Residential Aged Care Services in Tasmania

On the edge of extinction

Before the Reforms of 1997 A cottage industry managed by people

of goodwill, grateful to the government of the day for their largesse

Clients who were expected to be grateful for their care

Regular direct involvement by local bureaucrats

Standards Monitoring teams reviewed care and claims for funds

Aged Care Act 1997 Competition Certification Accountability of

Providers Charter of Rights Accreditation Agency Validation Complaints

Resolution Scheme Business Model

Early Days Successful in forcing change Accreditation spelt out standards Certification established minimum

standards especially in relation to fire Stated expected building

requirements to be achieved by 2008 in relation to privacy and dignity

Large turnover of senior staff in organisations

Progress Standards improved Standards often assessed in subjective manner Low care residents paying bonds Providers able to borrow and service debt Development of improved standards of

accommodation Complaints Resolution Scheme-: a costly

impost

Business Model Flaws Emerge

Government-: Controls supply of beds Sets standards of accommodation Defines services to be provided Regulates fees to be charged Controls access to capital Controls who is eligible for care

Supporting Success or Ensuring Failure?

Funding not keeping pace with costs. Services predicting significant losses

Cap funding just before 30th June 2004 Penalty for this funding -more

compliance Kerosene baths – claw back on

funding

Elder Abuse The most common form of elder abuse is financial

abuse The most common abuser of the elderly is a family

member Nursing Homes now required to have national Police

Checks for all staff, volunteers and contractors who have direct access to residents.

This does not include GPs This represents an unfunded burden of approx $50

per person. Compulsory Reporting requirements needed new

policies, procedures, recording and monitoring systems and training for all staff. I estimate that this cost $3000 set up plus $50 per employee per facility per annum

Supporting Success or Ensuring Failure?

Elder Abuse- Costly regime for homes

Additional prudential requirements- no facility has defaulted on a bond

since the introduction of Aged Care Act 1997

Compliance or red tape frenzy? Annual workforce

census for each site

Annual Staff training statement for each site

Annual Financial Statements

Annual CAP Return

Residential Aged Care Funding Claim

Monthly per facility BAS ATO Quarterly Annual Prudential

Compliance Statement

How Much Regulation?

Certification duplicates the BCA andState and Local Government

requirements Accreditation 4 standards 44

Outcomes Police Checks Mandatory reporting Nursing Board

Accreditation

4 Standards with 44 Outcomes Service must be compliant at all times Spot visits (Can be triggered by a

complaint or a change of senior personnel)

Burden of Proof -Paperwork To satisfy accreditation Standards we must-: Achieve the outcome for each resident Provide evidence of how this is achieved How it is tested? How it is evaluated? How it is improved?

Performance-Accreditation

2000- 63.5 % fully compliant 2004- 87.9% fully compliant 2007- 91.8% fully compliant “Exceptional performance in the

industry…indeed in any industry’ ‘Australia is leading international

performance” CEO of Accreditation Agency, Sept 2007

Performance: 2003-present In this period out of over 2,800 facilities, 42

have incurred sanctions or just 0.015% NSW -8 facilities Victoria -12 NT- 1 Qld- 17 WA- 4 Tasmania- 0 ACT -0

Complaints

Why don’t we buy Twinings tea? Why haven’t you got this person a

Doctor? My father did not receive anything to

eat or drink for a week. My mother was. shouted at by a staff

member

How many instruments does it take to deal with a complaint?

Potential for a complaint to be running concurrently with-:

DOHA Health Complaints Commission/

Medical Council Nursing Board of Tasmania Guardianship Board Unions

Signs of Industry Stress Growth of costs of

compliance Small operators

depart the scene Consolidation of

providers

Signs of Industry Breakdown

Skill shortages especially RNs and sophisticated business skills

Industry becomes government whipping boy

Community expectations exceed capacity to deliver

Providers starting to report losses on operations

Situation decline Changed profile of

residents entering residential aged care

69% of residents in 2005-2006 were high care

No bonds for high care (Except for Extra Services places)

Costs of care increasing beyond funding levels

Costs of compliance growing as requirements increase

Government continues to react to exceptional events and impose further requirements

Desperation emerges Exit of some large

providers from the industry e.g Salvation Army, some Anglican services

Growth of property development in “retirement living”

Blurs community perception of options for supported care and viability

Residential Aged Care providers subsidising operations from unit developments

Closures

Small services close Government funding

sidelines low care Specialist services under

threat Dementia care too

expensive to provide Emphasis placed on

elderly remaining in their own home

Residential Aged Care- The end