The long and winding road to reform

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We’re six years in and (still) counting! The journey to aged care reform has been challenging and difficult. The Royal Commission into Aged Care Quality and Safety was established on 8 October 2018 in response to systemic incidents and issues in Australia’s aged care sector. Find out what progress has been made.

After two-and-a-half years of work, the Commission tabled its final report to Parliament on 1 March 2021. Among its 148 recommendations was the fundamental proposal for a new Aged Care Act to transform the aged care system.

So what’s happened since?

Due for legislation in July 2024, the new Aged Care Act has been pushed back a further 12 months citing the need for additional consultation around several key elements of the reform. Nevertheless, since 2021, several reforms have been introduced:

  • 24/7 registered nurse coverage: Mandatory in all aged care homes.
  • Increased care minutes: From 200 to 215 minutes per resident by October 2024.
  • Food, Nutrition and Dining Hotline: For enquiries and complaints.
  • Star ratings: To compare residential aged care homes.
  • Wage increase: 15% for over 250,000 workers.
  • Capped fees: 20% for care and 15% for package management in Home Care Packages.
  • Face-to-face support: Available at Services Australia centres.
  • Quality indicator program: Expanded with six new health and wellbeing indicators.
  • Code of Conduct: To ensure safe, competent and respectful service delivery, including ‘banning orders’ to restrict or prohibit individuals from providing aged care or engaging in specific activities as aged care workers or governing persons of approved providers.

Funding challenges

With Australia’s ageing population, the demand for quality aged care has outpaced the sector’s capacity to pay or, indeed, deliver aged care reform to meet the recommendations of the new Aged Care Act.

In June 2023, the Aged Care Task Force was established to review funding arrangements, releasing its final report in March 2024 with 23 key recommendations across seven aged care funding principles, including:

  1. Supporting ageing at home: The system should support older Australians to live at home for as long as they wish and can safely do so.
  2. Sustainable funding: Establishing a more sustainable funding model for the aged care sector.
  3. Equitable contributions: Ensuring that older people make fair co-contributions to the cost of their aged care based on their means, while maintaining a strong safety net for those with low means.
  4. Transparency and simplicity: Making aged care fees and costs more transparent, fairer and simpler to understand for consumers.
  5. Quality and innovation: Promoting quality care, innovation and technological advancement in the aged care sector.
  6. Financial viability: Improving the financial sustainability of aged care providers and the sector as a whole.
  7. System reform: Implementing reforms to various aspects of the aged care system, including funding arrangements, accommodation models and service delivery.

The Taskforce acknowledged that further reform was still required, particularly in relation to workforce attraction and retention and improving the interface between aged care and the wider health system.

2024 Budget commitment

In May 2024, the Federal Government handed down their Budget, allocating $2.2 billion to improve aged care systems and services, including:

  • Technology and infrastructure: $1.2 billion for digital upgrades.
  • Home care packages: $531.4 million for 24,100 additional packages.
  • Workforce development: $87.2 million to attract and retain aged care workers.
  • Regulatory enhancements: $110.9 million for the Aged Care Quality and Safety Commission.
  • Palliative care: $35.7 million for ongoing programs and to upskill aged and primary care workforce.
  • Dementia care: $101.4 million for dementia care units, patient transition to aged care, research and CT awareness.
  • First Nations support: $137.3 million for health and aged care access through Aboriginal Community Controlled Health Care Services (ACCHS).
  • Veterans: $48.4 million for Home Care and Community Nursing
  • Transition care: $190 million for post-hospital short-term care.
  • My Aged Care Contact Centre: $37 million to reduce wait times.
  • Prescriptions: Five-year price freeze and 60-day prescriptions, effectively halving the cost of many common PBS medicines.
  • Vaccinations: More options to receive free vaccinations, including via pharmacists.

The budget also promoted stronger links between aged care and health systems to ensure older Australians receive necessary medical support in a safe and comfortable environment. This includes funding for outreach services, virtual care and complex care outside of hospital settings.

Roadblocks to reform

Many obstacles are blocking the path to aged care reform. Described as a ‘once-in-a-generation’ opportunity for systemic reform, the government cites more consultation is required to resolve issues around:

  • IT infrastructure and regulatory preparation to support implementation
  • Major considerations around how aged care will be funded in the future
  • Workforce strategy to attract, train and retain aged care workers
  • Balancing the interests and concerns of various stakeholders, including aged care providers, healthcare professionals and older Australians and their families.

Clock on background - aged care reform

So how are we tracking . . . six years in?

While the current government has committed to reform, the slow progress and potential for further delays could indeed make aged care a political football in future elections.

Aged care reform in Australia is needed urgently to ensure our older population receives the respect, dignity and quality of care they deserve. The Royal Commission into Aged Care Quality and Safety exposed heartbreaking instances of neglect, abuse, and substandard care making it clear that immediate action is crucial.

Every delay in implementing these reforms means more older people continue to suffer in a system that fails to protect and support them. These are our parents, grandparents, and eventually, ourselves. Having contributed much to society throughout our lives, we all deserve care and compassion in return. We all have a vested interest in getting this right.

Reforming the aged care system now is not just a policy necessity – it’s a moral imperative to ensure all people are kept safe, empowered and cherished as we age and access the services we deserve.