 Support at Home will commence by replacing the Home Care Packages and Short Term Restorative Care Programs. And the Commonwealth Home Support Program will transition to the new program no earlier than July 2027.

So what does this staging mean in terms of what the programs will look like? Well as I said in July 2025 the new Support at Home Program will commence bringing together the Home Care Packages Program and Short Term Restorative Care. In the first instance we will retain the current home care model in which an older person has a single service provider to manage and deliver all services. Existing Home Care Package clients will have a quarterly budget that aligns to their current Home Care Package since they will continue to receive the same services.

Home care and STRC providers will transition to a new funding model with a separate Assistive Technology and Home Modification Scheme. For CHSP providers and clients the existing program will continue until at least July 2027 and grant funding will continue under the current program during this period. I’ve seen a few questions coming through just now around will new people be able to continue to enter the CHSP and yes that’s the case. And some questions around will there be growth funding into the CHSP to continue to grow the program over that sort of period and that’s certainly something that we are currently considering how to continue that.

So we’re also looking to see whether there are opportunities to start to align some CHSP settings with Support at Home ahead of transition. So for example once the Independent Health and Aged Care Pricing Authority has advised on prices for Support at Home we’ll see how they compare to the CHSP unit prices. Similarly the Aged Care Taskforce is going to be advising on consumer contributions. And so we may want to start getting better alignment with Support at Home prior to transition but no decisions have been taken on that at this stage. And again I’m seeing a lot of questions coming through about CHSP pricing. That is something that we will be looking at but there will certainly be indexation for the 24-25 year.

From an assessment perspective the single assessment system will assess people into CHSP or one of the new classifications for Support at Home. The CHSP referrals will be similar to the way they operate now.

So why are we staging the implementation? So the staging reflects strong feedback we received from peak bodies and a range of CHSP providers that more time is needed for CHSP providers who face the most significant changes moving to Support at Home. With over 800,000 CHSP clients the Government felt it was critical to mitigate the risk of provider exits or failures associated with the changes. More time will also allow us to better understand and set budgets for CHSP clients. And we know many people using the CHSP only use services on a sort of short term basis and while we have good information from the recent assessment trial on the characteristics of CHSP clients the additional time is going to allow us to better understand the actual use of services particularly where it’s not ongoing.

Implementation of the new Assistive Technology and Home Modification Scheme will also benefit from the staging approach. We’re currently working with states and territories on using their existing loan schemes under Support at Home and by starting with Home Care Packages and STRC the new scheme will be smaller and more manageable. And I guess more broadly there are a range of ICT systems changes that we’re going to need to make in Government for the new program and staging will help to mitigate the sort of risks of the big bang change.

So if we go onto the next slide. What will in home aged care look like in July ’25? Well we’re still working through the finer details but this is the proposed high level approach. And I know this diagram has a lot in it but I’m just going to step through it to explain how it works for July ’25.

So starting from the left older people enter age care along that orange path through My Aged Care. That may be by phone or online, via their GP, via a care finder and so on. They’ll also be able to access advisory services like dementia, continence and vision support directly. That’s along the yellow path in the diagram.

After registering with My Aged Care a person will be referred to assessment either in the home or in hospital and under the new single assessment arrangements all assessment organisations will be able to assess people for all aged care services.

This may include referrals to the advisory services and approval for other aged care services such as residential aged care. In 2025 people with low needs would also be assigned to access services under the Commonwealth Home Support Program, so the pink box in the picture as occurs today.

People with higher needs who want to remain at home will be assessed for Support at Home. They will receive a support plan at assessment which in 2025 they will take to a single Support at Home provider similar to how the Home Care Packages Program operates today. I saw a question coming through about can we see an example of a support plan and I’ll take that on board as something we’ll try and make available early in the new year, an example of what we’re imagining that will look like. The support plan may include approvals for short term services and/or ongoing services that would be arranged through the single provider.

So the top purple box describes the three types of short term support available under Support at Home from 2025. Firstly the Assistive Technology and Home Modifications. We expect people to be approved for a sort of funding level for equipment, maybe low, medium, high. Some low risk equipment may be accessed immediately or some will require a prescription for example by an occupational therapist. There’s also a short term restorative pathway similar to the short term restorative care program today and this is typically a short term program of allied health support, multidisciplinary teams supporting people to build strength or capabilities. It will be available for up to 12 weeks rather than the eight weeks under STRC and we’re looking to expand the number of referrals into this stream compared to the current short term restorative care program.

And lastly we’re looking at establishing an end of life support for people diagnosed with three months or less to live and this would typically be an addition to existing ongoing services to boost the home support available during this period.

The lower purple box in the diagram is the ongoing services. So people approved for ongoing services at assessment will get a support plan with a classification and a quarterly budget. The plan will include a list of ongoing services agreed with the assessor that can be afforded within their quarterly budget but then people will be able to change these around as needed. All services will be listed in a service list for the program and providers will be separately funded to deliver care management services for their clients. Funded care partners will be available to help people make the most of their aged care services and care partners will be able to support people who might need more help as required.

In 2025 care partners will need to work within the older person’s service provider. One area we’ve been exploring is giving people the ability to pool their budgets together with their service providers so that the funding can go further to sort of help them across the group. So if you think about a retirement village you could imagine people pooling their funds with a provider to have a nurse on site or a mini bus service available as needed.

Previously we’ve talked about client budgets that reset each quarter so that unspent funds do not accumulate. We’re now proposing that people be able to retain savings of up to say around $1,000 for unexpected expenditure if they don’t fully expend their budgets. In the past we had put forward a concept of providers having access to a flexible pool of funds to support people as their needs change. This is no longer part of the program design given both the ability to save funds and the proposal to allow budget pooling to provide additional flexibility.

The area of the diagram between the two purple boxes on the right shows the payment arrangements. After a provider delivers services to a person they submit an invoice to the Government which is paid against the client’s budget or the provider’s care management funds. There will be price caps for each service set by Government based on the advice of the Independent Health and Aged Care Pricing Authority and providers may also receive additional grants if they meet a set of criteria and I’ll touch on our draft thinking on that shortly.

Lastly on this slide when a person’s needs change significantly they would need to be reassessed into a higher classification.

So that’s 2025 but what will in home care look like in July 2027? So this diagram’s a little different to the other. Firstly the CHSP will fold into the new Support at Home Program so no more CHSP program. Secondly the short term supports which have been provided or typically provided today through the CHSP will have a separate short term support pathway for time limited home help.

Third the single provider model will change and people will be able to choose to have multiple service providers.

And finally people will be able to choose to have a care partner who is independent of their service provider or service providers if that’s their preference.

So I’ll now go through some of the work we’ve been doing on the assessment classification and funding arrangements.

So we’re still working towards single assessment arrangements from July 2024 and by that as I said earlier I mean all assessment organisations can assess for all aged care services using a new integrated assessment tool. So we completed a trial using the new assessment tool earlier this year and completed 22,000 assessments. And the data collected in the trial is currently being analysed to help determine the final classifications and funding levels under Support at Home and we’re also finalising two other relevant studies. One’s looking at the provision of higher levels of care in the home and the other one is a clinical review of different personas reflecting people in the different classifications.

In terms of the assessment trial this slide just includes a few overarching statistics. As I mentioned we conducted 22,000 assessments. The median age was 80. Half the people assessed had no carer. Half of the people assessed had had a fall in the past year. Around 40% lived alone. 6% indicated they felt lonely or isolated all of the time. About a third had a garden or house that was considered unsafe by the assessor. And about a third had been admitted to hospital in the past 12 months.

For the next one I’ve just got a couple of slides but there are six mandatory assessment instruments in the new assessment tool covering activities of daily living, frailty, cognition, social needs and anxiety and depression. And across these six mandatory assessment instruments most clients had issues identified on four or more assessment scales and less than 1% had no issues identified on any of these instruments. Now that’s an interesting finding given there was a significant proportion of clients in the trial being assessed by regional assessment services for low level CHSP services.

On this one assessors indicated that 14% of clients would only require non-ongoing services and of these around two thirds received a service recommendation for non-ongoing allied health services such as occupational therapy, physiotherapy or an exercise physiologist. Other common service recommendations for this group were domestic assistance such as for a one off annual clean, nursing, such as for time limited services to change dressings on a wound, and transport for situations where a client’s informal carer is on holiday and is unable to take them to medical appointments during that time.

Okay. After assessment people receiving ongoing services will be assigned to a classification that aligns to their assessment outcome. Now we’re currently refining the classifications using the trial data and some of the other work we have underway and this is the sort of current draft structure – I think I’ve put this up at a webinar before – which has 11 classifications and the bottom two roughly align with the CHSP.

But as we do work to refine that part of that work is a clinical review of 100 personas based on assessments conducted in the trial to consider services that an individual might need and then see how that aligns to what could be afforded within their classification. So this relates to a 93 year old woman who lives with her family, has some medical conditions and a range of physical limitations. She struggles to walk, has had some recent falls. She needs help with transport, housework and shopping, and is unable to use online services. And a person with these characteristics has been assigned to a Level 3 Home Care Package at assessment and then the clinical review of this persona assigned two hours a week of personal care, one and a half hours a week of domestic assistance, four meals per week, a day a week in community respite, an hour a month of allied health, as well as an hour a week of care management. So what we’re doing is looking at where the personas fit in the classification system and how the recommended services align with those classification levels to inform the final classifications.

Part of our work on the classification system is also exploring a higher level classification that’s above a Level 4 Home Care Package. And I did see there was a question about this that’s come through as well. So Deloitte is doing a study for us assessing 200 people in residential aged care using the new assessment tool and they’ve also interviewed the families and informal carers of these people. And the study is looking at the services that could be provided in home with the higher funding that would have been paid to the residential facility to support the person through the AN-ACC funding model in residential care. And the study’s still being finalised but the initial findings suggest that around 88% of people who enter residential care would not really be able to be supported safely at home with a budget equal to their residential care funding. Of the remaining 12% who could be supported safely at home about half would still be expected to enter residential care as their preference or because their informal carers would still find it too difficult to support them at home even with the additional services. And that leaves around 6% of people who would otherwise enter residential care to take up a higher budget to stay at home instead.

All right. Look for those providers listening I thought I would just touch on how invoicing is likely to work under Support at Home. This is just a mock invoice to illustrate the sort of fields that would be reported. And the first thing I would say is please ignore the prices. They are just illustrative. The intention is that service providers can invoice as regularly as they wish, so kind of up to daily. The first column here lists the clients because we’re billing against client budgets. The second column lists the service types delivered across the period and the column shows the units of service delivered. Second last column is the subsidy rate and again please don’t read anything into these numbers. It’s just to illustrate the point. I’ve included total dollars in the final column. And I just want to highlight care management is identified separately as it’s not billed to the individual client budget but rather a care management pool for each service provider.

All right. This slide has our current thinking on the supplementary grants for providers in thin markets. We’d be looking at three to five year grants as well as retaining some provision for ad hoc grants as we have in the CHSP today. So to be eligible to apply there’s a range of draft criteria in relation to the size or location or specialised focus on different client cohorts by providers, and then eligibility criteria would then be that Support at Home prices are not sufficient to meet costs with some demonstration of organisational expertise, and we’d also look at contribution to the local community. So that’s our kind of draft criteria.

Other areas that we’ve been consulting on include care management. So we’ve been speaking with providers to determine some definition and scope around care management under Support at Home to test the possible funding model that would enable providers to be responsive to changing needs, and to determine what information sharing arrangements are needed to enable effective care management. So providers were supportive of some care management for all older people in the program and the concept of a care management fund according the characteristics of their clients. In terms of pooled funding as another area, we’ve been speaking to providers who deliver home care services in group settings such as retirement village or rural community to explore options for older people to pool their budgets. Providers have been supportive of the idea and are eager for the next level of detail.

And in relation to end of life care, as I mentioned earlier we’re looking at providing higher levels of care in the home for people who have been diagnosed with three months or less to live. Providers have sort of raised a range of just logical issues that we’ll need to consider like how to ensure urgent access to that support, streamlined processes when older people do transition in and out of home, as well as we’ll need to be thinking about how we complement state and territory specialist palliative care systems.

All right. So next steps. In terms of next steps on Support at Home we’ll be further refining the program design including through consultations in the first half of next year. From July we’ll be ramping up communications and change management activities for Home Care Package and STRC providers. And I was reminded in a session I did yesterday not to forget to keep the information flowing for CHSP providers through this interim period as well. I’ll be doing a Q&A session with providers and one with older people, family and carers next week. I know it’s the lead up to Christmas but it will be there for people who are available and have questions. I think yes they put up the QR codes and you can register through those QR codes. We’re certainly going to provide other opportunities in the new year for those that are not around but thought we would sneak a couple in before Christmas.

And as I said in the first six months of 2024 we’re going to be settling the program design that home care providers will need. And so some of the key areas where more detail is needed include around the Assistive Technology and Home Modifications Scheme, care management, restorative care, that end of life support I’ve been talking about, as well as support for our older First Nations people. And we’ve just started some engagement around how to make that work effectively. We’ll be putting some dates in the Engagement Hub hopefully in the next day or so for discussions about some of these topics in February.

The other thing I wanted to note is we’ve just put up a new branch in the Department to focus on Support at Home implementation. They’re going to have a focus on communications, provider readiness, change management, ICT design, program documentation, training and so on. So that dedicated focus will see our communications ramping up a lot more in the new year.

All right. I think that’s it from me so thank you and I’ll hand back to Amy.

Amy Laffan:

Great. Thanks very much Nick. And that concludes our presentations for today. We’ll now start our Q&A session. Just as a reminder, although I don’t think you need it because there’s over 200 questions there, that you can submit a question through the Slido Q&A function that’s on the right hand side of your screen. Just type in a question and hit enter. And while we probably won’t be able to answer all 200 questions today we will aim to provide responses on our frequently asked questions section on the new Aged Care Act Consultation Page.

So let’s go to our first question. And Mel this is one for you. There’s been a few questions on this theme.

Q:        Is the pace of change for significant reforms in the new Aged Care Act too fast? Wouldn’t it be more successful for consumers, the sector and Government for the Act to pass by July 2024 but with staggered starting dates for each of the reforms to take effect?

Mel Metz:

That’s a really good question. We want the reforms to happen as soon as possible but we certainly don’t want them to be rushed. We really want everyone to have the time to get ready for the new arrangements so that they work properly when they start. The current timeframes I think we can all acknowledge that they’re challenging but we are seeking your feedback on those timeframes as part of the exposure draft process and you’ll see in the consultation paper that there are some specific questions directed to that. If people have particular ideas about how reforms should be phased or prioritised or how long it might take for things to happen, some specific examples we’d really like to hear from you about those in the consultation process.

Amy Laffan:

Thanks Mel. Also we’ve had a few questions about sole traders and providers. So perhaps this is one for you Simon and a bit Mel.

Q:        Will the new legislation support sole traders as the current system does not?

Simon Christopher:

Did you want me to start on that one Mel?

Mel Metz:

Go for it Simon.

Simon Christopher:

Thank you. So the regulatory model envisages allowing sole traders to register for particular services really which is at the heart of the proportionate application of standards and other obligations across those registration categories. So yes sole traders will be able to register. I think in the phased approach to Support at Home there may be some funding programmatic limitations to sole traders coming in but also I think outside of those of course there will be a threshold piece for sole traders as to if they’re seeking to deliver nursing services and a full suite of services whether a sole trader could demonstrate all of the needs to achieve registration under say categories 1 to 5.

Amy Laffan:

I’m just checking Nick Morgan do you have anything to add to that on sole traders into the future?

Nick Morgan:

Just re-emphasising what Simon just said, that for 2025 as I said we’re looking at similar to the Home Care Packages Program today a single provider delivering all services. So that sole trader registration into Support at Home we would expect post-2027.

Amy Laffan:

Thanks. And while I’ve got you Nick.

Q:        Will the new categorisation remove all package levels or for clients will it remain the same?

Nick Morgan:

For existing clients the intention is for it to remain the same when the new program starts for you. So in other words if you’re on a Level 4 package you’ll move to a quarterly budget that’s just one quarter of your current package level each quarter. So it’s the same package level. And then new clients would be assessed into the new classifications or if you get reassessed you’d be assessed up into a new classification.

Amy Laffan:

Thanks. I might start with you Mel on this and then maybe Ingrid can come in.

Q:        How will the definition of ‘High quality care’ relate to the Quality Standards? So is it anticipated that the content of the Quality Standards will need to be further amended to be consistent with the definition of high quality care?

Mel Metz:

So the definition of ‘High quality care’ and the Quality Standards we think sit neatly together and we have thought about how the Quality Standards and high quality care operate together. They are different concepts though. So high quality care is really in the legislation to drive a shared understanding between providers, the Department, the Commission and everyone who receives services about what excellent care looks like. So it has a very different purpose to the Quality Standards themselves. It’s not measured in the same way that the Quality Standards are and that definition of high quality care in and of itself doesn’t have any penalties or breaches associated with it. It’s really an aspirational concept that we would like everyone to work towards over time. And I can hand over to Ingrid now to talk about the Quality Standards.

Ingrid Leonard:

Thanks Mel. Look the Quality Standards absolutely have at their heart this concept. And we’ll certainly continue to work with our colleagues internally if there are needing to be refinements to the language of the Standards but certainly that’s not sort of the current intention. Thanks Amy.

Amy Laffan:

Thanks very much. Okay. Next question.

Q:        I’m currently a CHSP provider. Do I need to be an approved provider to be deemed into the new regulatory model?

Simon?

Simon Christopher:

Thanks Amy. No is the short answer. All providers that are delivering funded aged care services, whether that’s under CHSP, Short Term Restorative Care Program, Transition Care Program, multipurpose service programs, NATSIFAC, or National Aboriginal and Torres Strait Islander Program, to name most of them, Flexible Aged Care Program, and Innovative Care Program – all of those providers will be deemed in to the new regulatory model when it commences. So if you are currently active and delivering Commonwealth funded aged care services there will be no impact on your continuity of care to older people. It will be seamless from one model to the next.

Amy Laffan:

Thanks very much. Nick question for you.

Q:        If we are ageing in place at home would we need to be pooling our money? We’re not in an aged care facility.

Nick Morgan:

Certainly not trying to make that a compulsory thing. So it would be an opt in thing and it’s really – I guess one way to think about it is – well the easiest way for me to think about it is if you’re in say a retirement village and that is your home that it’s almost like a subscription service to have access to for example transport that is run by your provider in the facility to provide access to move around as needed rather than only an amount in your individual budget when you use it. So similarly an onsite nurse. You pay a subscription to have access to an onsite nurse when you need them for as much time as you need. So it’s that kind of pooling idea to make the services go a bit further where it makes sense. And I don’t think it will make sense for all providers but where people are living in close proximity is what we’re sort of focusing on.

Amy Laffan:

Great. Thanks. So Mel for you.

Q:        Why is the Complaints Commissioner not independent and reporting directly to the Minister? Too often the current regulator protects providers and doesn’t work to achieve a good outcome on complaints or issues raised.

Mel Metz:

Thanks Amy. That’s a great question and I’ll just start my answer to that by saying with the position of the Complaints Commissioner what we’re very much trying to do is create a balance between independence of that position and also having the Complaints Commissioner and the complaints function integrated within the regulator so that the intelligence that comes through the complaints processes can be used by the Aged Care Quality and Safety Commission. So the model that we’ve proposed we think gets that balance right but I absolutely appreciate that people will have different views about how that should be set up. So we’re very happy to hear from people about their views on that through the consultation process.

Amy Laffan:

Thank you. Next question.

For you Nick.

Q:        How is Support at Home going to be substantially different from Home Care Packages between 2025 and 2027? I’m not understanding how it will really differ in practice.

Nick Morgan:

So there’s a number of differences. One is the incorporation of the Short Term Restorative Care Program and separately funded Assistive Technology and Home Modifications. So it’s really a much more upfront focus on independence and supporting people early on. At the moment people with a Home Care Package need to save their package funds and forego services to access a home modification or an expensive piece of equipment.

As part of the Assistive Technology and Home Modifications Scheme we are looking at providing access to sort of higher cost equipment as well that people don’t have access to now. So that’s one. Two, we’ll be looking at as I’ve mentioned the – I’ll just use the language of home care, but a Level 5 package, the higher level of support to help people stay home longer, along with that support for people who are in the last few months of life to get some extra services to be able to stay home. So that’s both new. That’s not available through the Home Care Packages Program.

In terms of the sort of general efficiency of the program at the moment we have prices and care management fees and other fees that we’ve had a lot of consumers come to us and say we have issues with the fees. So we commissioned the Independent Health and Aged Care Pricing Authority to look at prices that are if you like fully loaded prices, they incorporate back office costs and travel and so on, so that we don’t have to have separate fees in place which will also I think make the money go further and be able to support people in a more timely fashion. That’s the other thing we hope to do through the program, is with the Government ensure that we can enable people to access their Support at Home services in a timely fashion so we don’t have queues build up as we’ve seen in the past through the Home Care Packages Program.

Amy Laffan:

Thank you. For you Simon.

Q:        If standards don’t apply to registration categories 1 to 3 what are the quality systems that will protect older people accessing the services delivered under these categories?

Simon Christopher:

Thanks Amy. It’s a really good question and I think this kind of comes to – I mean I think we need to think about these services as part of a continuum of service that’s delivered to an older person. So I think Nick’s example earlier of the 93 year old person and their package talked to a number of services that they were delivering which in reality reach across those registration categories. So if you are a transport provider but also deliver in a whole series of other services such as nursing or personal care that will mean that your registration actually is subject to Quality Standards. And putting that to one side I think what we are really trying to do in categories 1 to 3 is recognise and apply a proportionate regulatory approach to those providers and recognise where there’s other co-regulation that exists for providers such as transport safety requirements within state and territory jurisdictions and not over-regulate where people can get on and do their jobs well by applying a set of standards or requiring them to do an audit which is unlikely to add to the quality of their service. There are a number of other new obligations just to finish it out in relation to more recent obligations, such as the Code of Conduct and others that do apply to everyone across the board.

Amy Laffan:

Thanks Simon. Yep. So Code of Conduct, worker registration, complaints. That’s going to apply regardless of whether the standards apply or don’t apply. So rest assured that there are certainly protections in place.

Nick.

Q:        Who determines how many hours of service are funded and if those hours are insufficient will there be a process for seeking additional time?

Nick Morgan:

So that’s at the point of assessment and I was talking about the assessment and classification system. And so the new assessment tool asks a series of questions that are in verified assessment instruments about your activities of daily living, cognitive issues, social support and so on. And on the back of the answers to those questions we’ll have a set of classifications with dollar amounts attached. So people with similar characteristics will land in a classification that has been determined to be a level of funding that’s appropriate to their needs to be able to access the hours of care that they need. And some of the work I talked about, we’ve got a clinical team taking the personas who sit within each of those classifications and saying this is the level of services that we reckon they need and then we’re comparing that to what the dollars are in the classification and we’ll be making sort of adjustments to the classes to make sure that we’re lining them up as best we can to those determinations.

So we’re trying to put a lot of upfront work in and we’ve done the big trial with 22,000 people to understand people’s characteristics so we can do a really good job of getting that classification structure to align the right level of resources to people’s needs. Now over time as needs change which they do, just as today if you’re on a Level 2 package and your needs change and you need to be reassessed to a Level 3 or a Level 4 package, that will be the same in the new system, that people will need to be reassessed for higher levels of support.

Amy Laffan:

Thanks. And I see it’s clicked past 3:30 so that brings us to the end of our time together. As I mentioned on the opening of today’s webinar I really encourage you to keep your eye out for announcements about the consultations on the exposure draft of the new Aged Care Act. The new Aged Care Act Consultation Page is now live on the Department’s website where you can find a copy of the exposure draft and consultation paper and a plain language summary. So that’s at health.gov.au/aged-care-act-consultation.

Thank you so much again for joining us today.

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