Minister Butler defends ‘very complicated’ co-contributions on air

A poor choice of words by the Minister for Health and Aged Care Mark Butler resulted in the politician calling aged care’s new user co-contribution system ‘very complicated’ during an appearance on ABC Adelaide Mornings with David Bevan.

The potential pitfalls of talkback radio arguably caught the Minister off guard as a caller, Hannah, expressed her thoughts on removing gardening and cleaning service caps.

The Aged Care Act initially proposed a cap of 18 hours of government-funded gardening per year and the equivalent of one hour of cleaning per week. 

Hannah believes it was a ‘pyrrhic victory’ to have the caps removed and that the co-payments for domestic assistance will provide the biggest challenge for older people. 

“I’ve done the maths and under the agreement by the government last year, we have to employ our support workers for a minimum of two hours,” she explained.

“So if you have two hours of cleaning, two of gardening, two of shopping and showers three times a week, which wouldn’t be unreasonable to expect, you’re going to be out of pocket as a pensioner for about $100. And that’s on conservative costs.

“So what are people going to do? They’re going to choose between going shopping or having a shower and having food or medication. It’s going to affect their mental health, their general health, their skin integrity.”

In the home care setting, aged care workers under the Social, Community, Home Care and Disability Services (SCHADS) Award are entitled to a minimum two-hour shift. Casual and part-time workers can work for more than one client during this period. 

As for the co-contribution set-up, new aged care entrants will pay between 5-50% for ‘Independence’ services and 17.5-80% for ‘Everday Living’ services. Self-funded retirees will pay the most while full pensioners pay the least with a sliding scale for those in-between.

Minister Butler reaffirmed that the no worse off principle protects most existing aged care recipients from paying co-contributions. 

The cut-off date of September 12 2024 means anyone receiving home care services on or before that date will not have to pay more for their aged care unless they move to Support at Home before entering residential care. 

“We have a very large increase coming down the pipeline of older Australians who will need support in their home or will need residential care, and we need to make sure that they get the type of care that they deserve after many years of contributing to the sort of society we live in now. But also one that is sustainable given the taxpayer base,” Minister Butler said.

“There are some contributions that people will be making to their own care at home or in residential aged care. But the taxpayer will continue to pay the vast bulk, like around 75%, of all aged care costs right across the system.

“They’re graded according to your assets and your income. They’re also different depending on whether they are the sorts of things that you would have to pay for anyway, like your meals, everyone pays for their own meals, for example, or whether it is clinical care. Clinical care is completely free of charge for everyone on the Medicare principles.”

However, his next statement highlighted the potential challenges older people face in navigating aged care services.

Adelaide Mornings host David Bevan asked the Minister to confirm the maximum co-contribution rate for self-funded retirees.

“I haven’t got the tables in front of me. They’re very complicated because they first depend on whether you’re a self-funded retiree, a Seniors Health Card holder, a part pensioner or a pensioner,” the Minister added.

“And they’re then different according to whether it’s clinical care or whether it’s services like showering, on the one hand, or whether it’s things like meals that you would pay for in the ordinary course of your life anyway. 

“It is quite complicated, but it’s been thought through very carefully, firstly by a taskforce that included providers and consumer groups that made recommendations to government and then over long negotiations that the government had with the Opposition…”

Age discrimination and disability

A follow-up question from a woman named Kathleen also put the Minister on the spot when she asked about the division between disability and aged care support for people aged over 65

Kathleen finds the ‘age discrimination absolutely abhorrent’ as anyone aged 65 and over who acquires a disability cannot qualify for National Disability Insurance Scheme (NDIS) support, unlike people under 65.

“Now, if you have a disability that might be from your birth or acquired during adulthood and you reach the age of 65, you will continue on the NDIS, on the National Disability Insurance Scheme,” the Minister said.

“But if you acquire some sort of disability, which might be through an accident or through a neurodegenerative condition, or something like that, in aged care age, then you will be cared for in the aged care system. And that was really the arrangement that pre-existed the NDIS, and that age breakdown was not changed by the introduction of the NDIS.”

The Minister did not suggest that any changes would occur to disability support for those over 65 who acquire a disability later in life. He said home care packages are one way the government is improving the level of care to help. 

Kathleen was unhappy with the response.

“I believe that it’s still inequitable and I’ve seen people have drawn the Minister’s attention to this many times with personal letters and so on, and protested this and it is still a matter of age discrimination. Because what you get in aged care is nothing like what you would get as a disabled person. And these people are disabled.”

The full transcript from Minister Butler’s Adelaide Mornings appearance is available here.