“Getting it right” proving the greatest challenge; How once in a lifetime change means providers must ready for protracted resource strain

“It was clear from the Aged Care Royal Commission that a rights-based Aged Care Act had to happen.” Alex Lynch of peak body Catholic Health Australia notes the collective sentiment from the sector after the handing down of findings in 2021. “Significant changes had to occur to shift the sector towards a more person-centred approach and long-term sustainability.” And that change has come with all its intended and unintended consequences in the reform act, once delayed already, to land November 1.

July 1 is a no go – a sector wide sentiment

Lynch highlights from the earliest of stages, the lift to get the changes “right” took significant time, “The pace of the reforms resulting from the initial delay in passage through Parliament meant that opportunities for engagement between the sector and the Department were limited.” Where July 1 was seen to be viable, “By the end of 2024, genuine co-development to ensure the smoothest possible implementation of the Act was underway, but it was pragmatic of the Government to recognise more time was needed to be ready for implementation”, it became evident it wasn’t.

Big change, more time

When speaking to providers across CHA members it’s evident that there was a ubiquitous understanding of the scope of the transition, and further time was needed. In lobbying for the delay, Lynch explains,

“The whole sector wants to get this right. That means ensuring providers have time to have fully informed discussions with older Australians with all necessary information about the reforms – particularly the Support at Home Program – available.”

For a July 1 commencement date, that necessary information was not present for providers, nor the time to have the appropriate conversations with older Australians, belying the “person-centred approach” that is the basis of the entire act reform.

After collective lobbying from across the sector, including CHA, Ministers Butler and Rae acknowledged and deferred the reform act to November 1. However, the work was just beginning.

All hands on deck

Lynch acknowledges the significant resource contribution by providers within the CHA membership. “A once-in-a-generation shift to a new Aged Care Act has required a massive lean-in from Catholic providers.”

Notwithstanding the in-house preparation required to meet the upcoming compliance and systems changes, but to also guide the formulation of the act itself, CHA heard from countless executives and front-line staff that are expected to make it all work.

“This hasn’t just been to get their own services ready for the new Act, but to influence the Act to ensure it meets the needs of older Australians to the greatest extent possible.”

Getting it right has meant financially and temporally allotting resources to assist with this goal. There is a cost to be understood by the Government from Providers leaning in to work towards shaping this once in a life-time shift, and that lean in has been and will be protracted.

“From before the first Exposure Draft of the Act existed, Catholic providers have been engaged with older Australians, other providers, unions, the Government, Opposition, Parliament more broadly and the Department to ensure the Act delivers for older Australians.”

“It has been a huge undertaking for the not-for-profit Aged Care sector, as the public would expect from the first new Aged Care Act in 30 years.”

The size of the lift

Lynch highlights the scope of the change and impact on providers in CHA’s membership and on the wider sector as well, “The level of detail involved in transitioning to a major new regulatory, care and funding environment is significant.”

Critically, CHA has communicated with the Government the impossibility to handle the full scope of the reform at once, “CHA has consistently worked with the Government and the Department to highlight key priorities, acknowledging that the sector cannot work on all areas of reform at once.”

Providers need clarity in the act

Lynch describes working with providers in CHA’s membership and consequently consulting a pragmatic sectional approach to working on the reform to Government. From a provider perspective, “our priorities have been to ensure safety, continuity of care and the viability of the aged care sector.”

Where gaps in information were present in the language of the reform ahead of July 1, Lynch notes, “CHA and Catholic providers have worked with the Government to improve the Act at all points, from the exposure draft, through the Senate inquiry and now in ensuring the rules are fit for purpose.”

Without clarity surrounding the rules within the act, many in the providers were deeply concerned about the ability to interpret, implement and at a basic level, explain the implications to the vulnerable older Australians in their care.

Continued resource push

As November 1 approaches, evident is a core resource requirement providers are needing to undertake, that of coming alongside residents that are confused and worried about the changes in the upcoming act. Lynch comments, “One of the key challenges is ensuring that older Australians are well informed about the changes the reform will bring, and that they are genuine partners in co-designing their care with providers.”

 “They [residents] also need to be equipped to provide proper consent to any co-payments they’re required to make.”

Lynch and many other peak body personnel are working to bring provider concerns to the Government to facilitate the best outcome for the act in practice.

This means continuing to request further clarity on language and impacts to residents, “That’s why it is important to ensure that all information required to build the service agreements and care plans that underpin older Australians’ care is available well in advance of the implementation date.”

Results from perseverance

Providers have needed to clearly, consistently and robustly lean into working with their peak body to help facilitate the answers they have required. CHA and Lynch speak to that listening, “CHA has been consistent that there is core information [initially missing] that is necessary to transition to the Act”.

Through bringing the concerns to Government, Lynch explains the CHA sought further information on “a final draft of the Rules that underpin the Act…Clarification of co-contribution amount and other important information includes the processing of hardship provisions and sub-contracting arrangements.”

With the Government having recently “released a summary of the changes to the Rules that have resulted from consultation” Lynch sees “, there were a range of issues that CHA now hopes have been resolved in the Rules. These include how hardship provisions will function, the regulatory approach, how and when providers can claim for a service provided and other issues requiring clarification.”

Leaning in continues

It is likely that even past November 1, providers across the sector will be required to lean in with resources to seek clarity for implementation and functioning of the act. While “Services Australia will inform every individual accessing care (and their providers) of the co-contributions they are required to make under the Act”, this means there will be an element of the reactionary and resident concern will need to be managed. “Understandably, older Australians wish to see this information prior to making decisions about the care that they wish to receive, so they understand what personal financial contributions they will need to make to it.”

CHA has additionally, “sought information about the process and practicalities of submitting and assessing claims to access hardship provisions, and what level of awareness providers will have over that process.”

With a once in a lifetime change to direct the standard, ethos, functionality and sustainability of an ever-growing aged care sector, the reform Act impacts all. The need to pivot, consistently seek clarification, and manage executive, front-line staff and resident confusion will likely warrant significant resources over the months and years to come.

Pivoting to this current and upcoming resource strain is a foundational need for peak bodies and providers alike.