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‘The bones are bare’

Cartoon by Jason Chatfield

The proposal to charge providers for unannounced accreditation visits is a cost too high for an industry-specific quality assurance system, writes Wayne Belcher.

I have been back working in the aged care sector for almost twelve months now – first on an interim basis with Baptistcare in Perth, and for the past four months as chief executive with Braemar Presbyterian Care in WA.

One of the most common questions on my return to the sector is about the amount of change there has been in aged care since I left the sector back at the end of 2010.

One could say that the change has been enormous with refundable accommodation deposits now part of residential aged care and significant changes made to funding around client centred care in the community aged care sector.

On the other hand, one could quite calmly suggest that no great change has happened.

After all, since I first entered the aged care sector back in 1982, we have had at least fifteen (perhaps closer to twenty) Australian Government ministers with responsibility for aged care services. In that same period, we have had at least three major changes to the funding regimes that providers live with daily.

There have been several major reviews of aged care in Australia by either eminent consultants or the Productivity Commission. Reduction of recurrent funding seems to be getting more desperate. What’s new?

There is no doubt that the major change to aged care in Australia by the then Howard Government announced in August 1996 and implemented some fourteen months later as the Aged Care Act was a momentous shift in aged care policy and service delivery in this nation.

That legislation has paved a way for better regulatory provisions around both built facilities and daily service delivery, with both components now strongly regulated under their respective compliance aspects.

The Australian Aged Care Quality Agency (AACQA) is responsible for the service accreditation delivered by approved residential aged care providers. The quality system itself is unique to Australia and does not equate to any international standards of quality assurance.

Could it simply be construed as covering the monitoring requirements of the arm of executive government and the bureaucrats who make departmental decisions about what is best for older Australians?

The accreditation system is not cheap with an application cost of between $3,000 and $22,400 per aged care facility, over a three-year period, and based on the number of places in that facility. Now we have the potential of being charged for an unannounced visit (read “spot check”) per facility each year.

You read it correctly.

Not only do we pay for the accreditation process, we also will soon pay for the AACQA to do one of their mandated unannounced visits to the tune of between $2,700 and $5,880 per facility, per annum, depending on the facility size.

That effectively adds, as I read the discussion document, between 50 per cent and 90 per cent of the accreditation cost to providers.

This change is to cover the cost of the AACQA, not the cost of care.

The bones are bare. This is a cost too high to be afforded by the providers of our aged care services for an industry-specific quality assurance system.

Wayne Belcher is chief executive of Braemar Presbyterian Care in WA.

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8 Responses to ‘The bones are bare’

  1. Richard Lightbody July 19, 2017 at 1:38 pm #

    Welcome back Wayne and a very insightful review of the state of affairs.
    Concerning indeed!

  2. Pam July 19, 2017 at 4:07 pm #

    I did some quick calculations on our stand-alone facility. Unannounced visit cost $4828 for a 99 bed facility, and they arrived at this figure by stating that it would normally equate to three days of assessor time. In the many years I have been at this facility a ‘spot’ visit has never lasted more than 9am arrival to 4pm departure for two people which would equate to two days of assessor time. During this stay of 7 hours, lunch break is usually an hour which brings the time back to 6 hours, add 2 hours travel time, add 4 hours reporting time = 12 X 2 people = 24hour total. $4828 divided by 24 hours = $201 per hour. I would hope that our peak bodies, LASA and ACSA stand up on our behalf and explain to the government that “The Bones are Bare”, we simply cannot afford to pay such an exorbitant charge.

  3. Wendy Rocks July 19, 2017 at 4:47 pm #

    Totally agree with Richard and Wayne, and I wrote to the Agency this week to that effect! I also suggested that the Agency look at a little technological disruption to defray their travelling costs as I see 2 or 3 auditors every time I go to any airport!
    It is unconscionable that we would be charged now for the privilege of an unannounced visit by a system that is not voluntary accreditation system!
    The bones are certainly bare and somewhat bruised

  4. Windsor Gardener July 19, 2017 at 5:22 pm #

    In an ideal world the cost of accreditation would be borne by the auditing government agency. However, we are increasingly in a situation where service providers of all types are being asked to shoulder the burden up front rather than the taxpayers (again).

    The proposal for AACQA to charge providers for unannounced accreditation visits between $2,700 and $5,880 per facility, per annum, depending on the facility size, works out to between $52 and $113 per week per facility. The cost per bed will be on a sliding scale depending on the number of beds.

    The sceptic would say, if the facilities in general were on top of their game, every day of every week, these spot visits would not be required in the first place.

    If we want to change the arrangement, only a flood of letters and phone calls to the Minister for Aged Care, Hon Ken Wyatt MP can bring this about

    Parliament House, Suite M1 40, Canberra ACT 2600

     Phone – (02) 02 6277 7720

     Facsimile – (02) 6289 7166

     Email – correspondence: Minister.Wyatt@health.gov.au

  5. Sandra Hills July 20, 2017 at 1:02 am #

    Many thanks for your article Wayne . Providers need to remember that if they are paying for this service then they need to make sure that they avail themselves of all the avenues to provide feedback on their accreditation experience to the AACQA and the government if necessary .Just as our clients have consumer rights when they purchase a service, so do providers .

  6. Nadia July 20, 2017 at 11:14 am #

    So very true Wayne and welcome back to the industry!

    The ‘government powers that be’ are determined to ensure that the elderly don’t get a fair deal, because the cost will have to be passed onto them – eventually.

    It will be difficult for any provider to afford this unrealistic additional cost in the running of an aged care facility particularly NPF – that’s why they’re called NFP!

    Hopefully sense will prevail

  7. Karen July 24, 2017 at 11:24 am #

    I would have to agree with Wayne, also, and find it incredible that we do not have the ability for a competitive market in our auditing system. We have the standards, why is auditing governed entirely by the quality agency? As providers we should be able to employ our own independent auditors to ensure we comply. If we are talking about choice and consumer equity, we, as consumers should have the ability to select in a competitive market, our auditors. The fact that we are now being asked to pay for a service we do not even request, is putting further burden on Organisations already stretched with the latest reform implementation.

  8. Kylie Wise July 24, 2017 at 3:33 pm #

    Perhaps we should be less concerned about how much it costs and more focused on what we get for our money?

    Based on its current performance, the AACQA should charge $0 for its services.

    This national body has consistently failed to identify and rectify the declining standards of aged care. The AACQA boasts of its achievements yet consumer dissatisfaction and complaints about care standards continue to rise.

    They continue to operate under a cloak of secrecy, only publishing generic and sanitised final assessments. Neither the public nor the industry have access to detailed accreditation information such as additional comments, highlighted areas of concern or correspondence such as facility action plans hastily cobbled together and presented to the secretary in order to pass accreditation.

    Their formulaic accreditation reports simply rehash the same old information; padded out to fill 33 pages. And it’s taken them until 2017 to realise this rubbish can be more efficiently replicated electronically…I suspect they’re implementing these new fees so they can pay for a few hundred iPads. It certainly isn’t because they need more funds to maintain their exceptional performance

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