Risks extreme for remote aged care providers
23 Mar 2021
Aged care in Australia faces major change across the industry. Our generation of Baby-Boomers is living longer than previous generations. The aged care funding model will change and present opportunities and risks to people receiving care in or outside of their homes. The shift towards consumer-directed care signals growth and development for the sector, as well as risks.
Yaandina Community Services provides care for the elderly in Western Australia. Its residents are from indigenous communities and the staff are long-term residents of the Pilbara region who have a deep understanding of their changing cultural landscape. Melanie Humphries is Yaandina Community Services Compliance and Risk Officer. She provided valuable insights into Yaandina’s risk profile, and the unique challenges in meeting the needs of the elderly in a place that is significantly under-resourced for the job.
What are the major problems facing the aged care sector where you are?
“Recruitment and retention of suitable staff. It’s difficult to take staff off the floor to attend training, and difficult to find local training as most is done in Perth, 1600kms away. There is a lack of advanced care planning in place for residents, especially the Aboriginal residents, and some difficulty to get family engagement.”
How does insufficient revenue and high costs of care challenge the facility?
“We have a lack of income from residents, we simply have no residents who can pay a bond from a house sale or sale of other assets, unlike in metropolitan centres. Costs are high for asset management and maintenance (including delivery costs when we purchase anything). No funds can be set aside to purchase large assets like a wheelchair bus. We spend a lot of time applying for grants which takes time away from managing and improving the facility.”
Does the government give support for basics, such as staff flu vaccines?
“We’re not supported by the government for some initiatives as we are a non-government organisation. We couldn’t get free flu shots like the carers at the government-owned aged care facility in Port Hedland – Kalarra House”
What real reforms will transform aged care services?
“All of the things reported in the current Royal Commission into Aged Care will help to transform services.”
“An immediate injection of funds is needed to cover operating deficits. We need to have a true cost funding for small remote facilities like ours. Not having to apply for so many grants and not having to compete with other deserving facilities to survive will be helpful.”
“Fundamental change in the distribution of resources, and a shift in community attitudes towards seniors are important for reforming the industry.
“We need equity of resources and supports, in line with government-owned facilities (for salaries, accommodation leave etc.). There needs to be an improvement to aged care work reputation. The general population being less ageist will have an impact.”
What are the most important risks for your facility during the COVID-19 pandemic?
“The real risk was the loss of our total small workforce and an inability to replace them. The government had advised that agency staff could be brought up to replace them if needed but that would require time and funding for flights and accommodation. The most important risk for us was the risk that all of the residents die because they are so health challenged and vulnerable.”
Can you describe your response to the COVID-19 pandemic?
“Our facility put together the following immediate response.”
- Developed a Covid-19 Response Plan including an outbreak management plan
- Onsite mandatory Infection Control training with all staff
- Online mandatory Pandemic/Covid-19 courses for all staff
- Mandatory flu shots for all staff by 1 May 2020
- Information to visitors, family, contractors that they were to have a flu shot by 1 May 2020 to come on site
- Regular updates to staff, residents and family about Covid-19
- Flu shots for all residents who agree to have them by 20 April 2020
- Additional cleaning of facility
- Social distancing: Additional mealtimes so residents are not all in the dining room at same time, change activities from group activities to more one-on-one activities
- Staff who are ill must be tested for Covid-19
- Development of Covid-19 leave
- Telehealth for residents
Yaandina Community Services cares for
Over 65: 14
Under 65: 6
“Our residents are a mixture of men and women, Aboriginal and non-Aboriginal. Most of the people (both Aboriginal and non-Aboriginal) grew up in the area. Some younger people have physical and/or cognitive disorders. Some older residents have Korsakoff’s (alcohol-related) disease. For some residents, English is their second or third language. Care needs range from low to high.”
How will changes to the aged care funding model impact your organisation?
Professor Kathy Eagar, director of the Australian Health Services Research Institute at the University of Wollongong (UOW), said the model zeroes in on improvements in care and rids the “perverse quality incentives of the current model”. Under AN-ACC, homes would not be able to select residents based on their payment class. How does this impact your organisation?
“This does not assist us as we cannot select our residents based on payment class because we are a small local provider and must take those in highest need, not highest payment class.”
The proposal includes the removal of identified flaws in the ACFI, including the complex and time-consuming assessment process, as well as eliminating incentives not always found to be in the best interests of consumers. Will this make a difference?
“This would help us as we do not have specialised ACFI staff, the manager does it all with the assistance of the Clinical Lead.”
The funding model is based on six key design elements:
- Resident assessment for funding to be separate from resident assessment for care planning purposes
- Assessment for funding purposes to be undertaken by external assessors capturing the information necessary to assign a resident to a payment class
- Assessment related to care planning to be undertaken by the residential aged care facility based on resident needs and underpinned by consumer directed care principles
- Provision of a one-off adjustment payment for each new resident that recognises additional, but time-limited, resource requirements when someone initially enters residential care
- A fixed price per day for the costs of care that are shared equally by all residents. This may vary by location and other factors, and
- A variable price per day for the costs of individualised care for each resident based on their AN-ACC casemix class.
“This model will assist us as long as it takes into consideration the special needs of isolated people in remote communities.”
What are the risks to aged care services where you are, and for remote communities in WA who are short of money?
“The risks are that we will run out of money to pay staff and not be able to keep the facility well maintained. Another risk is that people do not apply to work at the facility. For us, if we did not provide good care there may be community backlash.”
What can organisations like yours do to reduce the risk of closure?
“We need continuous improvements and efficiencies in strategic asset management, workforce planning, applying for all grants we are eligible for, participating in the Royal Commission, and keeping all levels of government abreast of our financial and other resources situation.”