Living Longer. Living Better.
Government response to Productivity Commission Report.
Important Note – Please read:
LGBTI relevant items may be mentioned under terms such as:
- “Sexually Diverse”
- “other special needs” (Note: while technically covered under this term, the Government may have specific categories of the special needs groups in mind for particular initiatives (eg Building fund is targeting ATSI and Homelessness)
The sections I’ve identified of the various documents released on 20 April are pasted below for your information (with reference to the original document). Key LGBTI points are highlighted in red.
A few things in your mind:
Special Needs – Update the Act not the Principles
Special Needs Status is discussed in the fact sheet as going to be an update to the “Allocation Principles 1997”, and in the Government’s more detailed Aged Care Reform documents – it states it will be updated “under the Aged Care Act 1997”.
It would be preferable that the amendment occurs as a change to the legislation (section 11-3 of the Aged Care Act 1997), in order to make it harder for any future removal from the legislation. (i.e. It would have to pass both houses, and would be subject to a higher level of scrutiny by all parties) The Allocation Principles are created by Ministerial Legislative Instrument, which means it may be easier for a future government’s Minister for Ageing to remove LGBTI from the Allocation Principles, without it being detected until it was too late.
In referring to the update of Special Needs – it is recommended that people refer to “update the Aged Care Act” rather referring to the Allocation Principles to continue momentum for this change.
LGBTI Strategy –still waiting on response
The Productivity Commission said
“At a broader level, several submissions argued for the development of a national GLBTI aged care plan or strategy (ACON, sub. DR764; AIDS Council of South Australia, sub. DR571; Jo Harrison, sub. DR710; National LGBT Health Alliance, sub. 138). In the Commission’s view, consideration of the development of a specific GLBTI strategy is warranted given the anticipated increase in demand for aged care services by this group and the limited recognition of their needs and preferences in the current policy framework, delivery of services and accreditation processes.
Initiatives that increase the awareness of GLBTI issues within the aged care industry, such as training for aged care workers, are important in creating an environment in which sexual diversity is respected and catered for. There should be further initiatives between DoHA and peak bodies to help create an aged care system that can better cater for and respond to the needs and preferences of GLBTI older people. Service providers have an obligation to ensure both policies and practices acknowledge these needs and respond appropriately.”
Caring for Older Australians Final Report, page 255
During the National LGBTI Ageing Roundtable, Minister Butler said he saw the endorsement for a strategy as one of the PC recommendations, and would consider this recommendation, as part of the Government’s response to the PC report.
As yet, there is no indication of the Government’s response to this other than the final dot-point of the response to 11.1 in the Government’s response to the PC recommendations. “In addition, there will be consultation with organisations representing this diverse range of groups on the need for further strategies to support their needs within the aged care system.”
It may also be that the Government will consider LGBTI strategies as part of a broader consideration of all “special needs” or diverse groups.
An LGBTI Ageing Strategy is needed to ensure that all the small things that form part of other government initiatives are comprehensively looked at, for example:
- Confirmation LGBTI will be included in residential standards in 2012 and pathway for inclusion in Common Community Care Standards which are no longer under review, to enable effective monitoring mechanisms
- How to ensure LGBTI people are able to access appropriate provider through the gateway system (eg system flags) and ensure gateway staff are appropriately trained.
- How to include sexual orientation, sex and gender indicators in ageing related research and compile best practice initiatives for LGBTI
- Assistance for service providers now needing to discuss LGBTI clients as part of funding application (commenting on special needs), on sensitive and appropriate approaches (eg not forced outing of clients in order to have statistics)
- Educate LGBTI seniors on aged care system with targeted communications, including addressing fears and concerns of discrimination.
FACTSHEET: Living Longer. Living Better – Older Australians from Diverse Backgrounds
The Government will provide $24.4 million to assist older Australians with diverse needs, their families and carers to access information and aged care services that are sensitive to their backgrounds. People who will be supported include those from culturally and linguistically diverse backgrounds; people who are homeless or at risk of being homeless; people who are care leavers; and people from the lesbian, gay, bisexual, transgender and intersex (LGBTI) community.
In addition, the Government will provide $2.5 million to support older people from the LGBTI community by delivering specific sensitivity training for people who work in aged care.
The Aged Care Principles 1997 will be amended to include people in the LGBTI community as a special needs group, to further enable access to appropriate care suitable to their needs.
Living Longer. Living Better Document
Chapter 5 – Residential Care
Ensuring the sustainability of aged care services in regional, rural and remote areas ($108.0 million)
In general, it is more expensive to deliver aged care services in regional, rural and remote Australia than in urban areas. To ensure access to these services for all older Australians wherever they live the Government provides a viability supplement to eligible providers, on top of other funding. The viability supplement is also paid to providers that care for specific groups of highly vulnerable older Australians, including Indigenous Australians and older people who are homeless or at risk of homelessness.
Since 1 January 2010, the Government has increased the level of the viability supplement by more than 40 per cent in recognition of the higher costs faced by these providers. As a result of the aged care reform package, the Government is projected to provide more than $280 million in viability supplements to aged care providers over the next five years.
Aged care homes in regional, rural and remote areas can also face higher building costs than those in urban areas. The Government will continue to provide access to low cost finance to build or expand services in targeted areas through the one remaining round of the Zero Real Interest Loans Program. The Government is also streamlining its assistance to providers in these areas by combining its current aged care capital grants programs into a single Rural, Regional and Other Special Needs Building Fund. Around $51 million will be available for the Fund each year.
Chapter 7 – Consumer Support and Research
More support for consumer advocacy and community visitors ($30.8 million)
Older people who receive aged care services need to maintain links with the community, have a greater say in the way their care is provided and also understand and exercise their rights. To provide timely access to advocacy support and education the Government is increasing funding to the National Aged Care Advocacy Program. This will drive quality improvement and reduce the need for regulatory intervention. The successful Aged Care Advocacy Program will be expanded by 20%.
Funding will also be increased for the Community Visitors Scheme (CVS). This will help lonely or socially isolated older people receiving aged care services to remain connected to the community.
The CVS will be extended to allow group visits, to leverage off new technology in home care environments and to target cohorts including culturally and linguistically diverse (CALD) groups, Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) community, veterans and Indigenous Australians.
Chapter 8 – Better Health Care Connections
Promoting better practice and partnerships ($58.5 million)
The Government is introducing initiatives to encourage aged care providers to work with public and private health care providers and medical insurers to deliver short term, more intensive health care services. This will involve grants to develop models of service which will remove barriers including regulatory road blocks, and aged care funding adjustments. This will result in improved access to complex health care, including palliative and psycho-geriatric care.
The Government will support implementation of innovative ways of delivering aged care services, and support translation of research into everyday practice and actual care delivery. Innovations will be shared and promoted. Projects that promote innovation, improved care and better business practice in priority areas of care will be targeted. These include care for people with dementia, mental illness, and culturally and linguistically diverse backgrounds or other special needs, and palliative care.
Significant barriers exist for people receiving aged care, particularly people in residential care, to access primary health care. Multidisciplinary care – encompassing GPs, nurses, and other primary health care providers, specialists and aged care providers – will be increased. This includes telehealth trials and removing barriers to accessing primary care for people with particular needs, including Aboriginal and Torres Strait Islander people and those living in rural and remote areas.
Chapter 10 – Older Australians from Diverse Backgrounds
Ensuring older people from diverse backgrounds can access aged care services that are specific to their needs ($24.4 million)
Older Australians with diverse needs continue to find it difficult to access information and services that are sensitive to their backgrounds and circumstances.
The Government is providing additional funding through the Aged Care Service Improvement and Healthy Ageing Grants Fund to improve the skills and knowledge of aged care providers to meet the care needs of diverse populations. This will include staff training, information sharing and access to expert assistance, with particular focus on the needs of culturally and linguistically diverse (CALD) sexually diverse and care leaver older Australians.
Ensuring sexual diversity does not act as a barrier to receiving high quality aged care ($2.5 million)
Many older lesbian, gay, bisexual, transgender and intersex Australians have experienced considerable discrimination over the course of their lives. It is important that their sexuality or gender identity are recognised and supported in delivering aged care services.
The Government will support training within the aged care sector that is sensitive to the specific needs of these older Australians. Aged care providers will be better equipped with the necessary skills to address their care needs. This will help ensure that sexual diversity does not act as a barrier to receiving high quality aged care in either community or residential settings.
Governments Technical Documents (detailed reform document and response to PC report)
LIVING LONGER. LIVING BETTER. AGED CARE REFORM PACKAGE APRIL 2012
Consumer Advocacy and Community Visitors
As part of the conversations on ageing held across Australia, the need for additional support for consumers of aged care was one of the most commonly raised issues. This included the preference to receive care in the community over residential care, the need for better information about the quality of aged care services to enable consumers to make more informed decisions about the care they need, and the increased need for care recipients to be able to access social inclusion programs and advocacy services.
The Government is already supporting these activities through a projected $47 million over five years to provide one-to-one Community Visitor Scheme services in residential aged care facilities and a projected $14 million over five years for the provision of advocacy services and education to aged care service providers.
As part of the Aged Care reform package, the Government will provide an additional $30.8 million over five years to:
- expand the scope of the National Aged Care Advocacy Program services to meet unmet demand for advocacy services, particularly in rural and regional areas of Australia; and
- expand the existing Community Visitors Scheme (CVS) to provide CVS services to recipients of Home care services and provide group visits in residential facilities.
This measure will provide additional advocacy services to empower older people to make informed decisions about their aged care services through the National Aged Care Advocacy Program. Consumers require access to timely advocacy support and education to empower them to exercise their rights. Significant increases in the number of people accessing aged care and in the complexity of their needs has resulted in advocacy organisations struggling to meet demand for services, particularly in rural and regional Australia.
This measure will also expand the scope of the Community Visitors Scheme to include visitors for people receiving care in the home, and to enable group visits in residential care. The expansion will enable increased support for people with special needs, including veterans, people from culturally and linguistically diverse backgrounds, and people from lesbian, gay, bisexual, transgender and intersex communities. It will also explore innovative methods of promoting social inclusion thorough the use of technology. The additional Community Visitors Scheme funding will facilitate more than 348,000 visits to almost 32,000 aged care recipients in the first four years.
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Promoting better practice and partnerships
Poor access and linkages to the wider health system not only compromise the health of older Australians in aged care but also result in more than 100,000 unnecessary hospital admissions each year due to poor medication management alone.
As part of its aged care reforms, the Government will provide $58.5 million over five years for projects with a focus on prevention of hospitalisation for older Australians and improved access to complex health care through a number of initiatives, including:
- improved access to complex health care services including palliative and psycho-geriatric care for aged care recipients;
- support for aged care providers to enter into partnerships with public and private sector health care providers and medical insurers for the delivery of short term, more intensive health care services;
- improvements to the care and support provided to older Australians by supporting research translation and better evidence-based practice across the community and residential aged care sectors, to test and promote innovations in service delivery and integrated care models; and
- improvements to the health and well-being of older people by providing support for multidisciplinary care for aged care recipients in both residential and community settings and the opportunity to test the use of video consultations to improve access to GPs for residents in aged care homes.
The Encouraging Better Practice in Aged Care (EBPAC) initiative, which is part of the ACSIHAG Flexible Fund, aims to encourage and support the uptake of evidence-based, person-centred, better practice in Australian Government subsidised aged care services, through a focus on improving staff knowledge and skills and developing supporting resources/materials, to improve outcomes for aged care recipients.
While there are a number of existing ad-hoc evidence-based guidelines to assist aged care staff in providing appropriate care for residents and people in the community, there is a need to establish practices, particularly at a strategic/business integration level within aged care services, to translate the evidence into everyday practice. This includes focusing on clinical aspects as well as non-clinical better practice which enhances business sustainability and increased consumer choice, such as integrated models of care.
Without support to implement evidence-based better practice, the industry will not be in a position to meet the future demand for services. Funding this proposal will build on the success of the EBPAC initiative and lessons from other innovation based initiatives (such as the consumer directed care trial) and provide a platform for innovation to launch the aged care sector into the post-reform environment.
This measure will target projects that promote innovation, improved care outcomes and business model sustainability in areas of care that have been particularly identified as priorities in the reform process, including care for people with dementia, care for older people with mental illness, care for people from culturally and linguistically diverse backgrounds or with other special needs, and palliative care.
This measure will also help ensure that low cost innovations to aged care practice in residential aged care and in the community will be shared and promoted. These might include innovative use of assistive technology and Personally Controlled Electronic Health Records, new governance models, and new, more diversified models of care, including innovations targeted at better integrating other types of care, including disability services or short-term or restorative care. It will also assist in fostering a culture of innovation in the aged care sector and provide a vehicle for the government to promote holistic models of care and consumer choice.
A range of initiatives will also be supported to encourage aged care providers to enter into partnerships with public and private sector health care providers and medical insurers for the delivery of short term, more intensive health care services. This will deliver improved access to complex health care, including palliative and psycho-geriatric care, for aged care recipients. This will help to improve the quality of health care for aged care recipients, prevent hospital admissions and shorten hospital stays, and build a more skilled and flexible aged care sector.
Seed funding will be available to aged care providers to build relationships with public and private hospitals and medical insurers to develop models of service that can be copied by other providers in the future.
Funding will also be available to assess and develop options to address barriers, for example regulatory impediments, to the provision of short term intensive health care services in the aged care setting, including both in-reach services from the hospital sector and diversification of the aged care sector into providing a broader range of health care services. Consultation with states and territories, Local Hospital Networks, medical insurers and aged care providers will be an integral part of this process. This work will include consideration of the interaction with existing programs, such as Transition Care, so as to minimise overlap and ensure new initiatives build on current action.
The Government will also consult with stakeholders on possible changes to the Aged Care Funding Instrument to better support aged care providers who are in a position to provide higher levels of specialised care, such as palliative care, to aged care recipients. This work will include consideration of approaches canvassed in the ACFI Review such as the development of a new short term complex health care supplement.
Despite Government incentive programs, there remains a shortfall in the number of GPs willing to travel to residential aged care facilities to provide face-to-face services. Where GP services cannot be accessed in a timely manner older people are often unnecessarily admitted to hospital.
This measure will address this issue and improve the health and well-being of older people by providing support for increased provision of multidisciplinary care for aged care recipients, encompassing general practitioners, nurses and other primary health care providers, specialists and aged care providers. New models for improving access by care recipients to primary care will be trialled, including the establishment of a multidisciplinary care coordination and advisory service (Aged Care Coordinators), and provision of GP consultations to aged care recipients in residential aged care facilities by videoconference.
These projects will support better links with the health system in both the community and residential settings and promote multidisciplinary care for aged care recipients. Early access to a comprehensive health care assessment and treatment planning through a multidisciplinary approach, including any relevant specialists such as geriatricians, contributes to better health outcomes. Importantly, a multidisciplinary approach to care involving medical, allied health, nursing and care support staff will also support better medication management, an identified issue for many older people that results in around 100,000 preventable hospital admissions for this group each year.
This measure will also provide funding for an establishment analysis of primary health care services, assisting the Australian Government to consider possible improvements in access for aged care recipients. Sustainable solutions will be developed in consultation with the aged care and health industries. Considering access to primary care for older populations with particular needs and barriers, including Aboriginal and Torres Strait Islander people and those living in rural and remote areas, will be a key feature of the review.
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Older Australians from Diverse Backgrounds
Through the aged care reform package, the Government will provide $192.0 million over five years to better support the aged care needs of older Australians from diverse backgrounds:
- $24.4 million to ensure older Australians from diverse backgrounds can access aged care services that are specific to their needs, by improving the skills and knowledge of aged care providers to meet the care needs of people from diverse populations, including through staff training, and access to expert assistance. Information on aged care will also be made more accessible to older Australians and their carers from diverse populations.
- $43.1 million to expand the National Aboriginal and Torres Strait Islander Flexible Aged Care program by an additional 200 places to allow more Aboriginal and Torres Strait Islander people with complex care needs to stay close to their home and country while receiving culturally appropriate care.
- $114.8 million to provide better services to veterans’ with an accepted eligible mental health condition who are receiving aged care through Home Care packages or in residential aged care.
- $2.5 million to help ensure that sexual diversity does not act as a barrier to receiving high quality aged care, by supporting training within the aged care sector that is sensitive to the specific needs of older Australians in the lesbian, gay, bisexual, transgender and intersex (LGBTI) community.
- $7.3 million to expand the Assistance with Care and Housing for the Aged program to better link older people who are homeless or at risk of homelessness with suitable accommodation and care services.
Ensuring Sexual Diversity Does Not Act as a Barrier to Receiving High Quality
The Productivity Commission’s report Caring for Older Australians noted that many older Australians from the Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) community. have experienced considerable discrimination over the course of their lives and this may continue in aged care where their sexuality or gender identity may not be recognised or supported. Both during the inquiry and in community consultations following the release of Commission’s final report, groups representing the LGBTI community have strongly advocated for the need to improve the provision of aged care services for older LGBTI people, including by ensuring aged care workers receive sensitivity training.
In 2010, the Government provided funding to ACON Health Ltd (formerly Aids Council of NSW) to deliver LGBTI sensitivity training to residential aged care providers in NSW. The training raised awareness of LGBTI issues among service providers and the broader community. The project was designed as a pilot with a view to expanding the training for national applicability after an evaluation had taken place.
An external evaluation of the ACON project recommended that support for the program should be made available nationally; that further resources should be developed to support workshop participants educating other staff in their workplace and implementing workplace changes; and that the program should be expanded to include home care settings.
As part of the Aged Care Reform package, the Government will provide $2.5 million over five years to help ensure that sexual diversity does not act as a barrier to receiving high quality aged care in either community or residential settings. The funding will support training within the aged care sector to improve the sensitivity of aged care staff to the specific needs of older people in the Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) community.
Older people in the LGBTI community will also be included as a special needs group under the Aged Care Act 1997, which will help ensure that members of the LGBTI community can access appropriate care suitable to their needs.
This measure aligns with the Government’s social inclusion agenda and is consistent with Australia’s human rights obligations. Supporting activities that ensure recognition, awareness and respect for older Australians from the LGBTI community will have a significant benefit on their wellbeing and facilitate social inclusion.
AUSTRALIAN GOVERNMENT RESPONSE – PRODUCTIVITY COMMISSION’S CARING FOR OLDER AUSTRALIANS REPORT (APRIL 2012)
|Catering for diversity|
|11.1||The Australian Government should ensure the accreditation standards for residential and community care are sufficient and robust enough to deliver services which cater to the needs and rights of people from diverse backgrounds including culturally and linguistically diverse, Indigenous and sexually diverse communities.||Supported.|
The current accreditation standards recognise that each resident is different, applying general standards to each resident’s care needs regardless of race, culture, language, social or religious choices. The Government is currently undertaking work to review, improve and streamline these standards. Responding to diversity is a priority in this work. Extending the role of the Aged Care Standards and Accreditation Agency to community care, will assist in supporting more consistent application of standards and recognition of diversity across residential and community settings.
More generally, the Aged Care Reforms include a strong focus on supporting diversity and ensuring that older Australians from diverse backgrounds can access information and aged care services that are sensitive to their needs including people living in rural and remote areas; people from culturally and linguistically diverse backgrounds; people who are homeless or at risk of being homeless; people who are care leavers; and people from the lesbian, gay, bisexual, transgender and intersex (LGBTI) community. Initiatives include:
|11.4||The Australian Government should ensure that rural and remote, and Indigenous aged care services be actively supported before remedial intervention is required.|
This support would include but not be limited to:
|Supported in principle.|
The Aged Care Reforms support a number of measures to improve the access of older people living in rural and remote areas and Indigenous Australians to aged care services:
In addition, current programs to provide management and other support, for example to indigenous services, will continue.
|11.5||The Australian Government should partially or fully block fund services where there is a demonstrated need to do so based on detailed consideration of specific service needs and concerns about timely and appropriate access. Such services might include:|
Direct access to these services would be available immediately but care recipients would be required to undergo an Australian Seniors Gateway Agency assessment within three months of entering such care services and, where appropriate, pay relevant co-contributions.
The review of service types delivered through the new Commonwealth home support program will provide an opportunity to consider the most appropriate ways to fund community based services to special needs groups. While in time it is envisaged that older people will increasingly access aged care services through the new Gateway, they will continue to be able to access basic care and support through existing mechanisms. However, the intention is to work towards standardising assessment protocols for these types of services to ensure older people are treated consistently regardless of their point of entry.
The Government notes that there is a range of ways of providing additional support for services specialising in providing access for special needs groups such as homeless and Indigenous Australians, including the viability supplement and targeted capital funding grants, and flexible funding arrangements for Indigenous and multipurpose services.
The Aged Care Reforms include a combination of block funding grants and other strategies. The National Aboriginal and Torres Strait Islander Flexible Aged Care program, to be expanded as part of the reform package (see the response to recommendation 11.1), essentially involves flexible funding arrangements, similar to block grants, that provide services with greater funding certainty and flexibility in how funding is used.
The Government will also continue to provide additional support to complement mainstream funding arrangements for example by providing continuing recent enhancements to the viability supplement (see response to recommendation 11.1) and better targeted capital grants funding (see the response to recommendation 7.5). The advantage of this approach is that it enables services to operate within mainstream financing and quality assurance arrangements, which has equity and efficiency advantages, while also providing additional support to recognise additional viability issues for such services.