Introduction

UnitingCare Australia welcomes the opportunity to provide a submission to the Community Affairs Legislation Committee Inquiry into the Aged Care Bill 2024 (the Bill), and we were pleased to see the Bill introduced to Parliament.

We believe that older Australians should be able to exercise their rights as fully participating members of society. Embedding a rights-based approach into a new Aged Care Act is critical to ensuring that all Australians can experience compassion and dignity as they age.

This Bill represents once-in-a-generation reform for the aged care sector, including for older Australians, their families, aged care providers (providers) and aged care workers. To ensure the sector can benefit from this reform as early as possible, it will be crucial that the Bill passes both houses before the end of the parliamentary term.

This submission, prepared in consultation with the UnitingCare Network, provides feedback on amendments made since the release of the Exposure Draft, as well as provisions not previously included. On balance we are supportive of the Bill in its current form, and we have highlighted provisions which would benefit from adjustments, appearing under:

• Chapter 4 – Funding of aged care services
• Chapter 2, Part 5 – Place allocation

We note the Aged Care Rules (Rules), which will provide much needed clarity and supporting detail, are yet to be released. We call on the Government to release the Rules as early as possible, so that providers and the sector at large has adequate time to prepare for the transition.

Amendments since Exposure Draft

UnitingCare Australia acknowledges and supports amendments made since the Exposure Draft. In particular, we are pleased to see updates to the effect of the Statement of Rights, the Statutory duty, and supported decision-making framework.

We support a rights-based approach to aged care and believe all people should experience compassion and dignity as they age. At the same time, aged care workers and the broader community deserve mutual appreciation. Therefore, we are pleased that under clause 24 individual rights will be balanced with the rights and freedoms of other individuals, including aged care workers and other individuals accessing services.

We are particularly pleased that criminal penalties have been removed from the provider and responsible person duties. This will significantly reduce the risk of skilled staff leaving the sector and will ensure that qualified personnel remain on boards and in leadership roles. In regard to the responsible person duty under clause 180, clarity is needed as to whether subclause 12(c)(i) is also intended to be carved out, or only subclause 12(c)(ii), particularly when these provisions are drafted to be read together. On the face of the Bill, any person who has responsibility for overall management of nursing services would be included as a responsible person, however not any person responsible for the day-to-day operations of the registered provider. Greater clarity on this carve out will assist.

The provisions on supporters have improved and appear to be more streamlined, particularly with guardians and people in similar positions now able to do a thing on behalf of an individual, even without being appointed as a supporter under the Act. Noting there is a newly defined role for decision-making supporters, we query what the threshold is for exceptional circumstances, which are required under clause 43 to grant decision-making authority. The note in this clause suggests an exceptional circumstance may include an emergency in relation to an individual seeking to access services, and a guardian isn’t available. However, there are likely to be scenarios where a supporter may want decision-making authority granted before a potential emergency arises, or when their loved one’s cognition has begun to decline. We would appreciate greater clarity on this point.

Above all, while we want to see a supported decision-making framework implemented, we would strongly urge for a 12-month transition period. This is a framework not previously legislated in the aged care sector and adequate time is needed for older Australians, providers, families and the Department of Health and Aged Care (the Department) to have the necessary systems and procedures in place. The Department will also need to deem across any person that is currently registered as an agent or representative under My Aged Care, which will be a large exercise.

Key Recommendations

1. Increase the Accommodation Supplement: An immediate increase to the Accommodation Supplement is needed so providers are not disincentivised from admitting supported residents in the short-term.
2. Index the Daily Accommodation Contribution (DAC): The DAC needs to be indexed concurrently with the Daily Accommodation Payment (DAP), to remain competitive with individuals providing Refundable Accommodation Deposits (RAD) or DAPs.
3. Undertake an Accommodation Pricing Review immediately: Note the risks on supported residents with the Accommodation Supplement not being correctly costed.
4. Allow residential aged care providers to disclose higher everyday living fees to residents before admission: Remove subclause 284(5) as this policy is likely to increase consumer confusion on residential aged care costings and undermine the delivery of additional services.
5. Ensure providers continue to meet supported resident ratios: Retain supported resident ratios and provision for a higher Accommodation Supplement (if the supported resident ratio is at 40% or above over a calendar month) to incentivise the intake of supported residents by providers.
6. Impose timeframes for place allocation decision making: The System Governor should have an imposed timeframe for the making and notifying of a place allocation decision.
7. Limit home care grandfathering arrangements to 3 years and increase home care places by 60,000: Co-contribution grandfathering provisions for individuals currently in
   home care should be limited to 3 years, and the number of home care places should be increased by an additional 20,000 in the Financial Year 24-25 and 40,000 in the Financial Year 25-26 to meet immediate need.
8. Implement reforms in a clear and cohesive manner: Undertake a staged approach for the commencement of reforms, noting the system upgrades and transformation efforts that will be required across the board.
9. Financially support providers to transition across to the new Act: Transitioning to the new Act will not be cost neutral for providers, who need adequate funding and support to transition to new arrangements.

Conclusion

UnitingCare Australia acknowledges the efforts that have gone into finalising the Bill, and the cooperation undertaken to have it introduced to Parliament. We look forward to working with Government, the Department and the Commission in reforming the aged care sector.

Noting many of the details for the new system will be contained within the associated Rules, we reiterate our calls for these to be released as early as possible, including in tranches to facilitate efficient review.

We would welcome the opportunity to discuss these matters with you or arrange for a provider in our network to appear at an upcoming hearing. We thank you for the opportunity to contribute to this important inquiry.