Living Longer. Living Better.

1. Living Longer. Living Better. Paul Sadler, CEO, Presbyterian Aged Care NSW & ACT Intergenerational Forum, Sydney, September 2012

2. Welcome • Today’s forum is picking up a major new theme in overseas programs • WHO work on Child Friendly Cities & Aged Friendly Cities • Examples of exciting developments in seniors communities, local government initiatives and design of people-friendly spaces • Australia couldn’t be classed a world leader • But we will hear local examples addressing social isolation of older people and providing the young with contact with older generations • Focus on intergenerational programs as well as buildings and public spaces • A learning opportunity for us all

3. Intergenerational Programs • Based on survey feedback for seminars • Opportunities: • Volunteering • Linking aged care and schools • Building spaces for all generations • Developing specific partnerships • More flexible approaches to retirement housing • Issues: • Attitudes – ageism (in both directions) • Difficulty in building meaningful relationships • Raising interest in the first place • Funding silos • Risk and liability

4. So does Living Longer Living Better make it easier or harder to conduct intergenerational programs? Note LLLB does nothing for State Government issues like retirement villages, planning laws

5. Productivity Commission Inquiry • Commenced in 2010 • Inquiry process: • Received 925 submissions • Held 13 formal public hearings • Met multiple stakeholders in individual and group meetings • Final report released August 2011

6. The Productivity Commission Report August 2011 Focus: Wellbeing of older Australians – promoting their independence, giving them choice and retaining their community engagement Balance: Individual responsibility Affordability for taxpayers Safety net for those that need it

7. Following PC report • Minister Butler conducted national consumer conversations on Caring for Older Australians Inquiry Report • Minister consulted with Ageing Expert Reference Group from National Aged Care Alliance (NACA) and working parties provided input on • Entitlement and assessment • Financing • Quality of care • Palliative care • Wellness • Workforce These reports are available at www.naca.asn.au/Age_Well.html • NACA ran Age Well Campaign and issued Blueprint to keep up pressure for reform www.agewellcampaign.com.au

8. Government Aged Care Reforms • Released by Prime Minister 20 April 2012 • Complements: • Health Reforms • National Disability Insurance Scheme (NDIS) • Response to Report on Economic Potential of Senior Australians

9. Living Longer, Living Better Residential Care • Residential care places adjusted down from 88 to 80 places per 1,000 people 70+ • Consumer Directed Care (CDC) will be trialled in residential care through a pilot starting in 2012-13 • ACFI subsidies cut by $1.6 billion with changes to ADL and CHC starting from 1 July 2012 / 1 January 2013 • No indexation of ACFI subsidies for 2012-13 • From 1 July 2013, new Very High Behaviour category added worth additional $15.89, funded by 1% reduction in High category (30 cents) • 9% of veterans, with mental health condition verified by DVA, will attract Very High Behaviour category

10. Living Longer, Living Better Residential Care (cont.) • From July 2014: • Accommodation supplement increased from $32 to $52 per day for new or refurbished buildings after 20 April 2012 • Low and high care distinction removed • Accommodation payments (lump sum and periodic) must be approved by Aged Care Financing Authority • No bond retentions allowed • All bonds must be insured • Additional user pays via change to means testing, with annual cap of $25,000 and lifetime cap of $60,000 on income-tested care fees • Providers can offer optional additional amenities and hotel services to all residents at an additional charge

11. Living Longer, Living Better Home Care & Support • Home Care packages adjusted up from 25 to 45 places per 1,000 people 70+ • Additional 84,538 Home Care packages over 10 years • 2 new levels of Home Care package

12. Living Longer, Living Better Home Care & Support • New dementia supplement for all Home Care packages, 10% of basic subsidy funded by 2% reduction of CACP and EACH from 1 July 2013 • 54% of veterans, with mental health condition verified by DVA, will attract dementia supplement • All future Home Care packages must be offered as CDC • Additional user pays via change to means testing, with annual cap of up to $10,000 and lifetime cap of $60,000 on income-tested care fees • Home Support Program to replace HACC, NRCP, DTC and ACHA from 1 July 2015 • 6% annual growth • Review of HACC service types

13. Living Longer, Living Better Workforce • Workforce Compact to be developed between Government, provider peaks and unions in 2012-13 • From July 2013, extra Conditional Adjustment Payment (CAP) available to providers (residential and home care) who sign on to Compact and complying enterprise agreement • 2013-14 – 1%; 2014-15 – 2%; 2015-16 – 3%; 2016-17 – 3.5% • Similar funding available to Home Support services via funding agreements Gateway • My Aged Care website and national call centre from 2013 • ACFI to be redeveloped into basis for national assessment framework across residential and home care • Linking service by 2014 for people with multiple needs

14. Living Longer, Living Better Quality Arrangements • Aged Care Standards & Accreditation Agency to be replaced by Australian Aged Care Quality Agency in July 2014 • Assesses quality across residential and home care • Aged Care Commissioner powers strengthened • Aged Care Complaints system remains with DoHA • National Aged Care Advocacy Program boosted by 20% • Community Visitors Scheme expanded to home care and group visits to residential care Other areas • Additional funding for: • Carer Support Centres • Projects to improve linkages between health and aged care, including palliative care • Measures to support older Australians from diverse backgrounds

15. Analysis of Government Reforms • $3.7 billion package over 5 years • Only $577m new funding • $1.6 billion taken from ACFI, plus failure to index subsidies • Other measures, such as dementia supplements, funded by adjusting basic subsidies • Marks further policy shift towards home care • Mixed bag for residential care • Removal of low/high care distinction; additional $20 accommodation supplement; better wages; optional services V • ACFI cut; unknown impact of Aged Care Financing Authority on bond levels; loss of bond retentions; cost of bond insurance

16. Analysis of Government Reforms • Fell short of Productivity Commission and National Aged Care Alliance recommendations: • No entitlement to care • No removal of supply-side planning controls • Family home not included in revised means testing • No government-backed home equity release program or Aged Pensioner Savings Account • Gateway only partly implemented (no regional or local physical presence) • There will be a review of reforms after 5 years • Further deregulation may occur at that point

17. LLLB Negative Effects Short-term severe financial pressure on residential aged care budgets Forcing providers to focus on medium-term survival Uncertainty about financing models for building residential aged care Banks stopped loaning capital Providers (like PAC) putting major developments on hold Extent of reforms to large swathes of aged and community care risks provider reform fatigue Not a conducive climate for taking risks with intergenerational programs

18. LLLB Positive Effects • Home Care Package and Home Support Program • This is the sector which will be experiencing significant growth • CDC – provide what consumers want • Be creative about opportunities in programs like respite and centre day care • Substantial volunteering opportunities (especially in former HACC services) • Residential Care • Nothing inherently stopping intergenerational programs • Optional services – could include user pays intergenerational programs • Quality indicators – important to make sure these include quality of life issues, not just clinical indicators Be creative, take risks!