1. Residential Aged Care Services in Tasmania  On the edge of extinction

2. Before the Reforms of 1997  A cottage industry managed by people of goodwill, grateful to the government of the day for their largesse  Clients who were expected to be grateful for their care  Regular direct involvement by local bureaucrats  Standards Monitoring teams reviewed care and claims for funds

3. Aged Care Act 1997  Competition  Certification  Accountability of Providers  Charter of Rights  Accreditation Agency  Validation  Complaints Resolution Scheme  Business Model

4. Early Days  Successful in forcing change  Accreditation spelt out standards  Certification established minimum standards especially in relation to fire  Stated expected building requirements to be achieved by 2008 in relation to privacy and dignity  Large turnover of senior staff in organisations

5. Progress  Standards improved  Standards often assessed in subjective manner  Low care residents paying bonds  Providers able to borrow and service debt  Development of improved standards of accommodation  Complaints Resolution Scheme-: a costly impost

6. Business Model Flaws Emerge  Government-:  Controls supply of beds  Sets standards of accommodation  Defines services to be provided  Regulates fees to be charged  Controls access to capital  Controls who is eligible for care

7. Supporting Success or Ensuring Failure?  Funding not keeping pace with costs. Services predicting significant losses  Cap funding just before 30 th June 2004  Penalty for this funding -more compliance  Kerosene baths – claw back on funding

8. Elder Abuse  The most common form of elder abuse is financial abuse  The most common abuser of the elderly is a family member  Nursing Homes now required to have national Police Checks for all staff, volunteers and contractors who have direct access to residents.  This does not include GPs  This represents an unfunded burden of approx $50 per person.  Compulsory Reporting requirements needed new policies, procedures, recording and monitoring systems and training for all staff. I estimate that this cost $3000 set up plus $50 per employee per facility per annum

9. Supporting Success or Ensuring Failure? Elder Abuse- Costly regime for homes Additional prudential requirements- no facility has defaulted on a bond since the introduction of Aged Care Act 1997

10. Compliance or red tape frenzy?  Annual workforce census for each site  Annual Staff training statement for each site  Annual Financial Statements  Annual CAP Return  Residential Aged Care Funding Claim  Monthly per facility  BAS ATO Quarterly  Annual Prudential Compliance Statement

11. How Much Regulation?  Certification duplicates the BCA and State and Local Government requirements  Accreditation 4 standards 44 Outcomes  Police Checks  Mandatory reporting  Nursing Board

12. Accreditation  4 Standards with 44 Outcomes  Service must be compliant at all times  Spot visits (Can be triggered by a complaint or a change of senior personnel)

13. Burden of Proof -Paperwork  To satisfy accreditation Standards we must-:  Achieve the outcome for each resident  Provide evidence of how this is achieved  How it is tested?  How it is evaluated?  How it is improved?

14. Performance-Accreditation  2000- 63.5 % fully compliant  2004- 87.9% fully compliant  2007- 91.8% fully compliant  “Exceptional performance in the industry…indeed in any industry’  ‘Australia is leading international performance” CEO of Accreditation Agency, Sept 2007

15. Performance: 2003-present  In this period out of over 2,800 facilities, 42 have incurred sanctions or just 0.015%  NSW -8 facilities  Victoria -12  NT- 1  Qld- 17  WA- 4  Tasmania- 0  ACT -0

16. Complaints  Why don’t we buy Twinings tea?  Why haven’t you got this person a Doctor?  My father did not receive anything to eat or drink for a week.  My mother was. shouted at by a staff member

17. How many instruments does it take to deal with a complaint?  Potential for a complaint to be running concurrently with-:  DOHA  Health Complaints Commission/ Medical Council  Nursing Board of Tasmania  Guardianship Board  Unions

18. Signs of Industry Stress  Growth of costs of compliance  Small operators depart the scene  Consolidation of providers

19. Signs of Industry Breakdown  Skill shortages especially RNs and sophisticated business skills  Industry becomes government whipping boy  Community expectations exceed capacity to deliver  Providers starting to report losses on operations

20. Situation decline  Changed profile of residents entering residential aged care  69% of residents in 2005-2006 were high care  No bonds for high care (Except for Extra Services places)  Costs of care increasing beyond funding levels  Costs of compliance growing as requirements increase  Government continues to react to exceptional events and impose further requirements

21. Desperation emerges  Exit of some large providers from the industry e.g Salvation Army, some Anglican services  Growth of property development in “retirement living”  Blurs community perception of options for supported care and viability  Residential Aged Care providers subsidising operations from unit developments

22. Closures  Small services close  Government funding sidelines low care  Specialist services under threat  Dementia care too expensive to provide  Emphasis placed on elderly remaining in their own home

24. Residential Aged Care- The end