Gerard Mansour - Leading Age Services Australia
Section
Level of details that is included in the Act and in delegated legislation such as the Principles and
the Determinations
LASA Response
LASA supports the intention to move much of the detail from the Act, however would advocate
for further feedback from the Industry, and a Standing Committee (e.g. based on the NACA
model) be consulted with before any changes are implemented. This would allow the flexibility
that is required, but ensure formal consultation with the industry is conducted before widespread
change occurs. The Standing Committee should be asked to regularly consider administrative
and legislative amendments that could be made to improve the overall scheme.
With the distinction between low and high care abolished, a review of the ‘Security of Tenure’
legislation is required. For example where a service is unable to provide a certain level of care
i.e. homes that traditionally only have low care residents. A review of jurisdictional legislation is
also required to ensure that there are not unintended consequences in relation to poisons
legislation and staffing requirements in respect to nursing homes as opposed to hostels.
LASA believes that there is a need to move toward cost of care funding models and to enable
appropriate concessions for regional, remote providers and those supporting people with special
needs, such as indigenous, homeless and those from a CALD background.
Residential Care
Part 1
Types of care and services
Removing high/low care distinction (page 11)
LASA Response
LASA generally supports this change subject to industry support of the amendments to the
Specified Care and Services and the costing of the care to be provided. There needs to be a clear
distinction between what is covered by the resident fees and the care subsidy from a costing
process and additional/extra service charge arrangements. This includes a rational application of
specified care and services relative to the subsidy level.
LASA advocates that the costs resulting from removing the high/low distinction must be fully
compensated via the subsidies paid through the Aged Care Funding Instrument (ACFI).
Types of care and services
All approvals of care recipients for residential care will be non-lapsing (unless they are expressly
time limited).
LASA Response
LASA seeks further information on why some ACCRs will continue to be time limited? This
may create a major funding problem for some facilities.
LASA advocates that time limited ACCRs be abolished.
LASA contends that from July 2014 all ACCRs (regardless of when they were dated) will be
recorded as ‘residential care’ and not limited to the level of care. Accordingly any ‘default’
payment currently being received due to the low ACCR/high ACFI rule should be paid at the
ACFI assessed subsidy level.
The ‘default’ payment for residents who have entered care and are waiting for the initial ACFI
appraisal to be submitted should be set at $70 per day (equal to the previous amount prior to
ACFI being implemented) rather than the current $47.40 per day.
Considering the average ACFI subsidy is approximately $134 per day, this will ensure that there
is not a significant shortfall in subsidy payment for the waiting period.
Types of care and services
Existing arrangements for respite care will continue to apply
LASA Response
LASA advocates that the arrangements for respite care should follow the changes to permanent
care, the ACCR should therefore remove the distinction between high and low care.
LASA also contends that the subsidy payment should be:
Based on the current subsidy payments this would be


High care - (105.78 x 15%) $15.88 + $52 = $67.88
Low care - ($38.33 x 15%) $5.75 + $52 = $57.75
If the residential respite approval will not differentiate between high and low care then the
subsidy rate should be set at approximately $125 and the supplement should be worked out in
accordance with the above formula. Therefore:




Subsidy - $125.00
Supplement max A/Supp - 52.00
15% of $125 - 18.75 - $ 70.75
Total Commonwealth payment - $195.75
Types of care and services
Choice in relation to amenities and services (page 12)
...That a price be agreed beforehand....
LASA Response
LASA cannot support changes to the Specified Care and Services schedule unless there has been
specific costing undertaken to consider the impact of extending the ‘standard’ care and services
to all residents and the additional/optional costs that may be available. For example, the cost of
providing continence aides to all residents who have an assessed need.
There needs to be clear distinction between additional/optional services to ‘extra services’.
LASA advocates that the price for additional/optional services be market driven and that
Government should not have a role in setting fees and charges.
The price should be agreed before the service is delivered, not before entry into care. This will
take into account price variation and the ability of the care recipient to ‘opt in’ and ‘opt out’ as
desired and the conditions will be included in the resident agreement.
Types of care and services
Extra service granted in respect of a service, part of a service, or one or more rooms within a
service (page 12)
LASA Response
LASA supports this change provided that the requirements for approval in relation to the smaller
areas are not onerous. Specifications for extra service need to be identified. Maximum flexibility
needs to be applied. The criteria that that the Pricing Authority proposes to use needs to be
published as soon as possible.
LASA seeks advice on whether Extra Service Places will be paid by the government under the
reformed legislation for admitting supported residents? In other words will the accommodation
supplement be payable to supported residents in extra service facilities or extra service places
within a facilities?
Further clarity needs to be provided on the difference between ‘extra service’ places and the
changes to the Specified Care and Services which is to provide ‘Services and amenities that
residents and their families may wish to purchase from the AP that are additional to the assessed
care needs of residents on an opt-in; opt- out basis’.
The relationship between specified care and services, additional services and extra services is
crucial. As there are no definitions of how these crucial aspects will interface it is not possible to
support this amendment without clarity around these issues.
Types of care and services
Aged Care Pricing Commissioner setting the fees for extra service and applications for extra
service is managed through the ACAR? (page 12)
There will no longer be an additional 25% charge that is recovered by the government
LASA Response
LASA disagrees wit h this proposal and advocates that assessment of applications for extra
service should not be limited to the ACAR round and should be available at any time. There
should also be a Fees Review Panel set up under the Aged Care Act to arbitrate on disputes
between providers and the Aged Care Pricing Commissioner on fees or any other matter relation
to pricing.
LASA supports this change; however it should be applicable to all residents entering Extra
Service on or after 1/7/2014. The rules applicable to extra service payments and clawback should
relate to when the resident enters extra service, NOT when they enter care.
LASA views the grand-parenting of the existing extra service arrangements to current residents
who become extra service residents on or after 1/7/14 as contrary to all other proposed changes.
LASA therefore considers that the rules applicable to residents becoming extra service on or
after 1/7/14 should be identical for all residents regardless of the date of entry to care.
On line 2 of the last paragraph on page 13 the words ’extra service’ should be inserted between
the words ‘enter’ and ‘care’.
Types of care and services
Fees for optional additional amenities (page 12)
LASA Response
LASA supports this concept, however LASA cannot support changes to the Specified Care and
Services schedule unless there has been specific costing undertaken to consider the impact of
extending the ‘standard’ care and services to all residents and the additional/optional costs that
may be available. It is vital that there is clarity on what will be ‘optional additional amenities ‘.
There needs to be clear distinction between additional/optional services to ‘extra services’.
Extra service places are rationed in each region. The dedicated/optional extra service distinction
is set to remain as an unnecessary artificial distinction between facilities, with some providers
having the ability to pass on costs and others not.
LASA advocates that the price for additional/optional services be market driven and that
Government should not have a role in setting fees and charges.
Types of care and services
Changes to resident fee calculator (page 13)
LASA Response
There are a number of issues involved with the calculator that LASA requires further
information; these are:
1. The income tested amount is increased to 50% as opposed to the 5/12ths as was
previously the case.
2. What has happened to the edict that no person will pay an income tested amount of less
than $1.00?
3. No thresholds have been provided i.e. the lower asset threshold and the higher asset
threshold. This makes it difficult to assess.
4. Why are the relevant annual assets divided by 364 days (rather than 365)?
5. The means tested amount does not have a daily ceiling other than the amount of the
commonwealth subsidies and supplements. Accordingly this could mean a massive initial
payment by the resident until the cap is reached.
6. This takes into account all the assets of the resident (less the asset free area) yet the
provider is limited as to the bond (or equivalent) by the ACFA ruling.
A spreadsheet to show indicative scenarios is provided as Attachment A.
Part 2 Means testing
Types of care and services
Government Subsidy (page 15)
New formula for calculating subsidies Supplements
LASA Response
LASA seeks advice on whether the dementia supplement is to be paid separately from the ACFI
basic subsidy. LASA advocates that it should be paid as a primary supplement.
LASA cannot support the removal of the accommodation supplement from the list of primary
supplements and being transferred to other supplements as this will mean a decrease in funding
via a reduced payroll tax supplement. Attached is the Payroll Tax determination 2001 as
amended in March 2008 for reference.
LASA assumes the assisted supplement will also be removed with concessional supplements and
charge exempt resident. LASA also assumes that the residents to which these supplements relate
will become supported residents and receive the accommodation supplement. If this does not
occur then LASA cannot support the amendment due to the issues outlined above in relation to
payroll tax. The methodology and intent of the Aged Care (Payroll Tax Supplement)
Determination 2001 should be maintained.
There is no mention of transitional residents. Will these residents become supported residents?
LASA notes that the conditional adjustment payment (CAP) is identified as an additional
supplement where in fact it is an additional PRIMARY supplement thus making it eligible for
the payroll tax supplement calculation. LASA contends that the CAP must remain an additional
primary supplement thus making it eligible for the payroll tax supplement calculation.
Types of care and services
Care Subsidy Reductions and Capping (page 16)
$25,000 annually and $60,000 lifetime
LASA Response
As the consequential amendments will have a major change on the means testing arrangements,
LASA has the following questions:




Will assets be deemed for income purposes?
Will the Social Security and Veterans Affairs Entitlements Acts be amended to make the
accommodation bond (lump sum) a non-exempt asset for pension purposes?
Will those Acts be amended to make income from renting the house to assist in the
payment of an accommodation charge (1998 inclusion) and an accommodation bond by
periodic payments (2005 inclusion) non-exempt income?
Under the new means testing arrangements, will the government continue with its income
testing ruling that residents will not be income tested if the resultant income tested fee is
less than $1.00?

How often will there be reviews of the means tested arrangements?
It is noted that the government has moved away from the daily capping as is the current ruling
for income testing. Depending on the resident’s assets and income they may not get any
Commonwealth subsidy until the $25,000 (indexed) is reached. If the means tested fee is greater
than the care subsidy or if the resident does not provide the information for means testing, the
means tested amount will be equal to the care subsidy.
Scenario:
Let’s assume that this is $200 per day (including the supplements) and that the resident had no
access to aged care prior to entering the facility. Then the resident would pay for the total care
for a period of 125 days until the limit is reached. How may high care residents exceed 125
days? This represents a massive saving to government with no possibility of loss unless the
resident remains there for 2.4 years which is highly unlikely.
LASA therefore recommends a return to the daily capping process with a $60,000 (indexed)
lifetime cap.
Types of care and services
Accommodation supplement (page 17)
Maximum amount payable is influenced by the status of building
Supported resident ratio
LASA Response
LASA can only support this proposed change if the definitions to Significant Refurbishments are
amended from the ACFA recommendations. See LASA’s response to ACFAs recommendations
as Attachment A.
LASA does not support the 40% supported resident ratio and it should be discontinued. The
DoH&A’s data demonstrates that the 40% requirement is unachievable in many areas.
The ratio simply discriminates against those facilities in affluent areas that cannot attain a more
than 40% ratio. Why should facilities in affluent areas provide superior accommodation and
receive less funding than a facility in less affluent areas?
In 1997 the Government also announced concessional ratios on a Planning Region basis. If the
government wishes to protect residents who do not have the means to pay accommodation
payments the ratios should be linked to the ratios for the planning region. For example, North
Sydney in NSW has a current ratio of 16%.
LASA also contends, that especially with the current occupancy issues, providers do not
discriminate, and all admissions are based on need. Accordingly there should be no penalty for
being below a percentage rate that has no basis and does not reflect the potential residents in the
catchment area.
LASA therefore contends that the 25% penalty should be abolished.
Types of care and services
Providing care recipients information about the effects of choosing to move to new arrangements
(page 22)
LASA Response
LASA does not support this proposal as this implies that financial advice is required to be
provided. Providers of aged care are not licensed to be financial advisers and therefore should
not be compelled to provide this information. These proposed changes are to be introduced by
government and accordingly it is the government’s responsibility to ensure all care recipients
(including prospective care recipients) are informed as to the effects of these charges.
The provision of financial advice is covers under other pieces of legislation and carries with it
substantial penalties for unqualified people for providing what could be construed as final
advice.
Part 3 Paying accommodation costs
Types of care and services
(pages 23 -25)
Refundable lump sum accommodation payment, non-refundable periodic accommodation
payment or a combination of both.
LASA Response
LASA continues to advocate that retentions are to be continued and allow the current retentions
amount to be deducted from lump sum payments.
Retentions are currently equal to $3876 per annum and it is estimated there are a total of 60,000
number of lump sum bonds currently attracting a retention. This means in the 2012 calendar year
the total annual income to the industry from retentions in the magnitude of $232 million, and this
is a most significant component of operating income for approved providers. It represents a
substantial portion of the operating surplus for many facilities, and the loss of this key income
stream will be particularly detrimental to rural, low care and providers on the margin of
sustainability. If retentions are removed, it will be impossible for providers to compensate for
this loss of income. At an interest rate of 4.6% per annum an additional bond amount of $84,261
would be needed to offset the annual loss of retention income.
Clearly, for providers receiving average bond amounts of $264,000 (AIHW 2009-10,) such a
large increase in bond levels will simply not be achievable. As noted above, rural and remote
providers will be the most severely affected.
LASA strongly supports, as outlined in our submission to ACFA, a model based on upper
benchmarks related to local real estate prices (median house prices) and/or residential rental
levels.
However, in the event that ACFA decides to proceed with the concept of a ‘percentile range’
approach, a more flexible approach is needed.
In the event that ACFA intends to include the following provision:
“That, in making the determination the Minister set the maximum amount at the 95th
percentile of all accommodation bonds for the most recently available year to date (the
Authority notes that based on current data this would equate to approximately $500,000”,
Types of care and services
Minimum permissible asset value limiting the amount a person can be asked to pay
Choice of payment method period to be 21 days
LASA Response
Then, LASA proposes the following additional clause:
“At the election of an approved provider, the 95th percentile bond range may be the applicable
range at local aged care facilities over the prior year”.
This would provide a greater level of flexibility for approved providers in meeting community
needs for appropriate accommodation in residential aged care, particularly in higher cost
metropolitan suburbs. It is important to stress this would only occur where an individual provider
opted for this local approach; otherwise the national bond percentile range would apply.
The intention is to ensure approved providers receive some additional flexibility above the
proposed 95 percentile range.
Modification of the Assets Test impact Modify the application of the ‘assets test’ on lump sum
payments so that all new entrants from 1 July 2014 will be required to make a lump sum
payment, or periodic payment or combination at the price advertised by the provider. This means
the current restriction placed on providers due to the operation of the assets test will be replaced
by the ‘combination’ option. That is, if a consumer would pay a lesser lump sum than the
advertised lump sum, they would pay the ‘remainder’ as a partial periodic payment.
Scenario 1: Current requirements
A consumer with total assets of $166,500 "cannot be asked to pay a bond" beyond $125,000
because they need to be left with "the minimum level of" assets of $41,500.
Hence even if a provider has current advertised for a bond of $250,000 (or equivalent) the
consumer (due to the impact of this minimum asset rule) will not pay ‘an accommodation bond’
more than $125,000 - creating a very clear 'price gap' for the aged care provider, "and, due to the
level of assets, the provider is not eligible to receive an accommodation supplement from the
commonwealth."
Scenario 2: Proposed requirements
A consumer with total assets of $166,500 is required to be left with "the minimum level of"
assets of $41,500 but will be required to pay the full advertised bond of $250,000 (or equivalent)
by paying a lump sum of $125,000 plus a periodic "charge" of $26.09 per day either as an
additional payment or as a draw down from the lump sum payment. "The periodic charge is
calculated as the difference between the advertised bond and the maximum bond payable x the
MPIR divided by 365. In this scenario $125,000 X 7.62% divided by 365 = $26.09"
This enables the provider to charge the full accommodation bond; the consumer pays a fair
market price while still retaining their minimum asset, and is not expected to pay the periodic
‘charge’ 'up front'.
There would need to be a maximum periodic charge or draw down which would be formula
based. A suggestion is the advertised bond (with the 95th percentile level being the absolute
maximum) less the maximum bond payable X MPIR divided by 365. This would need to be
reduced by any funds provided by the commonwealth by way of accommodation supplement.
Accordingly, if a resident’s assets are below the level for partially supported status, the amount
deducted from the advertised bond amount is the asset level for partially supported status,
currently $109,640.80.
LASA members have expressed a strong view that consumers should formally agree and commit
to their particular accommodation payment option before entry (that is lump sum, or periodic
payment or some combination) into residential aged care. Provided this occurs, LASA supports a
14 day period where a consumer can modify their payment option to one of the alternatives set
out in the formal resident agreement.
Types of care and services
Lump sum or equivalent periodic payment methodology – by the Minister in the Determinations
(page 26)
LASA Response
LASA seeks advice as to why the proposed changes do not identify the consequential changes to
the Social Security Act and the Veterans Affairs Entitlements Act? It appears that the
Government is removing the right of a resident to choose to make an alternate counter offer on
bonds by limiting them to a maximum.
This also disadvantages the resident’s negotiating power in relation to contracts. This is a return
to the pre 1/7/05 days when the accommodation bond was treated as an asset for pension
purposes. Is it the intention of the government to remove the current benefit to consumers of
having the bond no longer being treated as asset exempt for pension assessment purposes?
Any methodology needs to be provided to the industry for consultation.
Providers have entered into agreements with their financiers based on the acceptance of lump
sum accommodation bonds. To give the resident the ultimate choice as to the method of payment
of the accommodation payment and taking into account that the resident is in the facility (21-day
rule) will decrease the number of bonds paid by lump sum.
To offset the cost of capital incurred by the provider in the provision of the accommodation,
LASA recommends that the conversion from lump sum to periodic payment be calculated by
applying the Weighted Average Cost of Capital to the advertised or agreed accommodation bond
and not the Maximum Permissible Interest Rate.
Types of care and services
Application to the Aged Care Pricing Commissioner for charges above the maximum set Extra
Services Exempt from price application Reviewable decisions through the AAT
LASA Response
Existing extra services must be exempt from applying for approval of an accommodation price
above the maximum of the 95th percentile. It is important to note that the extra services system
has been in operation for nearly 20 years, and under existing rules of price setting, has most
certainly operated in the interest of consumers and providers alike. Providers have made
significant financial commitments which must not be placed at risk. There is simply no solid
rationale for seeking to impose a price application system for extra services places – these must
remain as market based where approved providers would advertise their accommodation prices
and consumers make decisions accordingly based on the nature of the accommodation and
services provided at each location.
LASA members do not support the recommendation for a relevant Government authority to have
the power to compel an approved provider to adjust their prices in circumstances where they are
set by the approved provider below a ‘maximum’ level or range.
LASA is strongly of the view that the requirement for all approved providers to publish prices in
advance will provide the appropriate and necessary protection for consumers.
LASA is strongly of the view that the proposed ‘complaints system’ would have the consequence
of this Government authority becoming the ‘defacto accommodation price setter’ for the entire
industry – and this is not an appropriate outcome. The approved provider can have undertakings
with a financier that are undone with a decision taken by someone with absolutely no contractual
involvement.
The reality is that once a number of such pricing decisions are made, where specific price points
or a specific price point is required below the maximum, there is the obvious and high risk of a
‘flow on impact’ to other approved providers.
LASA is of the view while this is not the intention of the ACFA proposal; it is the predictable
and unacceptable consequence.
In the event that ACFA decides to proceed with some form of complaints system, it must be
limited to circumstances where a consumer considers they were ‘mislead’ or ‘misinformed’
about the published prices. In addition, any such complaints process must be limited in its power
and not move beyond being able to require an approved provider to review their pricing
information and pricing model. The relevant Government authority should not have the power to
determine pricing.
LASA continues to oppose any change to the current bond protection system which has worked
effectively. This has been a very cost effective system for government, consumers and providers
alike.
There is no rational basis to impose greater costs which would need to be passed on directly to
consumers. However, in the event that some form of insurance is contemplated there should be
specific consultation with peak provider groups about the nature and structure of any such
insurance.
Key criteria would include but not be limited to: any lump sum bond insurance system must be
government backed to limit costs, operate across the entire industry, and cost impacts passed on
in full as an additional element to consumers with a range of flexible payment options including
deductions from the lump sum balance.
If the rationale for this recommendation is to remove the Treasury’s claimed risk exposure to the
total bond pool then an alternate would be the government taking a rational position of agreeing
to maintain the existing guarantee scheme but limiting the total government exposure to some
agreed amount say $1B.
Home Care
Part 4
Types of care and services
Choice and control (page 30) 4 new levels
LASA Response
LASA supports the proposed changes, however outlines the following concerns: What is behind
the Level 1 package and how will it interface with the large HACC Program? Given the meagre
$37.32 daily subsidy of a CACP or Level 2 HCP (based on the outdated RCS funding formula),
what benefit will be derived from a Level 1 package that is half this subsidy level. LASA
strongly recommends that Home Care Package funding be targeted at levels 2-4. This will
necessitate adjustments to the planning formula.
Types of care and services
Name change from Community Care to Home Care
LASA Response
This should not restrict the service offerings or Government’s funding scope to just those
delivered in the home as the whole purpose of Community/Home Care is to enable people to
remain or re-establish connections with their community.
Types of care and services
Dementia and Veteran Supplements (10%)
LASA Response
LASA identifies these changes as a welcomed move to have the supplements apply across all
four funding levels. However it requires clear guidelines and appropriate training for ACATs to
be put in place to ensure consumers and providers are entitled to the supplements and appropriate
levels of care and support.
For example, there continues to be issues in Queensland around differing interpretations and
qualifying factors for assessing people as eligible for an EACH Dementia package. LASA would
not want to see this magnified across four funding levels.
Types of care and services
Application as a provider and for places
LASA Response
LASA supports the proposed changes.
Types of care and services
Depending on the outcome of the assessment of the applicant’s care needs, approval will be
given for: Levels 1-2 only; or All levels of Home Care (page 31)
LASA Response
LASA does not support this distinction.
There is real concern that the unavailability of Level 3 or 4 packages for an approved client may
result in the provision of care through a level 1 or 2 package as an interim measure. This is
unacceptable as it would be akin to taking someone on a High Care Residential approval and
only be able to claim a low funding level through ACFI. It sets clients, family members and the
providers up to fail or be reliant on significant private or informal arrangements and masks the
real need for higher level packages. LASA strongly advocates for a system to reflect the
residential care sector, where there is one assessment for home care, with providers moving
clients through the four scales in the same manner as occurs with the ACFI in Residential Care.
Types of care and services
If already deemed as a provider for EACH and EACHD then can automatically be approved to
provide any level
LASA Response
LASA supports the proposed changes but continues to advocate for a free market approach to the
provision of packages based on regional demand.
By limiting CACP approved providers to levels 1 and 2, an underlying objective of system
flexibility is being ignored. It would be better to work with the industry so all CACP providers
are capable of providing services across the four care levels. This would support consumer
choice in the future.
Types of care and services
Moving some of the legislation out of the Act into the Principles and Determinations
LASA Response
As previously stated above.
Part 5
Types of care and services
Means testing for packages (page 33)
Attachment 3 (page 53) the wording “approved providers may charge up to....; however this is
negotiated between the care recipient and the approved provider.....”
LASA Response
LASA welcomes the inclusion of the hardship supplement to Community/Home Care as up until
now this has not applied.
LASA does not support this wording as it leaves the door open for fee reductions to be
negotiated by the client. This has significant impacts on a providers’ viability if the message
from Government through Legislation is it’s all up for negotiation.
This does not correlate with the arrangement in Residential Care where it’s 85% of pension as a
care fee or if not able to pay is funded by government through the hardship supplement.
LASA also seeks advice on whether Centrelink will be doing the Financial Assessments or the
Gateway or the Service Provider?
Types of care and services
Capping arrangements (page 34)
LASA Response
LASA needs further time and scenario testing to consider the implications of capping in a Home
Care context and particularly how this interfaces with Residential Care.
As daily care fees will not be counted towards the annual and lifetime caps (only income tested
fees) this could lead to bad debts, which providers will incur additional business costs.
Governance and Administration
Part 6
Types of care and services
Aged Care Pricing Commissioner (page 36)
Power to decide on the levels of accommodation payment and deciding on extra service fees
LASA Response
Currently the Minister determines prices, on advice from ACFA. In principle, the move to an
independent pricing setting authority is supported. However, there needs to be clarity about the
interface, handover, and timing from ACFA to the Commissioner.
A more fundamental issue is of a time limit on the Commissioner’s role. LLLB proposes a
review of the price regulation system after 2016-17, so there needs to be a clear ability for the
price setting role to cease as required.
Types of care and services
Australian Aged Care Quality Agency (page 37)
To become a Statutory Agency and sole agency that providers will deal with in relation to quality
assurance
LASA Response
LASA supports this proposal and the Act needs to give the Agency clear and sole responsibility
for quality, with the DoH&A having no oversight of this role.
The terminology quality assurance is an outdated term and the Agency should have a more
quality improvement focus rather than assurance.
By using this terminology it directs the new Agency along a purely compliance focus.
Accreditation today, some 16 years in the aged care system is much more mature and is about
quality improvement. Compliance responsibilities should be separate from quality improvement
strategies.
Types of care and services
Broaden across Residential Care and Home Care (page 37)
LASA Response
Introduction of audit fees for Home Care/Community Care will be a significant change and has
to be done with recognition to the available organisational budgets – especially given the
transparency of finances through Consumer Directed Care.
LASA advocates for an appropriate transition and support arrangements to be funded. Any costs
associated with audits should be a transparent cost within the administration costs of any package
provided and be reflected in the CDC budget.
Types of care and services
Detail of standards etc. be in the Principles as they currently are – (page 37)
LASA Response
There is no reference given to what the standards might look like and need to be set to reflect
modern aged care practice, based on evidence and research, and need to have the flexibility to
adapt as practice develops.
Given the Community Care Common Standards only came into application from 2011, LASA
does not support wholesale changes or development of new standards for Home
Care/Community Care.
Types of care and services
Staff of the Agency will be public servants (page 38)
LASA Response
LASA is seeking confidence that independence can still be maintained when staff will now
become employees of the DoH&A. Historically there was a balance of industry representative
who were assessors. Is this balance going to be retained and strategies put in place to maintain it?
Types of care and services
Aged Care Quality Advisory Council – membership (page 39)
LASA Response
The Aged Care Quality Advisory Council needs to comprise qualified experts who are
independent of government and the Aged Care Quality Agency. LASA supports the suggested
list of members.
Types of care and services
Review of Reforms (page 39)
LASA Response
LASA supports a review process and suggests that the effectiveness and continued role of the
Home Support Program should also be considered as part of the review process.
LASA also suggests that the Productivity Commission be tasked with conducting the review
given the generally positive view from all stakeholders when conducting the Caring for Older
Australian report.
It is extremely difficult to comment on the proposed changes when information which is pivotal
to the whole process has not been outlined. The government should provide any proposed
consequential changes to:
A New Tax System (Goods and Services Tax) Act 1999;
Social Security Act 1991;
Veterans Entitlements Act 1986;
Aged Care Bond Security Act 2006: and
Aged Care Bond Security (Levy) Act 2006
Types of care and services
ACFI appraisals (page 42)
Power of the Department to be to broadened to enable it to take action where false, misleading or
inaccurate information – relating to one or more appraisal
LASA Response
LASA recommends that this proposed amendment be deleted as it remains subjective and
broadens the power of the Department to where only one mistake may incur punitive action.
Types of care and services
Sanctions (page 43)
Requirements being replaced
LASA Response
These proposed new sanctions have not been discussed as part of the Prudential Advisory Group
(PAG) and are not mentioned in the draft Compliance Strategy Paper.
LASA recommends that these proposed changes be referred to the PAG for consideration.
Types of care and services
Relinquishment of places (page 44)
LASA Response
Explanation of repayment of bond balances
Types of care and services
Administrators and Advisors (page 44)
LASA Response
LASA supports the proposed changes.
Types of care and services
Certification (page 45)
Changes to untinted consequences
LASA Response
LASA supports the proposed changes.
Types of care and services
Flexible care (page 45)
Subsidy to MPS’s
LASA Response
LASA supports the proposed changes.
Types of care and services
Grants (page 45)
Detail in Act moved to Principles
LASA Response
LASA supports this but would like to be provided with the exact information as to what is to be
moved from the Act to the Principles as the Principles are easier to amend.
Category
Comment
Potential Solution
1. The refurbishment involves
a significant refurbishment to
a minimum of 40% of the beds
in the facility
Some refurbishments can
positively impact on residents
but not necessarily involve
their specific rooms. For
example, a substantial upgrade
to common areas, utilities
such as kitchen, laundry and
gardens etc. all impact
positively on the lifestyle of
residents.
Using the term ‘beds’ could be
interpreted too literally so that
significant upgrades to other
parts of a facility may not be
included.
Criterion ‘c’ be amended to
read:
The refurbishment involves a
significant refurbishment to a
minimum of 40% of the beds
in the facility OR the
refurbishment involves a
significant refurbishment to a
minimum of 40% of the
facility inclusive of beds and
common areas such as lounge
rooms, kitchen, laundry and
gardens.
2. Supported residents as a
proportion of total beds
Criterion ‘d’ in practice is
unable to be measured for the
following reasons:
Remove criterion ‘d’ as it is
not workable in practice.
Consider alternative strategies
to actively promote
availability of beds for
supported residents.


The ‘significant
refurbishment’
accommodation
supplement provides
positive incentives for
approved providers to
attract supported
residents, however,
current occupancy is
running at just over
90% and therefore at
any one point in time
the percentage of
supported residents
varies.
In most cases a vacant
bed is not left vacant
while waiting for a
supported resident to
be admitted. It is
normal practice for a
vacant bed to be
allocated to the next
available resident
despite their financial
status. Thus the
proportion of
supported residents
Category
Comment


Potential Solution
will continually vary at
the facility level.
Depending on location
and the demographics
of the population, the
ratio of available
supported residents can
vary substantially from
one area to the next.
It is not practical to
relate this variable
changing percentage to
a period when
‘significant
refurbishments’ are
being undertaken.
3. Phased refurbishment
To ensure residents are not
adversely affected many
refurbishments are completed
in phases. This ensures
minimal disruption to security
of place for the resident. It
may also take into account
special times of the year, e.g.
Christmas break
The criteria requires
clarification that where a
phased refurbishment is
undertaken the total
refurbishment counts for the
purpose of meeting the
criteria.
For example;
Phase 1 commences July November
Phase 2 commences March –
June.
It is important that each phase
is considered as a total to meet
the criteria for ‘c’ and ‘e’.
4. Provider appeal process
ACFA acknowledged that a
number of submissions called
for a provider 'appeal process'
but did not put this in their
recommendations.
Attachment B of the Final
Recommendations states:
Appeal
It has been raised that there
will need to be a system in
place for providers to dispute
A two part solution is
proposed:
There needs to be an 'in
principle' approval process in
advance rather than at
completion of refurbishments
in order to minimise potential
disputes.
An approved provider appeals
mechanism needs to be
Category
Comment
Potential Solution
their ineligibility for the
higher accommodation
supplement
established where the
Department determines the
Approved Provider is not
eligible for the higher
supported resident
accommodation supplement.
This needs to have minimal
red tape and allow for an
expedited decision making
process.


A process to appeal a
refusal to accept the
application
There should be some
mechanism whereby
an approved provider
would be able to make
an application to either
ACFA or the DoH&A
directly for their
particular
circumstances to be
taken into
consideration in having
their refurbishment
declared to be
significant.