Budget Review 2021–22 Index
Rebecca Storen
Overview
The 2021–22 Budget implements the Australian
Government’s response to the Royal Commission into Aged Care Quality and Safety
(the Royal Commission) and a generational
plan for aged care in Australia. This $17.7
billion package comprises five ‘pillars’:
- $7.5 billion for home care over five years from 2020–21 (p. 100)
- $7.8 billion for residential aged care services and
sustainability over five years from 2021–22 (p. 102)
-
$942.0 million for residential aged care quality and safety over
four years from 2021–22 (p. 101)
- $652.1 million for workforce skills, training and registration
over four years from 2021–22 (p. 103) and
-
$698.3 million for governance and regional access over five years
from 2020–21 (p. 99).
Stakeholders have broadly welcomed the Australian
Government’s response to the Royal Commission and the associated $17.7 billion
reform package. The Australian
Aged Care Collaborative (AACC) said the reforms provided a pathway to ‘a transformed
aged care system’, with resourcing to meet the needs of older Australians. Council
on the Ageing (COTA) Australia identified the aged care reform package as a
‘serious and meaningful response’ to the Royal Commission.
There are several significant announcements in the Budget
and the accompanying Government plan for aged care. This is one of three
articles which provide an overview of the aged care budget measures with
reference to the relevant elements of the response to the Royal Commission. The
articles should be read in conjunction with one another. Information on
stakeholder views has also been split across the three briefs but, except where
specified, their commentary should be viewed in relation to the whole package.
This article focuses on residential aged care and workforce.
The other two articles cover:
- access to aged care, and care and support in the home, and
- quality and governance.
For background information and context, this Parliamentary
Library quick guide provides an overview of the Royal
Commission’s Final Report.
Residential care
The Royal
Commission identified systemic problems which have led to ‘unacceptable
outcomes’ in residential aged care (vol. 1, p. 7). It identified a wide
range of issues in Section 1.2 of vol. 1, including:
-
insufficient and uncertain funding for the provision of the care
and services required
- uncertainty of the cost of high quality care in the aged care
setting
- poor integration with the health care system
-
additional challenges experienced by special needs groups,
including people living in regional, rural and remote areas, and people from
the LGBTIQ+ communities
- use of chemical and physical restraints
- quality of food and high estimates of malnutrition
- quality of care for people with dementia and
- quality of end-of-life and palliative care.
Measures in this Budget seek to address a number of these
issues.
New funding model
A new funding model, the Australian National Aged Care
Classification (AN-ACC) model, will be introduced from 1 October 2022,
replacing the Aged Care Funding Instrument (Health
Portfolio 2021–22 Budget Stakeholder Pack (DoH Budget Pack), p. [112]).
This announcement follows several
years of work to build an evidence base for a new funding model. The Budget
provides $189.2 million for the implementation of the new model, including
$53.3 million for a two-year transition fund to support providers to make this
change (DoH
Budget Pack, p. [112]).
Independent Hospital and Aged Care
Pricing Authority
The Royal Commission identified the need for an independent
pricing authority, similar to the one in the public hospital system. The
Commissioners provided separate recommendations on some of the particulars of
the pricing authority, with Commissioner Briggs recommending the expansion of
the existing Independent Hospital Pricing Authority (IHPA), under Recommendation
11 (vol. 3A, p. 78). The Budget provides $49.1 million over five years
from 2020–21 to expand the IHPA to provide independent advice on aged care
pricing (DoH
Budget Pack, p. [145]).
Minimum staff time standard
The introduction of the AN-ACC funding model includes a $3.9
billion funding increase to support providers to meet the minimum staff time
standard (DoH
Budget Pack, p. [116]) proposed by the Royal Commission in Recommendation
86, points 2 and 3
(p. 419). This would mean a resident would receive a set minimum amount of
care time from nurses and personal care workers each day. The timeline and the
continued increase in staff times recommended by the Commissioners, with an
increase to 215 minutes of care staff time and a registered nurse on site at
all times by July 2024, have not been incorporated into the Government’s
response but perhaps will be identified as part of the new Aged Care Act (refer
to the article on aged care quality and governance).
Implementation of the standard will be staged as follows:
- July 2021—providers will be required to report their care
staffing minutes at a facility level with their annual financial return in
October 2021.
- July 2022—providers will be required to provide a quarterly
report on the care staffing minutes. In addition, they will be required to
provide monthly care statements to the resident and their family that outlines
the care the person has received and any changes of significance.
-
December 2022—the data on the care staffing minutes will be used
as part of the staffing star rating system.
- October 2023—a mandatory minimum care staff time standard will be
introduced. This standard will require an average of 200 minutes of care time
per resident per day, with a minimum of 40 minutes with a registered nurse. In
addition, a registered nurse will be required to be on site for a minimum of 16
hours per day (DoH
Budget Pack, p. [116]).
Structural reforms in residential
aged care
From 1 July 2024, residential aged care places will be
allocated to the person needing care and support rather than the aged care
provider. In 2017, the Home
Care Packages program shifted to the package being allocated to the person,
allowing the person to identify the provider they would like to receive
services from and make it easier for people to change provider and take any unspent
funding with them. This $3.1 million change will result in the cessation of the
Aged Care Approval Round and the shift away from bed licences. This measure
aims to ‘create a more innovative and competitive residential care market’ (DoH
Budget Pack, p. [118]).
The new financial and prudential framework for aged care
providers has been allocated $55.3 million and will be from 1 July 2021 (DoH
Budget Pack, pp. [118–9]). New requirements will be phased in from
1 July 2021, with the prudential standards becoming the ongoing responsibility
of the Prudential Regulator, once established (Australian
Government Response to the Final Report of the Royal Commission into Aged Care
Quality and Safety (Australian Government Response), pp. 87–8).
The Budget includes $43.5 million for three measures to
support the sustainability of residential providers, extending two programs and
establishing another (DoH
Budget Pack, p. [119]). One of the measures provides $32.6 million
for the establishment of a Structural Adjustment Program, which will build on
the Business
Improvement Fund to assist with the provision of care continuity for
residents.
Fee supplements
The Royal Commission recommended an immediate $10 increase
in the basic daily fee per resident per day, for daily living needs. Recommendation
112 (vol. 3B, p. 645) stated that this funding should require an
annual review and report on the adequacy of all the goods and services provided
to meet people’s basic living needs, with a particular focus on nutritional
needs. This $10 increase will be introduced from 1 July 2021 until 30 September
2022 (p. 76). Service providers will be required to report on the adequacy of
daily living services, with this reporting supporting the new star rating
system. From October 2022, this supplement will be absorbed into the new AN-ACC
funding model on an ongoing basis (DoH
Budget Pack, p. [114]).
In its initial
response to the Royal Commission, the Government announced a 30% increase
in the homeless and viability supplements until 30 June 2021. The Budget
extends this temporary increase until the end of September 2022, at which point
it will also be incorporated into the AN-ACC funding base. The Budget provides
an additional $3.2 billion for these increases (DoH
Budget Pack, p. [114]).
New accommodation framework
The Budget provides $5.5 million over four years to develop
a new Residential Aged Care Accommodation Framework, which will commence from
July 2024. This measure will include consultation with the sector on the use of
Refundable Accommodation Deposits and ways to support residential providers to
raise capital (DoH
Budget Pack, pp. [121–2]).
Workforce
In chapter
12 (pp. 371–437) of the Royal Commission’s Final Report, 13
recommendations are made regarding the aged care workforce (Recommendations
75–87), with seven key areas identified in its consideration of:
- strategic leadership and workforce planning
- building an aged care profession
-
education and training
- improving pay for the aged care workforce
-
getting staffing right—residential care
- getting staffing right—home and community care and
-
leadership and culture.
As recognised by the Royal Commission, the Department of
Health has funded the Aged Care Workforce Industry Council (ACWIC) to lead the
implementation of Australia’s
Aged Care Workforce Strategy (June 2018).
The Australian
Government’s response to the Royal Commission notes the recommendation of a
minimum mandatory Certificate III qualification for personal care workers as
being subject to further consideration (pp. 52–3), instead encouraging
aged care workers to access the training opportunities identified below.
Expanding the workforce
The Budget provides $9.8 million over two years from 2021–22
to extend the ACWIC’s care and support workforce campaign to attract people
into the workforce (Budget
Measures: Budget Paper No. 2: 2021–22,
p. 103). This measure responds to the Royal Commission’s Recommendation
76.5 to raise awareness of the career opportunities and pathways within the
sector. In addition, the Government notes that the ACWIC will collaborate with
the Human Services Skills Organisation, which is leading work focused on the
skills needs of the care sector and carer pathways (Australian
Government Response, pp. 50–1).
Personal care workers
The Budget provides $91.8 million over two years from
2021–22 to expand the personal care workforce for home care (Budget
Paper No. 2, p. 103). This
funding is intended to grow the workforce by 18,000 through:
- establishing a Home Care Workforce Support Program, which is
expected to attract 13,000 new workers, with grants available to organisations
to deliver supports to attract, train and retain personal care workers and
-
using existing programs, such as JobTrainer, to attract an
additional 5,000 workers, and to provide support to connect and guide people
through training (DoH
Budget Pack, p. [134]).
As discussed elsewhere in this Budget Review, an additional
33,800 training places for Certificate III in Individual Support (Ageing) will
be made available for new and existing personal care workers under the
JobTrainer Fund.
Health professionals
The Budget provides $27.3 million funding to encourage
nurses and allied health professionals to work in aged care through:
Current workforce
The Budget provides $135.6 million of financial support for
registered nurses who:
- work for the same aged care provider for a 12-month period, with
up to $3,700 for full-time and $2,700 for part-time employees, with an annual
bonus after 2 years
- work in rural and remote areas
- hold a post-graduate qualification in palliative care, dementia
leadership or infection prevention and control or
- ake on additional training responsibilities (DoH
Budget Pack, p. [134]).
The Budget provides that $49.4 million will be made
available to support training in the delivery of dementia and palliative care.
The dementia training will be available to general practitioners (GPs) and GP
registrars, as well as being made available in regional and rural areas (p. 135).
Worker screening
The Budget provides $105.6 million over four years to
introduce nationally consistent employment regulations across the aged care,
disability and veterans’ care sectors (DoH
Budget Pack, p. [139]). This will include a code of conduct,
pre-employment screening processes and a worker register. These changes will
come into effect from 1 July 2022. This initiative aims to better enable people
to work across sectors and reduce red tape, as well as improving the
identification of unsuitable workers. The existing Aged Care Act 1997
will be amended to reflect these changes (Australian
Government Response, p. 52).
Regional, rural and remote locum
support
The Budget provides an additional $25.1 million to expand the
Rural Locum Assistance Program, so aged care providers in rural and regional
areas will have increased access to a surge workforce (a temporary workforce
who are already trained and qualified in the positions needed) (DoH
Budget Pack, p. [135]).
Workforce data
The Royal Commission recommended improvements to workforce
planning, which included more regular collection of aged care workforce data (Recommendation
75, vol. 3A, p. 373). The Budget provides $6.3 million to improve
data reporting and enhancing linkages with other aged care data sets (DoH
Budget Pack, p. [135]).
Stakeholder reactions
The Australian
Aged Care Collaboration, representing aged care providers, has broadly
welcomed the Australian Government’s response to the Royal Commission,
including the workforce support with more care minutes per day and more
training and career development as being a significant step forward. Council
on the Ageing (COTA) Australia encouraged the Australian Government to
become a party to the upcoming Fair Work Case to establish an increase in hourly
rates for aged care workers, calling on the Australian Government to make
provision for additional wage support in the Mid-Year Economic and Fiscal
Outlook 2021–22.
The unions representing nurses and aged care workers have
expressed their frustration and disappointment with the aged care package. The United
Workers Union stated that the Budget ‘gives the illusion of action on aged
care but fails to address fundamental issues facing the sector’, and asked
‘where is the commitment to secure, well-paid, safe jobs necessary for quality
care of older Australians, with the Royal Commission forecasting there will be
an extra 80,000 aged care workers needed by 2030?’
The Australian
Nursing and Midwifery Federation (ANMF) claimed that the Budget fell well
short of the promised reforms and would be nowhere near enough to provide safe,
quality care for people living in residential aged care. The ANMF stated that
the introduction of regulated staffing hours was recognition from the
Australian Government that staffing is at the ‘heart of best practice care’,
but that it should have gone further and immediately introduced the minimum
staffing levels and the requirement to have an registered nurse on site 24
hours a day.