Maria Tomasic - The Royal Australian and New Zealand College of Psychiatrists
Ms Kerrie Westcott
Director, Legislation Section
Transition Branch Ageing and Aged Care Division
MDP 550
GPO Box 9848
CANBERRA ACT 2601
By email to: LLLBenquiries@health.gov.au
Dear Ms Westcott,
Re: Proposed amendments to the Aged Care Act 1997
The Royal Australian and New Zealand College of Psychiatrist (RANZCP) welcomes the
opportunity to provide a submission to the proposed amendments to the Aged Care Act 1997.
The RANZCP congratulates the Commonwealth Government’s commitment to improve aged
care facilities and the ten year aged care reform program, which includes increased funding. The
RANZCP is committed to improving health outcomes of older Australians, and would like the
Department to refer to the RANZCP Position Statement Priority must be given to investment that
improves the mental health of older Australia (which can be found here:
http://www.ranzcp.org/Policy-and-advocacy/Aged-Care.aspx).
The RANZCP supports the principle of increased flexibility in care and supports the
establishment of a Quality Council providing it is created in a manner that makes it effective.
The RANZCP is a leader amongst Australasian medical colleges in developing partnerships with
consumers, family and other carers in respect to excellence of service provision. The RANZCP
supports the principle of consumer directed care. However, in regards to aged care, the
Department should ensure that sufficient safeguards are put in place for people with a mental
illness. This should not be limited to those with dementia but also people who have a mental
illness during periods when their capacity is impaired. It will be essential to ensure that
evaluation of this strategy includes this vulnerable group.
The RANZCP has reviewed the proposed amendments and congratulates the Department on the
proposed amendments in terms of patient outcomes. However, it should be acknowledged that
some care recipients will be further out of pocket and that some residential aged care facilities
(RACF) are likely to suffer from decreased funding. The RANZCP supports the removal of
distinctions between HLC and LLC approvals. This should allow aged care assessment services
(ACAS) to be more efficient and speed up patient transfers.
There are serious concerns that Australia may have already left action too late to prevent a
decline in mental health care for older people [1]. The RANZCP is deeply concerned that the
ambiguities regarding responsibility for psychological support or mental health treatment in
residential aged care continues to prevent appropriate planning by either aged care or mental
health services. The depth and range of the RANZCP’s concerns can be found in the Position
Statement.
In reviewing the proposed amendments, although the Act appears to state that people may
require Aged Care support due to psychological needs, associated materials do not appear to
support this in practice. In particular, the following appear to discriminate against people with
mental illness. The Aged Care Funding Instrument (ACFI) data shows that approx 50% of
people have a diagnosed mental illness on entry to a RACF [2].
In reference to Section 41.3, residential care does not provide care in a psychiatric facility and
appears to be interpreted as if long term psychiatric hospitals are a modern modality of mental
health care. The National Mental Health Strategy, supported by Commonwealth and state and
territory governments, has clearly identified that this not the case, with the possible exception of
a very small number of highly disabled individuals. Mental health care should be provided in the
person’s home, including an aged care facility, if this is required. The results of this dichotomous
thinking have been highlighted and condemned by the recent New South Wales (NSW)
Ombudsman's report [3].
The updated guidance regarding assessment of mental illness was a welcome improvement upon
the previous guidance, but it still emphasises that the person must have primarily an aged care
related disability [4]. Not only does this appear to contradict the inclusion of psychological need
as a reason for requiring residential care in the Act, it would also appear to contribute to RACF
providers' lack of preparation to meet these needs. In the context of the Aged Care Act, reference
to psychological need, and ACFI data showing up to 50% of people entering RACF having
mental illness, this appears discriminatory and detrimental to the well being of older people [2].
This is compounded further by, reportedly due to the reference to meeting psychological needs in
the Aged Care Act related documents, the apparent exclusion of people either with dementia, or
living in RACF, from access to Medicare funded psychological services other than those
provided by psychiatrists and GPs. The cost of an appropriate course of such treatment makes
funding from within the residential aged care subsidies impossible.
Recommendations



People with mental illness should be recognised as a special needs group in residential
aged care
There is a need for urgent joint reform involving Commonwealth and state departments
responsible for aged care and Mental Health to ensure that the older person's needs for
appropriate housing and support are met, whether they have mental illness or not.
People living in residential aged care, as well as those living with dementia, have
unimpeded access to Medicare funded mental health care.
The RANZCP believes these concerns must be addressed by the Department to ensure that the
Aged Care Act satisfactorily delivers better aged care policies and programs.
If you would like to discuss any of the issues in regard to this letter, or would like any further
information, please contact Dr Anne Ellison, via anne.ellison@ranzcp.org or by phone on (03)
9601 4918.
Yours sincerely
Dr Maria Tomasic
President
cc: Mr Andrew Peters, CEO, RANZCP.
References
1. National Health and Hospitals Reform Commission, A Healthier Future for All
Australians Final Report, 2009: Canberra.
2. Department of Health and Ageing. Aged Care Fundings Instrument Reports. 2012 5
December 2012]; Available from:
http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-acfi-march2012#04.
3. NSW Ombudsman, Denial of rights: the need to improve accommodation and support for
people with psychiatric disability A Special Report to Parliament under s.31 of the
Ombudsman Act 1974, 2012: Sydney.
4. Department of Health and Ageing, Assessment and approval of people with mental
illness, Australian Government, Editor 2010: Canberra.
Ref: 2722