industry & reform
Another miracle?
Government rethinks plans
for aged care assessment.
By Michael Fine
W
e only learnt of the federal
government’s plans to call
for tenders for the operation
of Aged Care Assessment Teams (ACATs)
in January 2020. These would have
effectively abolished the trusted, tried and
tested system of advice and approval for
admissions to residential care and home
care packages.
The decision was announced amid the
catastrophic bushfires of the summer, a
time when it might have been thought that
the reform would receive little if any public
attention. Nonetheless, as reported in Aged
Care Insite, the plans were widely criticised.
The geriatricians affected spoke
out, as did at least one federal Liberal
backbencher. So too did the Aged Care
Royal Commissioner, Tony Pagone.
Perhaps the most telling opposition
came from the health ministers of a
number of states, from both Coalition and
Labor governments.
Then, what Prime Minister Scott Morrison
would surely call a miracle occurred. The
federal government changed its mind.
The decision to put ACATs out for tender
was overturned at the Council of Australian
Governments’ (COAG) health ministers
meeting on February 28.
Buried towards the end of the
communiqué from their meeting
that day (following announcements
on the COVID-19 virus, the response
to the bushfires, and issues with the
Commonwealth-states health agreement),
it was noted that: “The Commonwealth has
confirmed that it is not proceeding with the
current tender process.”
Instead, the Commonwealth agreed
to work with the states and territories to
ensure a “consistent, uniform, efficient and
integrated aged care assessment process
that meets the needs of senior Australians
and their families”.
Prior to the development of ACATs,
Australia had the highest rate of admission
of older people (those aged 65 or above) to
residential care in the world.
One of the key problems was that there
was no source of independent advice
possible. Nor was it required – simple
approval by the matron in charge of a
home was good enough for many years.
Later, medical approval was required, but
this, if anything, seemed to make matters
worse. Many GPs owned or part-owned
private nursing homes, and it was not
surprising that they commonly referred
many of their own older patients into their
homes, ensuring that waiting lists grew,
putting pressure on the government to
increase the number of beds being funded.
The success of ACATs over the past 35
years is founded on volumes of evidence
produced in regional and national
demonstration trials that followed the work
of famous Newcastle-based geriatrician
Dick Gibson and his colleagues, who
pioneered a world-beating approach in
which expert practitioners provided advice
about the need to place individuals into
residential care that was independent.
Subsequent research repeatedly
demonstrated the value of the
independence of the ACAT teams from
the service provision system. Assessment
helped reduce the rate of admission to
‘institutions’, providing confidence to those
who wanted to remain at home and did not
need the high level of resources required.
Since 2015, another level of assessment
has been introduced. Access to the
basic community care services funded
through the Commonwealth Home
Support Programme (CHSP) now requires
assessment by the Regional Assessment
Service (RAS). To my knowledge, this new
assessment hurdle has not been clearly
demonstrated to be effective or even
necessary. Certainly it is difficult to obtain
accurate data on the operation of the RAS
and its outcomes.
One feature is clear – access to basic
community care is now much more
difficult. Not only is it confusing, there
are time-consuming waits of 1–2 months
before assessment and often longer
periods after it has taken place. The vast
increase in waiting times for access to care
packages coincides with the introduction
of the RAS approach.
Could they be referring people away
from the CHSP towards the HCP?
It certainly looks like this is what is
happening.
No wonder that one of the big themes to
emerge from the recent round of hearings
at the royal commission was the call to
open access to basic care – with many
doors being opened, not just one.
Assessment, as it is currently
implemented, is a one-off rationing
process that takes place at the point of
entry to the service system. Its great value,
however, is as an ongoing advisory process
that takes place on a regular – if possible,
daily – basis, adjusting the assistance
and care provided to the individual’s
changing needs.
Such a process will often free up
resources, as many people enter the
aged care system with urgent needs, but
gradually recover to an extent, sometimes
regaining all their capabilities to remain
independent. Without ongoing expert
assessment, these resources can’t come
free, and the system quickly becomes
clogged up with new referrals and long
waiting lists.
The Commonwealth’s rethink of aged
care assessment need not be seen as
a backdown or retreat. It should be
understood as an opportunity to open up
a full rethink on the nature and conduct of
assessment in aged care. That shouldn’t
take a miracle. Just common sense. ■
Michael Fine is an honorary professor at
Macquarie University.
agedcareinsite.com.au 11