Budget Review October 2022–23 Index
Rebecca Storen
Key figures and trends
The Budget October 2022–23 provides a ‘$3.9
billion package of reforms’ for aged care, predominately for the continued
reforms in response to the Final
Report from the Royal Commission into Aged Care Quality and Safety, noting
that costs will be partially met from existing resourcing of the Department of
Health and Aged Care (Budget
measures: budget paper no. 2: October 2022–23: 126). In addition,
funding has been provided for aged care under the COVID-19 Package to extend
existing measures, also to be partially funded through existing resourcing (Budget
paper no. 2: 119–123). This overview will briefly consider select
measures, with a focus on ones requiring legislation and agreements for
implementation.
Funding for aged care services is the fifth most expensive program
in the Budget, at an estimated $27.1 billion for this financial year (Budget
paper no. 1: October 2022–23: 180). The pattern of expenditure over the
forward estimates has changed from the March Budget and, in comparison, is
reduced for the first two years, but higher for the second two (Budget
paper no. 1: March 2022–23: 144). It is estimated that expenses for
aged care services will increase by 17.0% in real terms from this financial
year to 2025–26 predominantly due to the anticipated staffing requirements from
July 2023 alongside expected growth of the residential aged care population (Budget
paper no. 1: 189).
In contrast, the October Budget estimates higher expenditure
for aged care quality across the forward estimates compared to the March Budget,
notably with an estimated $1.7 billion for 2022–23, with a significant decrease
of 87.8% in real terms by 2025–26 due to the cessation of 2021–22 Budget
measures and COVID-19 support measures (Budget
paper no. 1: 189–190).
Staffing and the workforce
The Budget provides $2.5 billion over the forward estimates
to introduce new requirements for residential aged care services for a
registered nurse (RN) to be on site at all times and minimum time requirements for
the availability of care (Budget
paper no. 2: 125). These requirements will commence from mid-2023.
In its Final Report the Royal Commission noted:
There are many ingredients that enable the provision of high
quality and safe aged care, but it cannot be achieved without the sector having
enough staff with the skills and time to care. Adequate staffing numbers with
the right skills are a necessary but not sufficient piece of that puzzle.
According to a research study we commissioned, 57.6% of Australian [sic]
living in residential aged care receive care ‘in aged care homes that have
unacceptable levels of staffing’. This is entirely unacceptable and partly
explains the extent of substandard care that we describe [elsewhere in the
final report]. (Volume
3A: 418) [references removed]
The Royal
Commission went on to make Recommendation 86: Minimum staff time standard
for residential care, consisting of 8 Parts and including:
- introducing a requirement for residential facilities to meet a
quality and safety standard on minimum staff time
- from 1 July 2022, the minimum staff standard should be at least
200 minutes of staff time per day for the average resident, with at least 40 minutes
being provided by an RN
- this
standard should require, at a minimum, an RN to be on site for the morning and
afternoon shifts (16 hours per day)
-
from 1 July 2024, the minimum staff time should increase to 215
minutes per resident per day, with a minimum of 44 minutes being provided by an
RN, with an RN always required to be on site
- the minimum staff time standard should be linked to the
casemix-adjusted activity based funding model (p. 419).
The Morrison
Government accepted this recommendation stating that the introduction of
the new Australian National Aged Care Classification funding model on 1 October
2022 would provide funding to meet the minimum 200 minute care time requirement
as well as having a registered nurse on site for 16 hours a day. The
minimum care time requirement was to become mandatory from 1 October 2023, with
the new Aged Care Act to set the minimum staff time standards for residential
care (pp. 56–57). The recommendation for a new Act was accepted and intended to
commence on 1 July 2023 (p. 1). The Albanese Government has not yet announced a
commencement date for a new Act. It did, however, introduce the Aged
Care Amendment (Implementing Care Reform) Bill 2022, that introduces a
requirement for an RN on site and on duty at all times in residential aged care
from 1 July 2023, with a mechanism for exceptions being outlined in the Quality
of Care Principles 2014. As explained in the Explanatory
Memorandum, care minutes targets will be specified in new care minute
standards and will be mandatory from 1 October 2023, starting with an average
of 200 care minutes and include 40 minutes with an RN, and increasing to 215
minutes from 1 October 2024. These requirements will be in subordinate
legislation (consistent with the current Aged Care Quality Standards) (p. 21). For
further discussion on the amendments, please see the Bills
Digest for the Aged Care Amendment (Implementing Care Reform) Bill 2022.
The Budget provides $2.5 billion over the forward estimates
to introduce the RN and care minute requirements (Budget
paper no. 2: 125). As noted by the Parliamentary
Budget Office in its election commitment costing, the financial
implications of these requirements will be sensitive to wage changes and the
anticipated number of workers required (p. [3]). This is of particular note as the
Fair Work Commission is currently considering the Work
value case, with applicants seeking a 25% increase to the minimum wages of
aged care employees in 3 awards. The Government
has stated that it will fund the outcome of this case, which it reaffirmed in
its submission for the Work value case in late August 2022 committing to
provide funding to support any increases in wages. However, it also noted it was
still considering the most appropriate way to fund any wage increases and was
not in a position ‘to state with certainty the precise quantum or the extent of
the funding’ (p. 3). In its work to set prices for aged care, the Independent
Health and Aged Care Authority is expected to factor in wage increases that are
financially supported by the Government for the casemix funding model (Volume
3A: 418).
The Aged &
Community Care Providers Association has welcomed the aged care investment
in the Budget as an important step to fixing the system and realising the
vision set out by the Royal Commission. In welcoming the funding for additional
care minutes, it notes that ‘there is no escaping the fact that it requires us
to recruit thousands of extra staff in the context of record low unemployment
and a global shortage of nurses’.
National registration scheme
The Budget provides $3.6 million this financial year to
establish a national registration scheme and the code of conduct (Budget
paper no. 2: 125). The Government will provide $0.2 million to each
state and territory to support the establishment of the Scheme (Federal
financial relations: budget paper no. 3: 36)
Workforce screening and regulation has been discussed for
some time in aged care, including by the Royal Commission. The Commissioners
noted that, while they differed on their recommended approach to a registration
scheme, they agreed that one was needed for personal care workers and would
assist in professionalising and improving the quality of the workforce (it
recommended including a mandatory minimum qualification and code of conduct) (Volume
3A: 392).
The Aged
Care and Other Legislation Amendment (Royal Commission Response No. 2) Bill 2021,
which lapsed with the dissolution of the 46th Parliament, proposed a code of
conduct and a national registration scheme. Stakeholders raised concerns about
both the registration scheme and the code of conduct proposed under this Bill
(see the Bills
Digest for details). The Aged Care and Other
Legislation Amendment (Royal Commission Response) Act 2022, which
passed both Houses in August 2022, was very similar to the earlier Bill but
with one key omission: the national registration scheme had been removed. The code
of conduct is expected to commence in December 2022. In the debate of the
latter Bill, Minister
Gallagher stated that the Government was committed to implementing a
national registration scheme:
[The] scheme will include ongoing training, English
proficiency and criminal history screening to further professionalise the aged-care
workforce. The government is currently exploring options on the best way to
implement this scheme … As a result, former schedule 2 has been removed from
the royal commission response bill in the interim so that sufficient care and
attention can be given to designing the new scheme, which will be delivered as
part of the new aged-care act. [p. 338]
Inspector-General of Aged Care and
Complaints Commissioner
The Royal Commission made several recommendations to enhance
aged care governance, including the establishment of an independent office of
an Inspector-General of Aged Care in Recommendation 12. It proposed that
the Inspector-General would be responsible for investigating, monitoring and
reporting on the administration and governance of the system (Volume
3A: 80–81). The Budget provides $38.7 million over 4 years from
2022–23 to establish the Inspector-General and the Office of the
Inspector-General as a Statutory Agency (Budget
paper no. 2: 127).
In addition, the Budget provides $9.9 million over 2 years
from 2022–23 to (re)establish the Aged Care Complaints Commissioner. This role,
which
was transferred to the Aged Care Quality and Safety Commission when it was
established on 1 January 2019, will operate from within the Commission (Budget
paper no. 2: 125).
The Older
Persons Advocacy Network welcomed the measures in the budget, including the
Aged Care Complaints Commissioner and the Inspector-General of Aged Care,
noting that it ‘will address the end‑to‑end issues in aged care and
looking to longer-term system improvements’.
Support at Home Program and program
extensions
The Government has pushed back the anticipated commencement
date for the Support at Home Program to 1 July 2024; the Morrison Government
had planned its introduction from July 2023. As such, existing home and
community programs will continue for an additional 12 months, with existing Commonwealth
Home Support Programme grants again needing to be extended.
The Budget provides $23.1 million in 2022–23 to undertake
activities to assist the Support at Home Program, such as a trial of an
integrated assessment tool and the establishment of a Service List Advisory
Body (Budget
paper no. 2: 127). At this stage, the trial
is anticipated to commence in the first half of 2023 and will have a
particular focus on the assessment of Aboriginal and Torres Strait Islander
peoples to inform the work of the Indigenous assessment organisations expected
to be part of a consolidated and independent assessment process (p. 32).
Disability support for older
Australians
The National Disability Insurance Scheme (NDIS) includes an age-based
eligibility criterion that requires people to be under 65 years of age at
the time they apply for the Scheme. When jurisdictions agreed to the national
rollout of the NDIS, some older
people living with disability who were receiving state-based disability
services were ineligible for the NDIS. The Council of Australian Governments
then agreed that the Australian Government would implement the Continuity of
Support (CoS) Program that would be available for this group. The CoS
Program had a staged implementation and commenced on 1 December 2016
in line with the NDIS rollout, with the program now closed to new clients (p.
5).
More recently, three years of funding was provided in the 2020–21
Budget to replace the CoS Program with the Disability Support for
Older Australians (DSOA) program ‘to ensure that older Australians with
disability who were not eligible for the National Disability Insurance Scheme
continue to receive the supports they need’ (p. 90). The Budget provides $53.5
million to extend the program by 12 months until 31 December 2023 (Budget
paper no. 2: 127).
COTA
Australia congratulated the Government for prioritising aged care reforms
and noted that much remains to be done to fully implement the Royal Commission
vision and, among its prioritise for the next Budget, it will be strongly
focused on improving services for people with severe disabilities.
Systems and Government offices
The Budget provides $312.6
million over 4 years for information and communication technology (ICT) systems
maintenance and improvement, which is expected to improve platforms, provide
better connectivity and streamline processes for providers and ensure
up-to-date information is available through My Aged Care (p. [7]). The Budget
also provides $68.5 million to expand the Department of Health and Aged Care Regional
Stewardship of Aged Care network (Budget
paper no. 2: 127). The trial of this model was initially
announced in 8 regions in the 2021–22 Budget and was flagged for broader
roll‑out subject to evaluation.
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