Productivity Commission Draft Reports 2011 Carers NSW Conference 17 March 2011

Productivity Commission

Productivity CommissionDraft Reports 2011

Carers NSW Conference17 March 2011

Caring for Older Australians and

Disability Care and Support

Productivity Commission 2

Structure of presentation

• Carers in Australia – a snapshot• Overview of aged care report• Overview of disability report• Questions


Carers in Australia – a snapshot

• Over 2.6 million carers in 2009• 771 000 were primary carers• Most primary carers are female (67%)• Fairly even split between primary carers

for disabled under 65 and over 65• Value of informal care services

estimated to be $42 billion in 2010


Overview of Caring for Older Australians draft report

Robert Fitzgerald


Current weaknesses

• System complex, difficult to navigate• Quantity limits• Discontinuous care, not tailored to need• Constrained pricing• Financial inequities• Workforce shortages, low wages, regulatory

burdens• Complaints handling lacking independence• Poor interface with health system


Demand pressures

• Population over 70 to rise from 2m in 2010 to 6.2m 2050

• People receiving care to rise from 1m to 3.6m by 2050 − 3m to receive community care

• Residential care to grow from 160,000 places to 600,000 places by 2050


What has the Commission proposed?

• A coherent set of draft recommendations:− Care services− Catering for diversity− Funding (including user co-contributions)− Age-friendly housing− Informal carers, workforce, volunteers− Regulatory reform− Policy research and evaluation− Costing the system− Reform implementation


The gateway to aged care

Assessment & Referral

Australian Seniors Gateway Agency (ASGA) (with regional delivery)

Care coordination and care records

Information to communities and

individuals

Needs Financial capacity

Entitlement to approved care and support


Needs Assessment Framework

Personal Care (Community and Residential)

Personal hygiene, dressing, feeding, pressure area care, health monitoring

Specialised Care

Carer Support

Respite, carer counselling, carer education & training, advocacy

Health & Nursing

Dementia & challenging behaviour

Restoration & Rehabilitation

(including transitional and

sub-acute)

Palliative & End of Life Care

Continence

Cu

ltu

rally

an

d lin

gu

istica

lly d

ive

rse

, In

dig

en

ou

s,

rura

l a

nd

re

mo

te,

sp

ecia

l n

ee

ds Basic Support

Community – home cleaning, maintenance and modification, meal preparation, mobility and transport

Residential – domestic services


Enhancing choice, responsive competition and equity

• Remove limits− Care services and bed licences− Progressively over 5 years− Quality regulation remains

• Remove residential care distinctions− Low care and high care− Ordinary care and extra service care

• Supported resident quotas retained− Set by region and tradeable within regions− To be reviewed in 5 years


Funding principles

• Care (personal and health)− Co-contribution according to financial capacity (5%

to 25%)− Safety nets and hardship provisions

• Accommodation, everyday living expenses− Personal responsibility− Consumer chooses daily charges or

accommodation bond that reflects cost− Subsidised access for supported residents

Additional care and accommodation services -as consumer choose and pay for


Government Schemes to assist

• Australian Government Aged Pensioners Bond Scheme

• Australian Government Equity Release Scheme


Informal carers

• Carers will benefit from mainstream reforms:− navigable information− single gateway− flexible care services

• Assessment of older person’s needs to include capacity of carer to provide ongoing support through Gateway

• Entitlements to planned respite • Referrals to proposed Carer Support Centres for

emergency respite, peer support, training, etc


Structure of independent regulator

Australian Aged Care Regulation Commission (AACRC)FMA Act

Pricing Compliance & Enforcement

InformationComplaint Handling &

Review


What does this mean for consumers?

• Increased access to aged care − Expansion of assessment services− Assist consumers to make informed decisions

about providers• Greater care continuity- ongoing assessment • Greater capacity to receive care in the home• More options to allow older people to move

into appropriate housing without penalty• Fairer co-contribution system

− Catastrophic costs limited by stop-loss− Don’t have to sell your home


What next?

• Submissions by Monday 21 March• Hearings from 21 March• Extensive consultations

− System design− Financial modelling

• Final Report to Government June 2011

• Report tabled within 25 sitting days


Overview of Disability Care and Support draft report

John Walsh


Key messages

• Poor current system• Two new schemes are proposed• There are practical solutions to

complex design issues• Many groups of stakeholders can be

positively involved• Costs are affordable (cost estimates

are preliminary)


Key problems with current system

• Poor national insurance• Inequitable (the ‘lottery’)• Underfunded• Failures to intervene early• Fragmented• Lack of clear responsibilities• No real choice or power (a ‘barber for a bald man’)• Unsustainable (the ‘death spiral’)• Inefficient & poor governance• Uncertain future• A maze or ‘confusopoly’• Poor evidence base


Key features of the NIIS

• Federated model• No-fault• All catastrophic injuries• Lifetime care & support• Build on well-run schemes• Start only with new cases (800 a year – but

growing to 20,000 stock)• Costs $685m a year• Mixture of state revenue sources• Starts in 2013


Key features of the NDIS

• Universal insurance cover• ‘Reasonableness’ tests permeate the report• 360,000 people covered• Annual costs lie between:

− net $4.6-8.0b (with median of $6.3b or $280 per Australian)

− gross $10.8-$14.2b (with median of $12.5b)• Funded from consolidated revenue according to a

strict formula• People start getting NDIS supports in 2014, but more

funding in the mean time using the existing system


3 tiers

3b 3c

3a

Tier 1

3d

Social participation and minimising the impact of disability (target=Australian population) 22 million

Tier 2

Information, referral & web services, so people get clear information about support groups and assistance available (target = all people with disability) 4 million

Tier 3People receiving funding support from the NDIS (target = people aged 0 to the pension age with sufficient needs for disability support and early intervention)

(3a) Significant core activity limitations (225 000) (3b) Intellectual disability not already included (50 000)(3c) Early intervention group (80 000)(3d) Others optimally supported (unknown, but modest)

Total = around 360 000


A consumer perspective

People with disabilities

private, for- profit firms

non-government

organisations

paid individuals

eg neighbours

other government

services

state and local

government providers

Disability Support Organisations (DSOs)if people with a disability wish, they could choose an intermediary to be a service broker, provide management services, personal planning etc

NDIA case managers would provide case

management services and liaise with the NDIS and other government

services

Service providers (SPs)$ funding

National Disability Insurance Agency

Assessment, plans

& supportpackages

specialist disability service

providers

their needs and approved spending plan determine the types and nature of services

from the groups below


What’s in and out?

• In: − Traditional disability supports - attendant care;

community access; aids, modifications; supported accommodation; respite; taxi vouchers, supported employment

− New supports: early intervention

• Out: − public housing, education, health (except early

intervention therapies), Income support, open employment

• Uncertain: aspects of mental health


Many parties play a role in the NDIS

• National Disability Insurance Agency− federated model− Independent (board & rules)− CAC not FMA− Proper governance

• Specialist service and support providers• Links to other government-funded services• Disability Support Organisations• Mainstream services• Governments• Courts


What are the impacts for….

• Australians generally?• People with a disability?• Carers …… the “death spiral”?• Providers?• Workers?• States & territories?• Australian Government?


Timetable for NDIS

• 2011-12 MOU and taskforce• 2013 Intergovernmental agreement &

appoint board of NDIA; recruit & train key staff, build some infrastructure; provide information

• 2014 Rollout in a region• 2015-2018 A path to full coverage for all

significant disability Australia-wide• 2017 and 2020 reviews of self-directed

funding and schemes respectively


Timetable for NIIS

• 2011-12 COAG agreement• 2013 Vehicles and medical• 2015 All catastrophic injuries• 2020 Independent review


www.pc.gov.au


$1719m

$6300m

$4481m

$1719m

$10781m

$904m SPP

$815m for own

$4481m

$815m

$5385m

Spending

Funding

States & territories transfer $ to the NDIA

States & territories lower tax rates

$12500m

National Disability Insurance agency

revenue

Australian Government spending

State & territory spending

Now Under the NDIS

Option A9 funders

Option BOne funder (preferred)

Total $6200m Transfers to the NDIA Total $12,500m

States & territory funding

New Australian Government funding

Old Australian Government funding

Funding across jurisdictions


Alternative financing options

• Private insurance• Social insurance• State & LG taxes• GST• Levy on personal income tax• Earmarked consolidated revenue• State role vs Australian Government???• The 5 options:

− The ‘free ride’− The GST give up− Write a ‘cheque’− A razor to SPPs− A tax swap

Productivity Commission Draft Reports 2011 Carers NSW Conference 17 March 2011

Documents

Transcript of Productivity Commission Draft Reports 2011 Carers NSW Conference 17 March 2011