Big changes are planned for aged care in 2025. But you’d never know from the major parties
- Written by Hal Swerissen, Emeritus Professor of Public Health, La Trobe University
There has been little new in pre-election promises for Australia’s aged-care workers, providers or the 1.3 million people who use aged care.
In March, Labor announced A$2.6 billion for another pay rise for aged-care nurses in addition to previous pay increases.
There’s been nothing substantial on aged care from Labor or the Opposition since.
Major changes are scheduled for the sector later this year, four years after the damning Royal Commission report into aged care. Yet no additional funding has been announced.
Estimates suggest funding is short around $5 billion to address losses by residential care providers or the shortfall in Home Care Packages.
What can we expect this year?
A new Aged Care Act will come into force on July 1 with a much greater emphasis on the rights of older people to get the care that suits their needs. This will mean:
a new system to regulate aged care
a new independent complaints commissioner
a new Support at Home program for older people who want to live at home, and in the community
changes to fees for residential aged care.
But a number of problems remain and it is not clear the reforms being introduced this year will fix them.
Access is still an issue
Access to aged care continues to be a problem, particularly in rural and remote areas. The system is difficult to navigate for often vulnerable and confused consumers and their families.
The government relies heavily on the My Aged Care website to inform older people and their families about aged care options. But this provides only basic information and it is difficult to get individualised support.
There is also a “digital divide” for a significant group who are unfamiliar with, and lack confidence in, using online services.
So we need a much greater emphasis on providing local “one stop shops” for personalised support and advice, particularly when people first enter the aged-care system. These services could be provided through Centrelink or new regional aged-care offices.
About one-third of older people say they need help to live at home. But to get assistance you need an aged-care assessment and that process too needs improving.
Waiting times for assessment have blown out, with reported delays of up to five months.
Older people prefer to stay at home
There are some concerns the number of new aged-care beds is not increasing fast enough. For instance, there are shortages of residential aged care in particular areas such as Canberra.
But admission times to residential aged care generally have not increased and occupancy rates are declining. This suggests older people would prefer home to residential care.
Yet increased demand for home-care packages is not being met.
For those who need more intensive services at home, waiting times remain stubbornly and unacceptably long because there aren’t enough home care packages.
Despite years of complaints, there are still more than 80,000 people on the waiting list for care at home.
The new Support at Home program will introduce an eight-level system of support. The highest level of home-care funding will increase to $78,000 to bridge the gap between funding for home and residential care. But many more intensive care packages for home care will be needed to reduce waiting times.
The Support at Home program also introduces significantly higher out-of-pocket costs for older people. Such costs for everyday services – such as meals, cleaning and gardening – currently funded through the Commonwealth Home Support Program will increase significantly.
Most controversially, there will also be greater out-of-pocket costs for “independence” services including personal care, social support, respite care and therapy.
Staff shortages still a concern
For aged-care providers, chronic workforce shortages are still the biggest problem. Recent increases in wages for aged-care workers, including nurses, are a step in the right direction. But wages are still low.
It remains hard to attract staff, staff turnover is high and staff are under-trained, risking the quality of care. Shortages are particularly acute in rural areas.
The aged-care industry is calling for streamlined migration, better training and incentives for regional workers to make up the shortfall. But so far no new election announcements have been made.
No real reform
Despite changes we’ll see from July, the organisation and financing of aged care remains fundamentally unchanged.
Overall, Australia’s aged-care system is still heavily privatised and fragmented. In 2022-23 there were 923 home-care providers, 764 residential-care providers and 1,334 home-support providers, nearly all in the private and not-for-profit sectors.
The Commonwealth continues to manage the sector through a cumbersome combination of highly centralised regulation and prescriptive funding contracts.
It has not put into place an effective, regional management structure to plan, organise and govern the sector to drive quality, innovation, equity, responsiveness and efficiency.
Nor has the Commonwealth been willing to adequately finance the system either through a levy, a social insurance scheme or via increased taxation. Instead, it’s upping the reliance on user fees to meet the cost of providing services.
Authors: Hal Swerissen, Emeritus Professor of Public Health, La Trobe University
