Aged care should be universal like Medicare, report urges

The nation’s independent aged care overseer is urging the Albanese government to tear up parts of its planned new aged care act so that care becomes a universal entitlement for older Australians, like Medicare.

Caring for the elderly should be a universal entitlement for older Australians, the acting Inspector-General of Aged Care says.

Key parts of the Albanese government’s proposed aged-care act should be torn up and rewritten to ensure care is made available to all older Australians based on need rather than continuing with the rationed approach, the nation’s ­independent aged-care overseer says.

Acting Inspector-General of Aged Care Ian Yates has urged the government to “be bold” and recast taxpayer-funded support for older Australians in their own homes and in nursing homes into a universal entitlement, similar to Medicare.

Moving to enshrine a needs-based, demand-driven approach in the new legislation would meet a “bedrock” recommendation of the 2021 aged-care royal commission and be achievable without putting the federal budget under undue pressure, Mr Yates said.

In his 2024 report card on the government’s progress in implementing the 148 recommendations of the royal commission, Mr Yates said “the current rationed approach results in many older Australians not being able to ­obtain the care and support they were assessed as being eligible for”, and the government’s planned legislation won’t address that.

“Under the new act proposed in the exposure draft, there is nothing to prevent a continuation of the current situation where around 50,000 people approved for Home Care Packages are on the waiting list. Some are having to wait for up to 12 months,” his report, tabled in parliament on Friday, says.

“Moreover, there is nothing to prevent residential care developing into a similar situation in the coming 5-10 years, noting that it is already experiencing blockages.”

Acting Inspector-General of Aged Care Ian Yates, Picture: AAP

Australia’s aged-care system is capped, meaning the federal government supports only a certain number of people in home care and residential care at a given time. This year it is set to cost the budget $36bn, making it the government’s fourth biggest spending program.

About 193,000 Australians are in residential care and another 258,000 receive home care packages. More than 800,000 older Australians also received some degree of home support through a Commonwealth Home Support Program during 2022-23.

Creating an Inspector-General of Aged Care was itself one of the royal commission recommendations. Aged care minister Anika Wells appointed Mr Yates into the role as acting Inspector-General in October last year.

Mr Yates’ report notes the “understandable concerns” the government has about the financial cost of a needs-based system, particularly in light of the unanticipated cost blowout of the NDIS. But the nature of aged-care spending was more certain, with future demand measurable and predictable based on demographics.

“The Inspector-General is very confident that a demand-based aged care system does not pose a threat to budget integrity and is not inconsistent with ensuring the financial sustainability of the aged care system,” the report said.

Mr Yates also said the new ­demand-driven approach would allow for more home-care, the overwhelming preference of older Australians, taking costs out of the far more expensive residential aged care sector.

A new aged care act was the first of the royal commission’s 148 recommendations in its final report in March 2021. That report found the standard of aged care in Australia was “inexcusable” and had been for many years.

It found at least one in three people who used either nursing home or in-home care services had experienced substandard care, and up to 18 per cent of aged care residents had been physically or sexually assaulted.

Since the commission reported successive governments have taken up many of the recommendations, including funding for more nutritious food in nursing homes, a star-rating system for residential aged care, imposing mandatory minimum care minutes per resident, funding increased wages in aged care, and bedding in a new increased and flexible funding model for aged care providers.

And successive federal budgets have committed more money for in-home care packages, though waiting lists continue to be an issue for older Australians and have recently blown out substantially.

But meeting the commission’s recommendation for a new aged care act has been a longer road.

The royal commission’s final report in March 2021 called for the new aged-care act to start on July 1, 2023. The current government has committed to legislating it this parliamentary term, and originally proposed a July 2024 starting date. But in May it deferred the start date of the new act to next July in order to engage in more consultation about the proposed laws.

So far it has circulated an exposure draft, but has yet to put the draft legislation before parliament. Nor has it responded to its own aged care taskforce chaired by aged care minister Anika Wells, which in March this year set out a range of recommendations on the

financial sustainability of the sector.

Key among a Labor taskforce recommendations was the introduction of more user-pays elements into the system, so older Australians with the means will pay for more for the non-direct components of their care, including accommodation, food and cleaning. This means government funding will be focused on direct personal care of those either in nursing homes, or, as is their preference, in their own homes.

Attempts to find a bipartisan approach to both the contents of the new aged care act and taskforce recommendations have dragged on for months.

Aged-care providers and advocacy groups for older Australians are calling on the government and Coalition to quickly find a path forward with more than half of aged-care homes running at a loss and amid threats of more closures of services, particularly in rural and regional areas.

Mr Yates’ report also calls for urgency in this regard.

“The Inspector-General considers it critical that there be no further delays in commencement of the new Act. It is to be hoped that the revised Bill can be introduced in time for thorough parliamentary consideration and passage before the end of 2024.”

Mr Yates’ broader assessment of the progress in implementing the royal commission’s recommendations acknowledges much has been done to improve aged care for older Australians in the last three years, and more reform was underway.

He recognises his call for the government to legislate a move to a needs-based aged care system would be a “paradigm shift” from the government’s proposed path, but a necessary one.

“The finalisation of the new Act provides the government with an opportunity to be bold. Maintaining the current, rationed system will not fulfil the Royal Commission’s intent,” the report said.