LASA-Policy-Documents-2015

July 2015 (V.2.0)
The voice of aged care
www.lasa.asn.au
Leading Age Services Australia PO Box 4774, Kingston, ACT 2604
P: 02 6230 1676 | F: 02 6230 7085 | E: info@lasa.asn.au
POLICY STATEMENT
Access to Care – Consumer
AIMS
All Australians have a choice of high quality age services through timely access to a broad range of
appropriate residential, community and retirement services.
An age services industry that supports and responds to the needs of all Australians regardless of their culture,
background, location or entry point.
LASA WILL
 Advocate that while ACAR remains, a more streamlined and timely process needs to be articulated,
whereby the allocation of aged care places through the ACAR be transitioned to better allow market forces
to dictate where and how aged care places should be distributed.
 Support the Aged Care Financing Authority and the Government in investigating in a better means of
allocation of places.
 Seek that aged care places be adequately funded to meet demand and service level requirements.
 Support the premise that funding arrangements be simplified, including the assets and means testing
arrangements, and annual and lifetime capping.
 Continue to support the premise that access to care should be based on assessed need and urgency,
through a consistent assessment process undertaken via My Aged Care but not to the disadvantage of
those groups who have diverse and additional needs.
 Argue that while ACAR remains for Home Care places, Providers who receive an allocation of packaged care
should not receive further allocation until the original allocations are commissioned, where allocations
should be returned after an appropriate time period if they have not been activated.
More than one million people receive aged care
services, with over half a million people receiving
support at home (whether that be in their own
home, rental property, retirement living or
elsewhere). Support for those people include
around 2.7 million carers, many of whom are family
members, and the system employs around 350,000
aged care staff across approximately 2,100 aged
care providers (within the traditional aged care
setting)1
.
LASA welcomes the announcement that the
Government intends to amalgamate the Home Care
Packages Programme and the Commonwealth Home
Support Programme (CHSP) in mid-2018, as well as
moving towards consumer directed funds2 & 3
.
Furthermore, the Government will increase the total
number of Home Care Packages from around 66,000
to around 100,000 by 2017. More than 40,000
additional packages are expected to be available
over the following five year period, from 2017-18 to
2021-224
. It is not known at this stage as to what
level of packages this refers to, however, with Level
1 Packages difficult to fill in some areas, and
insufficient numbers of Level 3 and Level 4 Packages,
the allocation process sorely needs to be reviewed.
LASA advocates that the proposed changes include
extensive industry consultation and allows for
sufficient time for implementing the required
infrastructure and stakeholder training prior to the
commencement date.
Furthermore, the Government states that there are
a range of initiatives that will support consumers to
access the aged care system/s within the industry,
including the expansion of the National Aboriginal
and Torres Strait Islander Flexible Care Program, the
National Care Advocacy Program, the Community
Visitors Scheme, the National Respite for Carers
Program and the Assistance with Care and Housing
for the Aged Program5
.
Overall, 59.2% of all people commencing Home Care
during 2013-14 received it within 3 months of their
ACAT approval, though this proportion varied across
jurisdictions. Nationally, 30.7% started receiving
Home Care within one month of Aged Care
Assessment Team (ACAT) approval6
.
Less people entered residential home care during
2013-14 (19.3%) within seven days of being
approved by an ACAT compared with 2012-13
(22%). Similarly, 47% entered within one month of

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their ACAT approval in 2013-14, compared with 50%
in 2012-13. Those entering care within three
months of their approval dropped to 69.4% from
72% in the same period6
. In other words, people are
not entering care as quickly as in previous years for
which there could be a multitude of reasons,
including the lack of available places6, 7
.
The distribution of the population aged 70 and over
is used in the planning process for the distribution
of age service places, with a national target in 2012-
13 of 113 places per 1,000 persons for this age
group. Long-term planning is aimed at a target of
125 places per 1,000 aged 70 and over by 2021-22,
including an increase of 45 home care packages per
1,000 people7
. LASA queries the authority on this
planning rationale and questions whether this will
meet the projected demand.
Nonetheless, with an ever increasing amount of
information available to prospective care recipients
(through My Aged Care and other avenues) the
consumer is now better placed to make informed
decisions as to how and where they access care and
services and an arbitrary calculation, the Aged Care
Approval Round process (ACAR), should not
interfere with that consumer choice.
In fact, a consumer peak body has suggested that
“the current rationed system needs to be replaced
by a model which provides a level of Government
resources to an older person to support them to live
as independently as possible. Giving the resources to
the older person enables them to continue to
manage their own life and tailor services to meet
their specific and individual requirements which will
change over time. This will require the aged care
service system to shift from its current welfare
entitlement model to one which operates from a
market basis, driven by the needs and expectations
of our ageing population”8
.
Despite the increasing information available, some
consumers are confounded with the decisions they
are faced with, not only for what care and services
they require but also who delivers the service,
where the service can be delivered (home or
residential care) and how much it will cost. As
identified on the My Aged Care website, the system
can make aged care seem complex and confusing,
especially if a person is urgently seeking information
for themselves, or a family member or friend. It's
often the first step which is most difficult for
families9
.
The funding arrangements developed under the
reform initiatives in 2014 were meant to simplify
the current system and make it easier for the
consumer to understand what their contribution to
care and services would be when accessing aged
care services. This is a premise that time may show
to be incorrect. This may be even more complicated
when the funding is managed by the consumer and
when the CHSP and Home Care Programmes are
amalgamated.
With the introduction of the National Screening and
Assessment Form from 1 July 2015 and the
development of the Central Client Record10
the aim
is to ensure access to care is based on assessed
need and urgency. It is imperative that matching
and referral to services is undertaken to meet
consumer needs, is fair and equitable between
services, and ensures care is delivered as and when
required. It is also imperative that the process is
undertaken in an expedient and efficient manner.
The provision of care and services for people should
be delivered on an assessed needs basis and be
consistent with the Schedule of Specified Care and
Services in residential and home care services, with
services outside the Schedule being negotiated
between the person and the Approved Provider as
identified in the Resident and Home Care
Agreements.
With debate occurring on a daily basis there
remains much to consider in relation to pension
arrangements and housing options, let alone care
decisions. LASA advocates for clear information to
be available for older Australian to ensure they have
the choice of how best they can live well, in a setting
of their choice.
STRATEGIC PILLAR LINKS TO OTHER POLICIES
Access Access to Care – Providers; Supporting Independent Living; & Consumer Directed Care
REFERENCES
1. Department of Social Services (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform)
2. Media Release from M. Fifield (12/05/15) (http://scottmorrison.dss.gov.au/media-releases/supporting-greater-choice-for-older-australians)
3. Budget 2015, Budget Paper No. 2 (http://www.budget.gov.au/2015-16/content/bp2/html/bp2_expense-20.htm)
4. Department of Social Services (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/home-care-packages#01)
5. Department of Social Services (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/overview)
6. Report on Government Services 2015 – Aged Care Services Chapter 13 (http://www.pc.gov.au/research/recurring/report-on-government-
services/2015/community-services/aged-care-services/rogs-2015-volumef-chapter13.pdf)
7. Australian Institute of Health and Welfare (AIHW) (http://www.aihw.gov.au/aged-care/residential-and-community-2012-13/services-and-places/)
8. (http://www.cota.org.au/lib/pdf/COTA_Australia/publications/submissions/federal_budget_submission_2014.pdf)
9. My Aged Care (http://www.myagedcare.gov.au/about-us/my-aged-care)
10. Department of Social Services (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/my-aged-care)

July 2015 (V.2.0)
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POLICY STATEMENT
Access to Care – Provider
AIMS
All Australians have a choice of high quality age services through timely access to a broad range of
appropriate residential, community and retirement services.
An age services industry where providers have sufficient funding to deliver a fair and affordable system of
care and accommodation to meet the needs of the ageing population.
An age services industry sufficiently viable to attract investors to meet demand in a truly contestable market
based system.
LASA WILL
 Advocate that while the ACAR remains, a more streamlined and timely process needs to be articulated with
the allocation of aged care places through the ACAR be transitioned to better allow market forces to dictate
where and how many aged care places should be distributed.
 Support the Aged Care Financing Authority and the Government in investigating in a better means of
allocation of places.
 Lobby to ensure that aged care places are adequately funded to meet demand and service level requirements.
 Seek that the funding arrangements be simplified, including the assets and means testing arrangements,
and annual and lifetime capping.
 Continue to support that access to care should be based on assessed need and urgency, through a
consistent assessment process undertaken via My Aged Care but not to the disadvantage of those groups
who have diverse and additional needs.
 Argue that while ACAR remains for Home Care places, Providers who receive an allocation of packaged care
should not receive further allocation until the original allocations are commissioned, where allocations
should be returned after an appropriate time period if they have not been activated.
 Advocate that for the purpose of the care contribution means test, money paid to the Approved Provider in
the form of a RAD should be exempt.
Despite the projected increases over the coming
years1
to home care places (including the
Commonwealth Home Support Programme (CHSP)
and Home Care Packages Programme) and
residential care places, aged care places remain
rationed. As rationing secures a limit on the number
of places available, some consumers either wait
significant lengths of time for services to
commence2, 3
or decide not to access formal care
and accommodation; sometimes to their detriment.
The Aged Care Approvals Round (ACAR) is described
as a ‘competitive assessment process that allocates
aged care places to those applicants who best
demonstrate they can meet the needs of the ageing
population within a specified aged care planning
region’4
. LASA support the recent announcement
from Minister Fifield stating that the next ACAR is
likely to be the last that includes home care
allocations given the proposed changes to consumer
directed care following the release of the 2015-16
Budget5
.
However, LASA argues that market forces, care
recipient mix and the prevailing competitive
environment should be the deciding factors that
encourage the expected growth for the next 20 plus
years. It is obvious that the ACAR process is not
keeping up with demand. An immediate audit of
provisional licences, a realignment of planning ratios
with a focus on regional impacts (especially for rural
and remote areas) and a determination of whether
some allocated licences should be cancelled should
be undertaken. This would inform the creation of a
more transparent and realistic allocation process.
In fact, others in the industry have long suggested
the same, “a rationed aged care system places
unnecessary pressure on hospitals and families and
the government should move, in consultation with
the sector, to abolish aged care ratios”6
.

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To assure sufficient investment commitment is
maintaining, improving and expanding the aged care
residential base, as well as the infrastructure
required to support both the CHSP and Home Care
Packages provision, Government must ensure that
adequate support for aged care services are
maintained and appropriately increased in line with
cost of living as community expectations increase.
There has been significant debate in relation to the
legislative changes introduced in July 2014, which
enabled the commencement of more flexible and
transparent accommodation payments; new subsidy
and fee arrangements for people entering residential
aged care; the removal of the distinction between high
and low care in residential care; implementation of the
outcomes of the review of specified care and services
in residential care; and new subsidy and fee
arrangements7
. Now, twelve months later, more needs
to be considered, including the inflexibility for
providers where consumers are offered, via the 28 day
rule, to determine whether they wish to make the
accommodation payment via a refundable
accommodation deposit (RAD) or daily
accommodation payment (DAP), or combination in
residential services.
LASA supports the new arrangements whereby the
consumer is accurately assessed for aged care
services and where the provision of information
assists them in making decisions about the most
appropriate services to support them to live as
independently as possible. This however cannot be
at the expense of the provider, and a collaboration
between the provider and the consumer needs to
be nurtured and supported.
With greater transparency of information, the use of
the Provider Portal within My Aged Care must
ensure that there is a reduction of red tape in the
provision of provider information.
For some providers, the ability in the past to ‘cross-
subsidise’ has supported access to care in the Home
Care Packages Programme for consumers and enabled
service provision to be aligned to assessed need. For
some consumers the complete amount of the package
was not fully utilised, enabling more services to be
provided to those whose needs exceeded the level of
package they were allocated. With the 1 July 2015
changes, this will not be able to occur. LASA is of the
opinion that this will negatively impact on the care
recipient and their families and may not support the
premise that people should be able to ‘age in place’.
Inevitably in some cases consumers will experience the
unintended consequences of CDC with a reduction in
service provision as services are limited to direct fund
availability. Although Senator Fifield has implied that
providers are at fault for not transitioning consumers
to higher level packages over time, what was not
considered in his comments was the lack of available
higher level packages8
. Providers in these instances
have tried to accommodate increasing client need
within the restricted funding circumstances, and not
tried to avoid their responsibilities as suggested by
Senator Fifield8
.
An area that is currently under scrutiny is the
supported resident ratio and the impact this has
both on the consumer and the provider. LASA look
forward to advice from the Aged Care Financing
Authority (ACFA), which is due to be provided to
Government by 31 December 20159
. LASA supports
the Productivity Commission recommendations,
specifically the two recommendations regarding the
maintenance of the regional ratios and the
introduction of the sliding scale of penalties for non-
compliance (Recommendation 7.5), as well as
Recommendation 17.6 which proposes that
providers have the ability to transfer a percentage
of their supported resident ratio requirements10
.
Access & Economic Access to Care - Consumer; Consumer Directed Care; Newly Built or Significant
Refurbishment; & Residential Accommodation Pricing
REFERENCES
1. Department of Social Services (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/home-care-packages#01)
2. Report on Government Services 2015 – Aged Care Services Chapter 13 (http://www.pc.gov.au/research/recurring/report-on-government-
services/2015/community-services/aged-care-services/rogs-2015-volumef-chapter13.pdf)
3. Australian Institute of Health and Welfare (AIHW) (http://www.aihw.gov.au/aged-care/residential-and-community-2012-13/services-and-places/)
4. Department of Social Services (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-funding/aged-care-approvals-round-acar)
5. Fifield, M. 2015, National Aged Care Alliance (NACA), Melbourne (18.05.15)
6. http://www.australianageingagenda.com.au/2013/11/01/renewed-call-to-abolish-aged-care-rationing/
7. Department of Social Services (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/get-involved/aged-care-reform-release-
of-exposure-draft-subordinate-legislation/overview-proposed-changes-from-1-july-2014-to-the-aged-care-principles-made-under-the-aged-care-act-1997-
april-2014)
8. Doorstop interview (http://www.mitchfifield.com/Media/MediaReleases/tabid/70/articleType/ArticleView/articleId/937/TRANSCRIPT--Doorstop-
Interview.aspx)
9. Discussion Paper: Access to Care For Supported Residents (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/discussion-
paper-access-to-care-for-supported-residents)
10. Caring for Older Australians (http://www.pc.gov.au/inquiries/completed/aged-care/report/aged-care-overview-booklet.pdf)

July 2015 (V.1.0)
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POLICY STATEMENT
Commonwealth Home Support
Programme
AIMS
Frail, older people living in the community are assisted to maximise their independence.
Services are provided with a wellness and reablement focus.
The care relationship between the care recipient, their family and the service provider is supported.
The Commonwealth Home Support Programme is an entry point into age services.
LASA WILL
 Advocate for a fair and equitable referral service with a transparent process based on service capacity.
 Work to ensure the central client record achieves its aim in reducing administration time and red tape.
 Work to ensure this entry level to age services is the commencement of a streamline continuum of care and
service delivery as required by older Australians.
 Lobby to ensure the National Fees Policy is equitable and affordable, and is clear on the consumer and
provider responsibilities when fees are not paid.
 Advocate that the Personally Controlled Electronic Health Record (PCEHR)/myHealth Record be capable of
seamlessly interacting with the Central Client Record to ensure streamlining of process and optimise access
to essential information.
First of July 2015, will see the Commonwealth Home
and Community Care Program (HACC), the National
Respite for Carers Program (NRCP), the Day Therapy
Centres (DTC) and the Assistance with Care and
Housing for the Aged (ACHA) Program brought
together under the Commonwealth Home Support
Programme (CHSP) 1
.
LASA supports this initiative and will welcome the
Programme when it is delivered fully across the
nation.
The CHSP is aimed at delivering small amounts of
timely low level home support services to large
numbers of frail, older people, either through a low
intensity framework on a short-term or on-going
basis, or higher intensity services in a short-term or
episodic basis.
The CHSP is also designed to offer services that are
lower than the cost or volume provided in a Home
Care Package on a per annum basis.
A key feature of this entry level service is My Aged
Care, whereby contact centre staff will undertake a
screening process using a standardised assessment
process generating a central client record.
People who are not directly referred to service
delivery will undertake a face to face assessment by
a Regional Assessment Service (RAS) building on the
support plan developed at time of screening that
will outline the goals of care and service delivery2
.
Training and an appropriate qualification level for
contact centre and RAS staff must be guaranteed to
ensure a comprehensive assessment of a person’s
needs is undertaken to confirm an appropriate
referral to the service that can best meet the needs
of the person.
Senator Fifield has stated that the CHSP will operate
under a streamlined programme structure with four
streams: community and home support; carer
relationships and support; assistance with care and
housing; and service system development.
The Senator submits that providers will benefit from
the streamlined funding arrangements, with less red
tape, simplified grant agreements and more time to
deliver important services for older Australians3
.
LASA supports the initiative of a National Fees
Policy, however this may not reflect the varying
costs of service delivery across the sector, especially
in rural and remote areas and specifically for the
Indigenous population. Minister Fifield suggests the
policy will bring fee arrangements for home support
and Home Care Packages closer together, aiming to
address the disincentive that currently exists for
those with higher support needs to move to
packaged care where they can be better supported3
.

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LASA supports this premise, however is unsure
whether the current Fees Policy will achieve the
aim. LASA does however, welcomes the exclusion of
fees from the acquittal process.
An area that has not been considered, nor has
funding been recognised, is in the use of assistive
technologies. LASA has made significant reference
to this in its submission to the Department of Social
Services on the CHSP Manual, Fees Policy
Consultation Paper and Good Practice Guide4
.
Although carers are incorporated in the Programme
they are not considered recipients or a target group.
LASA is concerned that service provision to the care
recipient may be diluted as energies will also need
to be focused on the carer.
LASA supports the announcement that the
Commonwealth Home Support Programme and the
Home Care Packages Programme will be
consolidated into one programme5
. LASA contends
that a consolidated home care programme would be
less confusing to the consumer, be delivered in a
more cost effective manner and enable consumer
choice to direct care delivery processes. However
there needs to be acknowledgement that to
maintain a level of service delivery that meets the
needs of the consumer, one funding system might
not be appropriate for all people and for all
geographical locations. Block funding will still need
to be considered as part of the broader funding
mechanisms.
While LASA is not in conflict with private providers
being listed on the My Aged Care website, which will
enable wider choice for consumers, there must be a
distinction between approved providers and non-
approved (and not in receipt of Commonwealth
funding) providers. This distinction must recognise
the extensive compliance and regulatory
expectations on an approved provider that non-
approved are not required to meet.
Access, Quality, Workforce, Economic, & Capability Access to Care; Repealing Red Tape; Supporting
Independent Living; & Consumer Directed Care
REFERENCES
1. Australian Department of Social Services, Commonwealth Home Support Programme (https://www.dss.gov.au/our- responsibilities/ageing-and-aged-
care/aged-care- reform/commonwealth-home-support-programme)
2. Commonwealth Home Support Programme. Programme Manual 2015 (https://www.dss.gov.au/our-responsibilities/ageing-and-aged- care/aged-care-
reform/commonwealth-home-support- programme/commonwealth-home-support-programme-programme- manual)
3. Speech given by Minister Fifield 10th March 2015
(http://www.mitchfifield.com/Media/Speeches/tabid/71/ArticleType/ArticleView/ArticleID/887/Default.aspx)
4. LASA Submission on the Re: Commonwealth Home Support Programme
5. Programme Manual 2015, National Fees Policy Consultation Paper, Good Practice Guide for Restorative Care Approaches (http://www.lasa.asn.au/wp-
content/uploads/Comments-on-the-Commonwealth-Home-Support-Programme-Manual-Fees-Policy-and-Good-Practice-Guide-15-April-2015.pdf)

July 2015 (V.1.1)
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POLICY STATEMENT
Consumer Directed Care (CDC)
AIMS
An age services industry that is easy to understand and navigate.
Age services that reflect population needs via facilities, accommodation and services that are fit for purpose.
A funding system that enables vulnerable, marginalised or disadvantaged Australians to access affordable
care, accommodation and lifestyle choices as they age.
LASA WILL
 Promote the expedient roll out of increased numbers of higher level Home Care Packages and a review of
the need and viability of Level 1 and 2 Packages.
 Seek a review of how Packages are distributed and managed, especially when the consumer has control of
how and with whom funds are spent.
 Participate in the preparation and dissemination of relevant materials for consumers, families and carers,
and service providers to ensure they are consistent and provide accurate information and be available from
a variety of avenues.
 Advocate that the Government commitment to red tape reduction be actively applied to streamline the
implementation and ongoing operation of CDC, including through quality and compliance processes.
 Advocate that block funding be made available for communities with diverse or additional needs.
 Advocate that regular evaluation of CDC needs to be undertaken, which identifies the benefits and
unintended consequences and provides recommendations on improvements to a CDC approach. This action
research approach would further support the comprehensive evaluation due in 2017.
 Contest that CDC should not be introduced into the residential care sector (including as a pilot) until a full
evaluation of Home Care CDC has been undertaken to determine the impacts and/or benefits for both
consumers and providers. Outcomes and future planning for CDC in the residential sector must be evidence
based.
 Ensure, by working collaboratively with Department of Human Services, that the difficulties encountered
with the Home Care Payment System and the Means Testing notifications are resolved as a matter of
urgency.
LASA supports the continued Government policy of
consumer directed care across the age services
continuum. The implementation of this policy
direction requires refinement and further
development, initially in the context of the Home
Care Packages Programme, and the Commonwealth
Home Support Programme (CHSP), and prior to the
planned roll out of CDC in residential care.
CDC is “a way of delivering services that allows
consumers to have greater control over their own
lives by allowing them to make choices about the
types of care and services they access and the
delivery of those services, including who will deliver
the services and when"1
.
The benefits of CDC are well documented in
international literature, both in terms of reduced
cost (compared to residential accommodation) and
consumer choice and control. The demographic
bubble of the ageing baby boomers ensures a
demand for flexibility and choice in the parameters
of care and a willingness to break away from the
traditional ‘aged care’ paradigm.
LASA welcomes the announcement that the
Government intends to amalgamate the Home Care
Packages and the CHSP in mid-2018, as well as the
move towards consumer directed funds2 & 3
. LASA
advocate that the introduction of these proposed
changes include extensive industry consultation and
allows for sufficient time for implementing the
required infrastructure and stakeholder training
prior to the commencement date.
The expected cost benefits are a major attraction
for Government and the flexibility of care at home
ensures that bed based construction will
increasingly be targeted at older Australians who
are most frail, chronically ill, and/or experiencing

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cognitive decline and symptoms preventing them
from receiving ongoing care at home.
Further work is required by Government to ensure
that providers of age services are able to maintain
viable, sustainable and successful businesses
through efficient operational systems and reducing
compliance costs, as the provider industry is critical
to the success of the CDC policy. CDC is consistent
with the self-directed care initiatives being piloted
through the National Disability Insurance Scheme
(NDIS), and together they form a major social policy
shift towards consumer rights and choice. Despite
many similarities, it must be noted that the aged
care industry is not the same as the sector that
relates to the NDIS.
For providers, CDC may have unintended cost
impacts and the complexity of CDC needs to be able
to be managed as efficiently as possible. In
transitioning to CDC, providers need the flexibility to
adopt a wellness and reablement focus, and change
care models, organisational culture and business
processes1
.
LASA is also concerned that there may be
unintended consequences from the roll out of CDC.
These concerns include: that the provider and client
may be put at risk by the move away from a ‘global
approach’; that the targeted nature of CDC may lead
to ‘overserving or underserving’ of clients; recipients
with specific and or specialist needs are unlikely to
see benefits from the CDC approach; and that there
needs to be confidence that the new approach is
adding value, especially for the client, over and
above the old system. The current constraints of
CDC do not support cross subsidisation and this
could be a disadvantage to some care recipients,
with service reduction to some current consumers.
Many providers have expressed concerns about the
legal implications of CDC, not only for their ability to
provide care for clients but also their ability to
provide a safe working environment for staff4
.
With the impacts of the 2014 changes in care
recipient contributions to care, with the basic daily
fee and applicable income tested care fee, and the
difficulties encountered with the Home Care
Payments System through the Department of
Human Services, some care recipients are
questioning the affordability of a Home Care
Package and in some instances in comparison to
what they may have received under a Home and
Community Care Package or that will be available
through the Commonwealth Home Support
Programme. This concern may also be exacerbated
by the varying information provided to potential
care recipients through avenues such as My Aged
Care and Aged Care Assessment Teams (ACATs).
There are reports of the undersubscription of Level
1 and 2 Packages (possibly due to the cost benefit
when considering the care recipient contribution)
and the need to offer more Level 3 and 4 Packages.
The price disparity between the consumer
contributions to a Level 4 Package versus entry to a
residential service needs to be considered. This
should be in concert with reviewing the difference
in funding to the provider between these two levels
of care.
Much work is yet to be undertaken for the
introduction of the CDC philosophy in Home Care
Packages Programme, with results of the formal
evaluation due in early 20155
. LASA advocates that
CDC in residential services should not be considered
until the results of the evaluation are known and
widely considered by the industry as a whole.
Economic, Quality & Workforce Access to Care – Consumers; Repealing Red Tape; Provision of Quality Care
and Services; & Commonwealth Home Support Programme
REFERENCES
1. Home Care Today (http://www.homecaretoday.org.au/)
4. Home Care Today (http://www.homecaretoday.org.au/provider/consumer-directed- care/legal-issues-project)
5. Evaluation of HCP and CDC (https://www.dss.gov.au/our- responsibilities/ageing-and-aged-care/aged-care-reform/reforms- by-topic/home-care/evaluation-
of-the-home-care-packages- programme-and-consumer-directed-care)

July 2015 (V.1.0)
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POLICY STATEMENT
Data
AIMS
Older Australians are supported to receive, and industry to provide, appropriate evidence-based services.
An age services industry that safeguards quality and innovation and focuses on continuous improvement.
LASA WILL
 Advocate for an improved co-design of ongoing and future data collection strategies.
 Seek for the collection of meaningful data which doesn’t only focus on cost.
 Advocate that new and ongoing data collection does not increase red tape and includes consideration of
the cost that may be imposed on industry.
 Seek to inform industry of the positive aspects of data collection.
 Advocate that industry information collected is available to Government and the industry equally to better
inform policy development.
 Advocate for an industry benchmarking system co-designed and owned by industry and Government.
 Co-design strategies that better utilise existing data.
LASA recognises the value of robust data and its
ability to inform research and service delivery.
However, obtaining high quality, meaningful data
and interpreting it into practice can prove to be a
significant enough hurdle as to halt the data
collection process. LASA notes that there is a chasm
of difference between data collection and effective
information management.
Aged care is predominately government funded and
this has therefore led to the government collecting a
large amount of data that has not always been
made available to the age services industry, nor
used in an informative manner. Although the
industry provides the raw data, they do not own nor
store it and this therefore decreases the accessibility
of the information. This access issue is potentiality
perceived as a power imbalance. Whilst the
government has responsibilities, including
considerations of privacy and confidentiality, this
existing information has the ability to enhance
service delivery and assist in continuous
improvement of the industry.
LASA seeks an improved interface between
government and providers when outlining questions
and defining the measurability, appropriateness,
scalability and affordability of revised and/or future
data collection strategies. Furthermore, any request
for information should have a defined aim and
outcome/s for service delivery rather than collection
that is not utilised.
There are a number of challenges with regards to
data use and collection, including:
 Evolution of information collected and/or
processes used to do so - methodology and
usability needs to be considered for proposed
and existing collections.
 Considerations need to be made to avoid the
introduction of additional ‘red tape’. This
addresses a potential two-fold issue, one
around time considerations and the other
around industry willingness to provide the
requested data.
 Real and perceived risks with information
usage.
 The ability to effectively communicate aims and
desired outcomes, to consumers and providers.
 Ability to obtain a consensus on what
information should be collected and how it can
be used.
 Unintended consequences, either through the
data collection process itself or the data use
(e.g. shifting funds to ‘improve’ reportable
components).
 Appetite for data collection.
These issues do not have answers readily available
but perhaps one of the bigger challenges is at least,
in part, being addressed with providers voicing their
desire to contribute and utilise industry wide data.
LASA seeks to encourage this engagement and
attempt to improve providers’ sense of ownership
of the information so as to start to breakdown the
potentially negative perception of data collection.

July 2015 (V.1.0)
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The National Aged Care Data Clearinghouse1
is an
independent and centralised repository for national
aged care data. The Data Clearinghouse provide
aged care data to a range of stakeholders including
policy makers, researchers, service providers and
consumers with a range of resources readily
available.
Quality & Capacity Provision of Quality Care and Services; & Information and Communication
Technology
REFERENCES
1. National Aged Care Data Clearinghouse (http://www.aihw.gov.au/national-aged-care-data-clearinghouse/)

July 2015 (V.1.1)
www.lasa.asn.au
POLICY STATEMENT
Diversity and Special Needs
AIMS
An age services industry which supports and responds to the needs of all Australians regardless of their
culture, background, location or entry point.
Develop new funding measures to support service provision in disadvantaged, rural, regional, remote and
Indigenous communities enabling vulnerable, marginalised or disadvantaged Australians to access affordable
care, accommodation and lifestyle choices as they age.
LASA WILL
 Assist Government to assess the true costs of care, including for all special needs groups listed in legislation
as a matter of urgency, and the additional costs of care for those with diverse and special needs be
recognised through equitable provision of adequate funding.
 Advocate that the Government commitment to reduce red tape be actively applied to streamline the
implementation and ongoing provision of care for special needs consumers and residents.
 Seek support, especially for rural and remote services, for independence enhancing technologies to be
provided.
 Encourage the Government to implements the CALD and LGBTI strategies.
LASA supports the continued Government policy of
defining groups or categories of consumers with
special needs1
to address actual, perceived and
potential discrimination across all levels of care.
Some of these special needs are already being
addressed through specific supplements and
supports to providers, with supplements already in
place for consumers with dementia and behaviours
of concern in Home Care Packages for veterans, and
for consumers who are financially and socially
disadvantaged. This leaves potential inequities for
those special needs consumers due to the higher
costs of delivering care and services in a fixed
funding and resourcing environment. The cost
burden of special needs care has been well
documented but not necessarily in the Australian
context.
By evaluating service utilisation trends of these
groups (e.g. people from a non-English speaking
background are more likely to access assistance with
home care services than residential care than their
Australian born counterparts2
) programmes can be
tailored to suit the community that it works in, in a
sensitive and appropriate manner. These
evaluations could also identify any potential
barriers, either real or perceived, so as to determine
whether these trends are based on cultural norms
or system failures. This proactive and responsive
approach will also support the identification of the
changing needs within these groups.
In the context of residential care, cultural, ethnic
and language diversity can require additional cost
elements such as dual kitchens, bilingual and
multilingual staff, and dual or multiple provision of
ethno-specific food choices and celebrations. For
consumers at home, the need for interpreters and
specific culturally relevant staff and care comes at
an added cost to ‘standard’ care, and Consumer
Directed Care (CDC) Packages are fixed, therefore
allowing less products or services to be purchased
within the available budget. The National Ageing
and Aged Care Strategy for People from Culturally
and Linguistically Diverse (CALD) Backgrounds
recognises additional requirements for these
consumers3
.
In rural, regional and remote areas of Australia,
there are challenges for providers recruiting and
retaining qualified staff in both residential and
home care services. For Home Care Package
providers, there is also an impost in the cost of
travel for workers, especially in CDC, where the
consumer has choice of staff and choice of timing of
care delivery. This occurs at the expense of care
delivery. For Aboriginal and Torres Strait Islander
(ATSI) consumers, who are often but not always
located in rural or remote communities, there is an
identified need for culturally safe and sensitive care,
as well as the travel and choice of worker
implications noted above.

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For homeless consumers and those in insecure
housing, there are additional access costs including
a requirement for two workers in many
circumstances. For care leavers, and for people
separated from their children by forced adoption or
removal, there are additional support requirements
often allied with a need to support these consumers
at home in preference to residential placement. For
Lesbian, Gay, Bisexual, Transgender and Intersex
(LGBTI) consumers, the National LGBTI Ageing and
Aged Care Strategy has been developed to define
and recognise their special needs and
circumstances, many of which cost more and
therefore reduce funds for direct care. Sustainable
funding, in conjunction with innovative programs,
are required to assist with some of the identified
needs for these individuals, as well as an
acknowledgement of the potential diversity within
each defined group.
LASA recognises that a number of group which may
have specific needs (e.g. people that require
bariatric equipment) are not included in the current
legislative definition of ‘special needs’, which can
therefore result in insufficient resources to meet
these needs. LASA advocates that a gap analysis be
undertaken to assess the impact of this issue so that
an action plan can be drafted for consideration.
A small but significant cohort of people accessing
care and services in both home and residential
services are those less than 65 years. Approximately
6,500 young Australians with disability reside in
residential aged care4
and an unknown but growing
number access Home Care Packages and
presumably Commonwealth Home Support
Programme services. Although young people with
disabilities are funded in the same manner as all
other care recipients their specific and often highly
expensive requirements are meant to be provided
from the same funding envelope.
Access & Quality Access to Care - consumer; Consumer Directed Care; & Specialist Funding
(Supplements)
REFERENCES
1. Aged Care Act 1997 (Cwlth), (http://www.comlaw.gov.au/)
2. AIHW, Cultural and linguistic diversity measures in aged care, 2014.
3. National Ageing and Aged Care Strategy for People from Culturally and Linguistically Diverse (CALD) Backgrounds (https://www.dss.gov.au/our-
responsibilities/ageing-and-aged-care/older-people-their-families-and- carers/people-from-diverse-backgrounds/national-ageing-and-aged-care- strategy-
for-people-from-culturally-and-linguistically-diverse-cald- backgrounds)
4. Young People in Nursing Homes Alliance (http://www.ypinh.org.au/)

July 2015 (V.1.1)
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POLICY STATEMENT
Information and Communication
Technology
AIMS
Age care services are enhanced through innovative Information and Communication Technology (ICT) in order
to establish care and services that are accessible and sustainable.
An age services industry that uses timely and accurate data in order to anticipate market trends and stimulate
research into future directions.
An age services industry where key stakeholders are engaged and use their knowledge and information to
provide industry thought leadership.
LASA WILL
 Assist Government to recognise ICT as a key enabler for sustainable age services to create incentives for the
adoption of technologies that improve the quality and efficacy across industry.
 Encourage the industry to take a leading role to harness the power of technology.
 Encourage industry to join with Government to create an ICT framework to enable age service providers to
‘Think Big, Start Small and Scale Rapidly’, consistent with the Aged Care Industry I.T. Council’s (ACIITC)
Digital Care Services framework.
 Work with the aged care industry to promote the benefits of ICT to older Australians.
Enhanced Information and Communication
Technology (ICT) is an essential component to the
sustainable delivery of care and services for older
Australians. Governments understand the desire for
the majority of older Australians to stay in their
home for as long as possible. Enhanced ICT capacity
will not only enable the delivery of health care and
essential services but also prevent social isolation.
There is currently variation in the technical
competency and capability across service providers,
with many providers still using paper based records
and struggling to keep pace with new ICT
capabilities1
. LASA supports the Aged Care Industry
Information Technology Council’s (ACIITC) call for a
baseline evaluation to be undertaken to make
available information on providers’ use of ICT, which
would in turn, support the drafting of a strategic
plan that would outline resource and investment
prioritises.
Aged care has not yet received the support that
State Health Departments, Community Pharmacies
and General Practitioners have been afforded to
enhance their ICT capability. Industry is seeking a
partnership with Government with a goal of
moderate investment in the short to medium term
making long term gains for all key stakeholders.
There are five key areas of ICT enhancement to
assist service providers. eHealth, which will ensure
the right information is provided to the right person
at the right time and place in a secure format. This is
of considerable importance when older Australians
transfer from home care to hospital or residential
care, and the interface between primary and
specialist care. Telehealth and Mobility to assist in
addressing challenges due to isolation and distance
thus ensuring equity of access to healthcare and as
a method to enable older Australians to remain in
their communities for longer. Care Management to
enable integration of care planning, personal health
support and medications management to enhance
quality and assist in managing chronic health
conditions. Management Information and
Reporting, which involves information management,
data exchange, analytics and reporting functions are
critical to the delivery of quality care and a culture
of continuous improvement. Core Technology and
Support to allow for more robust systems to better
manage the complicated interface of data storage,
payroll and transaction management and reduce
capital investment.
LASA supports the ACIITC’s call for the commission
of proof-of-concept projects to assist providers in
their service delivery but also calls for support for

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assistive technologies for home, community and
residential care services.
Assistive technologies support independent living,
privacy and safety, as well as helping to relieve
workforce pressures and family anxiety. LASA
encourages the support of research and pilot
projects into new assistive technologies as well as
ongoing financial support for their use2
.
The indicative benefits of ICT enhancement are
substantial for consumers, providers and
Government. The uptake of telehealth services has
shown a reduction between 30 – 60% acute hospital
admissions for older Australians that received these
enabled services3
. Evidence suggests that enhanced
ICT capacity for providers has a 20-30%
improvement in workforce productivity, which
translates to approximately 45,000 additional care
workers across the industry4
. Furthermore, ICT
enhancements support older Australian’s to be
independent, safer, maintain their privacy and
dignity and help to reassure family and friends.
LASA is fully supportive of the cooperative work
undertaken between the ACIITC and the
Department of Social Services in the development of
IT solutions to enhance the use of My Aged Care and
the Provider Portal.
Access, Quality, Workforce & Economic Commonwealth Home Support Programme; & Data
REFERENCES
1. Aged Care Industry Information Technology Council (ACIITC) Digital Care Services (2014)
2. LASA submission to DSS regarding the Commonwealth Home Support Programme (2015)
3. ACIITC and Accenture Telehealth Pilots Program evaluation (2014)
4. du Plessis D The Dollars and Sense: Quantified Benefits of Technology in Community Care, Healthcare Pty Ltd (2013)

July 2015 (V.1.1)
www.lasa.asn.au
POLICY STATEMENT
Newly Built or Significant
Refurbishment
AIMS
An age services industry that has sufficient funding to deliver a fair and affordable system of care and
accommodation.
The redevelopment, building of infrastructure, services and operations occurs by accessing a funding stream
and resources from investors who are attracted to the industry via sufficient return on investment and from
Government.
LASA WILL
 Advocate that the national 40% concessional rate be abolished and the regional concessional rate be
adopted as the trigger to qualify for the maximum accommodation supplement.
 Support and contribute to a review of the Guidelines for applying for the Higher Accommodation
Supplement. These should be reviewed as a matter of urgency.
 Highlight where decisions on applications are not made within the legislative timelines and hold the
Department of Social Services to account where the timelines are not met.
 Advocate that the Government commitment to reduce red tape be actively applied to streamline the
application and compliance process for refurbishment.
 Support the direction that State and Local Governments be encouraged to provide timely, transparent,
robust, planning and approval frameworks.
 Recommend that the building code requirements continue to be administered by the States and be based
on the Building Code of Australia.
The residential sector of the age services industry
provides living options for people that are
geographically, culturally and religiously diverse and
also offers a range of accommodation options. The
sector is a comprehensive mix of public, private and
not for profit organisations competing in an
increasingly transparent marketplace to provide
residential care services to an ever expanding
cohort of ageing Australians.
There is an overwhelming community demand for
accommodation options and an expectation that the
Government play a significant role in the
maintenance and expansion of the available
infrastructure.
Industry cannot fund these improvements and
expansions alone, especially given the significant
proportion of publicly supported residents and the
pricing controls exerted by the Commonwealth
across the aged care spectrum.
As of June 2014, religious (26.4%) and private
(37.4%) organisations were the main providers of
residential care. Community-based (13.6%) and
charitable (17.4%) organisations and state and local
governments (5.1%) provide the remaining
services1
. As a component of the age care reforms
the Government has determined to continue
providing financial support for refurbishment and
expansion of aged care residential facilities1
. This
capital co-investment is critical to ensure the
ongoing upgrading of facilities as well as supporting
the expansion of the available facilities. This
investment should expand, at least by CPI, and
aspire to the OECD average of 4.1% per annum2
.
With an estimated $31 billion needed over the next
decade to fund the construction of new or
expanded aged care homes to accommodate an
additional 76,000 older Australians3
this higher level
accommodation supplement is vital in supporting
the viability of provision to consumers.
The higher accommodation supplement has been in
place since 1 July 2014, however data presented to
the Aged Care Sector Committee indicates that as of
30 September 2014, nearly 16% of applications for
significant refurbishment have been denied and
approximately 26% of pre-approval applications
denied.
With such high levels of failure to meet the
legislative requirements (as defined in the

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Guidelines4
), LASA proposes that either the
applications do not meet the legislative
requirements or that the Guidelines do not reflect
the legislative requirements clearly enough to
support an application. The current Guidelines are
very complex, require unnecessary information and
should be reviewed as a matter of urgency.
LASA advocates for improved process and
communication strategies as, in some instances,
decisions on applications for the higher
accommodation supplement by the Department of
Social Services (DSS) have taken longer than
expected.
The 40% of supported resident threshold exceeds
the national average achievable and is therefore
seen as a deliberate intervention to limit the
number of organisations that qualify for the
maximum accommodation subsidy. The excessively
punitive nature of this policy directly impacts the
industry ability to meet consumer need.
Industry will maintain its commitment to
improvement and expansion and co-invest with
government where it provides a transparent and
accessible model for application, approval and
implementation of government support.
Economic Access to Care – Providers; & Repealing Red Tape
REFERENCES
1. Report on Government Services 2015 (http://www.pc.gov.au/research/recurring/report-on-government- services/2015/community-services/aged-care-
services/rogs-2015- volumef-chapter13.pdf)
2. ACSA Submission on significant refurbishment (http://www.agedcare.org.au/campaigns/acsa- submissions/submission-on-significant-
refurbishment.pdf/view)
3. ACFA Report on the Funding and Financing of the Aged Care Industry (https://www.dss.gov.au/sites/default/files/documents/08_2014/201
4_report_on_the_funding_and_financing_of_the_aged_care_indust ry_0.pdf)
4. Guidelines for applying for the Higher Accommodation Supplement June 2014 (https://www.dss.gov.au/our-responsibilities/ageing-and- aged-care/aged-
care-funding/higher-accommodation- supplement/guidelines-for-applying-for-the-higher-accommodation- supplement).

July 2015 (V.1.0)
www.lasa.asn.au
POLICY STATEMENT
Planning Ahead
AIMS
All Australians are able to plan for future legal, health and financial decisions.
A person’s values, beliefs and preferences are respected when making decisions for their future.
Families are assisted in supporting their loved ones decisions.
LASA WILL
 Lobby to have the introduction of advance care planning commenced as part of entry into the aged care
system, through My Aged Care and the national assessment process.
 Lobby to support General Practitioners being compensated through the MBS for consultations on advance
care planning.
 Advocate that the Decision Assist Project should continue to be funded by the Commonwealth Government
past the 2016 project completion date.
 Advocate for an improved alignment of State and Territory advance care planning terminology and
regulation, and transferability between jurisdictions.
Overall, 80% of people who died during 2010-11 at
aged 65 or more used at least one aged care service
in the 8 years before their death, and of that cohort,
one in six people used aged care within one year of
their death. Predominately community care was
used first, with permanent care the first service
used by one in ten of those who accessed aged care.
Home and Community Care (HACC) was the first
program used by nearly three-quarters of people1
.
There are three primary areas to consider with
regards to planning ahead: future legal; financial;
and health decisions. There can be significant
difference between the State/Territory
Governments in these areas, which has the
potential to result in substantial confusion for the
consumer, as well as their family. LASA advocates
for consumers to seek financial, legal and medical
advice regarding the appointment of an individual(s)
or trustee organisation to manage financial, legal
and/or health decisions if the consumer is unable to
continue to do so. This not only supports the
consumers but also assists family and providers in
ensuring that they are respecting the person’s
preferences and beliefs2
.
Advance care planning involves thinking about,
discussing and potentially documenting, an
individual’s preferences regarding health, personal
care and preferred health outcomes, if that
individual is no longer able to communicate their
decisions. Advance care planning includes the
appointment of a substitute decision maker, the
terminology used to describe this individual varies
depending on the State/Territory legislation, as well
as an advance care directive3
.
Advance care planning is therefore the domain of
the health and age care systems. However, advance
care planning is a process that is often left to
residential aged care providers to initiate, often
much too late in a person’s life span.
LASA argues that if a person has not been provided
with information about advance care planning or a
conversation has not been initiated prior to their
admission into residential services then the system
has failed them. Some people may not want to
enter into the conversation, nor want to
contemplate end of life, and this must be respected,
however there at least must be some attempt to
offer the information to the person.
LASA therefore seeks for an advance care planning
question to formally be included as part of the
National Screening and Assessment Form, to ensure
that anyone completing that process will have had
the conversation initiated. This conversation should
be undertaken with appropriately trained staff who
are able to address the potential sensitivities
surrounding this area.
Research and anecdotal evidence shows that if
doctors inform people about possible future
treatments and listen to their wishes, better end of
life care follows. Studies conducted in a range of
healthcare settings suggest that advance care
planning can improve individual and family
satisfaction with care, reduce the number of people

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transferred from residential care to hospitals and
reduce stress, anxiety and depression in surviving
relatives2
.
The Decision Assist Project, a Government funded
initiative, supports age service providers to improve
both palliative care and advance care planning
processes within their services. This includes a range
of two day workshops, a telephone link to specialist
advice on both palliative care and advance care
planning, a website housing evidence based
material and other important initiatives to improve
end of life care in the community and the residential
aged care settings4
. Decision Assist also includes
information for General Practitioners (GPs), through
access to specialist services, a phone application
(app) and formal training4
.
GPs also need to be appropriately compensated
through the MBS for consultations on advance care
planning.
LASA seeks for the aged care workforce to be
provided with specific education on advance care
planning, including advance care directives. This
would not only support staff in their practice but
would also provide them an understanding of how
to respect an individual’s decisions as well as
provide an appreciation of the legal considerations
regarding advance care planning, especially with
regards to end of life care.
Quality & Workforce Access to Care – Consumer; Provision of Quality Care and Services; &
Workforce
REFERENCES
1. AIHW Use of Aged Care Services Before Death (http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129550 411)
2. Planning Ahead Tool (NSW) (http://planningaheadtools.com.au/)
3. Advanced care planning Australia (http://advancecareplanning.org.au/)
4. Decision Assist Project (http://www.caresearch.com.au/caresearch/tabid/2583/Default.aspx)

July 2015 (V.1.1)
www.lasa.asn.au
POLICY STATEMENT
Provision of Quality Care and
Services
AIMS
An age services industry that supports older Australians to live well.
An age services industry that safeguards quality and innovation, enjoying a high level of public confidence
without unnecessary regulatory red tape and compliance.
A high quality age services industry whose focus is on continuous improvement rather than regulation or
compliance.
Age services availability reflects population needs via facilities, accommodation and services that are fit for
purpose.
LASA WILL
 Promote the provision of quality care and services across the spectrum of age services. This includes:
˗ Achieving a level of compliance to a set of standards for residential, home care and retirement living
services;
˗ The provision of specified care and services in residential and home care services (as per the Quality of Care
Principles); and
˗ Benchmarking performance indicators.
 Advocate that a contestable quality improvement process, through an independent accreditation body be
available to the age services industry.
 Actively participate in the National Aged Care Quality Indicator Programme through representation on the
Quality Indicators Reference Group.
 Advocate for the development of a suite of performance indicators that are relevant to service provision
and in concert with a continuous quality improvement framework.
 Actively lobby on how performance data will be displayed and used on My Aged Care (not in a “trip advisor”
format), including evidence based methodology with sufficient statistical rigour for data analysis.
 Advocate that the collection of performance data for the National Aged Care Quality Indicator Programme
is of no greater impost or additional burden than is otherwise undertaken as part of normal business
assessment.
 Advocate that the methodology for collection and reporting of quality of life/consumer experience
information will not automatically fall to the provider to undertake, and that it will be co-designed by
Government, consumers and industry. Extensive evidence based research needs to be undertaken as to the
best way this can occur and LASA commits to support and actively participate in the research process.
Quality is a multi-faceted concept which has been
defined in different ways1
, however a definitive
concept and vocabulary of quality is elusive. People
interpret quality differently and few can define
quality in measurable terms that can be
operationalised2
.
Using the National Health Performance Framework
(2nd
ed.) as a guide, quality, in the context of age
services, could include, determinates such as access
to care that is acceptable to the care recipient, with
effective outcomes, achieved efficiently for the
consumer, provider and tax payer, on an equitable
basis, and in a safe manner3
. This therefore
considers the allocation of aged care places (both
home and residential), the funding available to
providers, the fees and charges for consumers and
the delivery of contemporary, evidence based care
and services through a competent, skilled and
available workforce.
Quality improvement has been defined as an
ongoing response to quality assessment data about
a service in ways that improve the processes by
which services are provided4
.

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Accreditation and quality compliance is an accepted
core business activity for age services and should
provide public recognition of achievement to peer
developed standards that build on the safe
provision of quality care and services.
However, continuous quality improvement and the
process of accreditation should not be confused.
They have, as an end product, different reasons for
being implemented, though both are intertwined.
The former serves for the benefit of the consumer
and provider, the latter, serves for compliance with
the Australian Aged Care Quality Agency (AACQA)
and the Department of Social Services (DSS).
Currently the AACQA is the sole agency that
providers of aged care will deal with in relation to
the accreditation of the aged care services they
deliver, whether those services are delivered
through residential age services or in a person’s own
home5
.
LASA strongly contends there should be a
separation of powers between standard setting, the
accreditation process and any actions or sanctions
for non-compliance. Standard setting (incorporating
regular review), with a continuous quality
improvement focus and the accreditation to those
standards should be undertaken by an independent
body/ies separate to the DSS and Government.
Regulatory compliance is an approved provider’s
responsibility which should be administered by the
DSS. With the recent Budget announcements LASA
firmly thinks the independent provision of
accreditation services will lead to improved services
and would support working with the DSS and the
AACQA in how best to ensure this occurs in a timely
manner.
A number of providers are of the opinion that for
those organisations which have a robust quality
improvement system in place, and have consistently
met the standards over a prescribed period, there
should be less surveillance responsibilities than
would otherwise be required. Furthermore, given
that a number of providers offer a range of services,
and therefore are subject to multiple, and often
repetitive, accreditation schemes, LASA advocates
for the introduction of one accreditation system
across the entire industry.
The collection and reporting of valid, relevant and
reliable performance indicators is currently under
consideration for residential services and later for
home care services. A two fold use of such data
should be to provide the consumer with information
pertinent to their needs and to assist service
providers with continuous quality improvement.
LASA supports the proposed voluntary National
Aged Care Quality Indictor Programme and
subsequent display of trend data on the My Aged
Care website. However LASA does not support the
“Trip Advisor” rating system referred to by Minister
Fifield in his speech to the Committee for Economic
Development Australia (CEDA)6
.
LASA also considers that a diverse suite of
performance indicators should be developed,
whereby the provider can make an informed
decision on which indicators best suite their
business model and supports consumer
engagement, rather than a prescriptive list of
indicators. The establishment of these performance
indicators would then allow for the development of
useful and accurate benchmarks.
Although difficult to develop and articulate,
consumers are often interested in quality of
life/experience measures. Work is underway on
developing such measures, which could assist in
providing standardised measures for use, therefore
acting as an informative measure for Government,
the industry and for consumers7
. Significant work is
required before results of any measure introduced
are publically available.
Quality, Workforce & Capacity Repealing Red Tape; & Data
REFERENCES
1. Australian Institute of Health and Welfare (http://www.aihw.gov.au)
2. https://totalqualitymanagement.wordpress.com/2009/08/27/definition-of-quality/
3. Australia’s Health 2014 Australian Institute if Health and Welfare (http://www.aihw.gov.au)
4. EQuIP National Resource RISK MANAGEMENT & QUALITY IMPROVEMENT HANDBOOK
(http://www.achs.org.au/media/69305/risk_management_and_quality_improvement_handbook_july_2013.pdf)
5. Australian Aged Care Quality Agency Annual Report 2013/14 (http://www.aacqa.gov.au/about-us/AACQ043_Annual_Report_2014_web_01.pdf)
6. Speech to the Committee for Economic Development Australia (http://www.mitchfifield.com/Media/Speeches/tabid/71/ArticleType/ArticleView/ArticleI
D/836/Default.aspx)
7. Courtney, M, Edwards, H, Stephan, J, O’Reilly, M. & Duggan, C 2003, ‘Quality of life measures for residents of aged care facilities: A literature review’,
Australasian Journal on Ageing, vol. 22, no. 2, pp. 58-64.

July 2015 (V.1.1)
www.lasa.asn.au
POLICY STATEMENT
Repealing Red Tape
AIMS
An age services industry that safeguards quality and innovation, enjoying a high level of public confidence
A high quality aged services industry whose focus is on continuous improvement to ensure older Australians
age well, rather than a focus on regulation or compliance.
LASA WILL
 Continue to advocate that the Federal Government deliver on its commitment to Boost Productivity and
Reduce Regulation to the aged care sector by:
- Meeting its commitment to make publicly available Regulatory Impact Statements on all relevant
legislation to eliminate red tape creep;
- Creating a transparent and competitive regulatory framework that minimises government impact on best
business practice informed by the Ten Principles for Australian Government Policy Makers;
- Ensuring regulatory compliance is commensurate only with a Provider’s operational risk and/or their
responsibility to the consumer. It should not place an unjustifiable burden for no additional material
outcome on the aged care industry.
- Implementing the recommendations in respect of regulatory compliance of the Productivity Commission
report Caring for Older Australians.
 Ensure that the full suite of red tape reduction suggestions presented to the Aged Care Sector Committee by
NACA are considered as a matter of urgency.
 Advocate for the role of Aged Care Pricing Commissioner to be abolished.
The Federal Government has provided Ten
Principles for Australian Government Policy Makers
as the initial implementation framework for its
commitment to Boost Productivity and Reduce
Regulation. The aged care industry recognises the
commitment of the Government and has clearly
articulate a range of areas that can be identified as
candidates for red tape reform, via the National
Aged Care Alliance (NACA) processes. The baseline
rationale for such reform is supported by the
substance of the Productivity Commission’s Caring
for Older Australians report in 2011, “…the current
aged care system contains a plethora of
unnecessary, complex and burdensome regulations.
Many of them relate to quantity and price
restrictions and over-reaction to specific incidents.
Problematic governance arrangements have also
inhibited best practice regulation.”
LASA considers red tape to be any unnecessary
and/or inefficient burden on productivity, whether
this be in the form of excessive or inappropriate
regulation requirements or overly costly processes,
and inclusive of existing legislation.
LASA acknowledges that providers who receive
funding from Government, or that provide a service
that impacts on a consumer, have a higher level of
obligation than they would otherwise have in areas
without the same burden of public expectation.
There is nevertheless a separation between efficient
and responsible compliance and self-perpetuating
bureaucracy.
Given the mood for regulatory reform, it is timely to
revisit the compliance burden applied, even to
highly funded or highly consumed areas of activity.
Equally, areas with less responsibility for public
reporting and compliance need to be assured that
the level of regulation is appropriate and efficient.
Year on year, additions to the regulatory burden by
Government are heavily felt by the age services
industry. A ‘clean sheet of paper’ approach that
applies only a level of compliance burden
commensurate with a realistic expectation of the
risk or the level of community responsibility is the
most prudent outcome for regulators and providers.
There are a range of areas of prospective
interventions that will reduce red tape, this process
is under active development by a NACA Red Tape
Reduction Working Group, which has presented its
findings to the Aged Care Sector Committee (ACSC)

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resulting in the Red Tape Reduction Action Plan1
.
LASA recognise that NACA have identified a number
of ‘red tape opportunities’ and would specifically
identify the following items for priority
consideration:
 Simplification of the Aged Care Allocation
Round (ACAR) process and the centralisation of
common [provider] information;
 Transparency and simplification of
accommodation price regulation.
 A review of the Aged Care Funding Instrument
(ACFI) to address usability of the instrument;
 Removal of jurisdictional duplications – for
example food safety and fire safety regulations;
and
 Review accreditation and quality assurance
requirements so that there is one process for
providers to undertake.
LASA encourage the government to partner with
industry representatives in identifying and repealing
red tape opportunities, as well as avoidance of
potential ‘red tape creep’. LASA notes recent
increases in red tape including the Pricing
Commissioner, prescription of invoice content in
Consumer Directed Care, and potentially more
extensive and complex financial reporting with
significantly more expensive audit costs.
A further initiative involves the South Australian
Innovation Hub Trial, which is reviewing, for
example, less frequent government audits and less
complicated assessment to the accreditation
standards2
.
LASA supports the recent repeal day initiatives on
certification and key personnel, however LASA
continues to advocate that the full suite of red tape
reduction suggestions presented to the ACSC by
NACA are considered as a matter of urgency.
Access; Quality & Economic Newly Built or Significant Refurbishment; Provision of Quality Care & Services;
Residential Accommodation Pricing; Specialist Funding; & Workforce
REFERENCES
1. Aged Care Sector Committee – Communique (5 September 2014) (https://www.dss.gov.au/our-responsibilities/ageing-and-aged- care/aged-care-
reform/reforms-by-topic/aged-care-sector- committee/aged-care-sector-committee-communique-5-september- 2014)
2. South Australian Innovation Hub Trial (https://www.dss.gov.au/our- responsibilities/ageing-and-aged-care/ensuring-quality/the-south- australian-innovation-
hub-trial)

July 2015 (V.1.1)
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POLICY STATEMENT
Residential Accommodation Pricing
AIMS
A range of options for financing care and accommodation are available to meet the changing needs of older
Australians.
An age services industry that safeguards quality and innovation enjoying a high level of public confidence
An age services industry that is economically viable, sustainable and able to meet demand.
LASA WILL
 Advocate for the role of Aged Care Pricing Commissioner to be abolished.
 Remain supportive of the argument that providers should have a clear understanding of the methods by
which they are paid by consumers prior to admission.
 Advocate the ‘threshold amount’ for Accommodation Pricing be abolished.
 Support the My Aged Care website through co-design to remain as a public search portal including pricing
and other promotional detail.
 Seek that the MPIR is regarded only as a maximum and that a Provider may choose a lower interest rate
than the maximum when converting a Refundable Accommodation Deposit (RAD) to a Daily
Accommodation Payment (DAP).
 Strongly support that the MPIR should only change when there is a material change.
 Advocate for the 28 day rule for a decision to pay a RAD or DAP be abolished.
A key component of the transition towards
implementation of the age care reforms has been to
broaden the capital base available for industry by
allowing Refundable Accommodation Deposits
(RAD) to be charged to all residents who have
sufficient means to pay them. An understandable
consequence of the age care reforms is to provide a
‘one stop shop’ - My Aged Care - for consumers to
access a comprehensive, searchable and
comparative dataset of information on pricing and
service information.
An unnecessary component of this reform has been
the introduction of an Aged Care Pricing
Commissioner (the Commissioner). The
Commissioner is charged with approving RAD prices
above the arbitrary Ministerial threshold of
$550,000 and approving extra service fees1
. The
intent appears to be to provide some level of
consumer protection, the effect however serves
only to introduce an unnecessary level of
compliance burden with no evidence of any
consumer protection. In fact there is very little
evidence that any significant number of applications
have been denied.
LASA therefore seeks the immediate abolition of the
role of Commissioner with any savings applied to
enhancing residential subsidies. Such abolition
would naturally and coincidentally also remove the
threshold for accommodation pricing approval with
all RADs listed in equal manner on the My Aged Care
website and other company based promotional
platforms.
Significant uncertainty is also created via the
provision of the 28 day decision period for a
resident to determine how they wish to fund their
accommodation, i.e. whether by RAD or Daily
Accommodation Payment (DAP) or both. This
compromises the decision making process for a
provider as to whether they offer a place, as they
cannot be certain of the ‘terms’ of the residency,
and thus adds an unnecessary layer of risk to capital
planning.
Despite consistent representations from LASA there
remains difficulty with the way the Maximum
Permissible Interest Rate (MPIR) operates2
. There
are two concerns; firstly that the rate operates as a
set application of a formula, not, as the name would
suggest, as a maximum. This means that a provider
cannot choose to calculate a DAP under the formula
using a lower rate than the MPIR, despite this being
to the favour of the consumer, there is no logical
explanation as to why this is so. This exacerbates

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the second problem which is the compulsion to vary
the DAP when the three month moving average
interest rate changes, even if the variation is
minuscule.
While LASA does not propose that any adjustment
should be made to the MPIR that will apply
additional cost to the consumer, it does propose
that a threshold for recalculation of the MPIR apply.
This will prevent the need to recalculate the DAP
where it is otherwise not material nor therefore
viable. With recent means testing outcome
difficulties, many providers are reluctant to enter
into resident agreements (and therefore can delay
entry to aged care) until a correct assessment of
assets and income are clear. LASA has patiently
worked with the Departments of Social Services and
Human Services to fix outstanding problems. The
system must be corrected and improved without
any further delay.
Access & Economic Access to Care; & Repealing Red Tape
REFERENCES
1. Aged Care Pricing Commission (http://www.acpc.gov.au/)
2. Maximum Permissible Interest Rate (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-funding/refundable-deposit-balance-and-
accommodation-bond-balance-refund-interest-rates#03)

July 2015 (V.1.1)
www.lasa.asn.au
POLICY STATEMENT
Specialist Funding (Supplements)
AIMS
All Australians who have specialist needs have access and choice of high quality aged services.
An age service industry that supports and responds to the needs of all Australians, and specifically those
requiring care and service not met within the boundaries of existing funding levels.
Specific funding allocations reach those for whom it is identified.
LASA WILL
 Continue to seek that the true cost of care be identified for those people requiring specialist care and
services.
 Advocate that any funding initiative be based on a full disclosure of available data analysis to enhance
appropriate policy co-design.
 Advocate that funding initiatives be person focused, based on measurable outcomes.
 Continue to seek the government commitment to reduce red tape be actively applied to streamline the
identification of people requiring specialist care and services.
 Adopt a collaborative approach with Government and industry to provide efficient and effective funding
programme design, delivery and evaluation.
Evidence suggests that the subsidies currently paid
via the Aged Care Funding Instrument (ACFI) do not
fully capture the cost of care needs of residents
exhibiting severe and complex behaviours1
. This gap
has not be quantified, however with a growing
number of older Australian’s expected to
development dementia co-occurring with other
conditions, there is strong grounds for a
comprehensive investigation to assist in the
development of evidence based funding of services
for residential, home and community care.
The entry of the baby boomers into aged care
introduces a new generation of older Australians
with a different set of needs from the current
consumer cohort. This group have been predicted to
not only live longer, but enter care facilities at a
stage where they require more complex and/or
extensive care. It is possible that the future care
needs, as well as service expectations, of this
generation will be vastly different from the previous
one, as well as changing trends of their
carers/families.
Specific and specialist funding is not available for
palliative care services provided in home or
residential care, nor for advance care planning
processes. As dementia care is now seen as core
business for providers, so should palliative care and
advance care planning. Despite the Aged Care
Funding Instrument (ACFI) User Guide stating that
ACFI funding focuses on the main areas that
discriminate care needs among residents and on
care needs related to day to day, high frequency
need for care and for which are appropriate for
measuring the average cost of care in longer stay
environments2
, it is apparent that the current
funding does not support the specialist needs that
some residents require in residential care nor for
care recipients in home care.
The Viability Supplement is available to residential
care facilities that offer aged care services in rural
and remote areas. It seeks to assist providers with
the additional costs of care delivery in these areas.
To be eligible for the supplement, providers must
either meet a specific facility criteria, which may
include location or the number of beds, or provide
specialist aged care services to: people with a
history of, or a severe risk of, homelessness and/or
people from Aboriginal and Torres Strait Islander
Communities. There is some variance within this
supplement depending on the specific residents
and/or location of a facility (e.g. Homeless
Supplement of $15.29 per day)3
.
In mid-2014, the Dementia and Severe Behaviours
Supplement in residential services was ceased4
despite investment made by the industry to deliver
enhanced services. Consultation on such major
decisions needs to be a hallmark of Government
relations.

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LASA has consistently sought from the Department
of Social Services, information on what level of
modelling has been undertaken when recent
supplements have been introduced. This
information has not been forthcoming and requests
from the National Aged Care Alliance have also
proved to be futile.
With significantly more than 50% of residents in
residential aged care having dementia (90,000+
people) and with almost half those with dementia
also having a diagnosis of mental illness5
, it is
obvious that dementia services are no longer ‘niche’
but a core component of care and service delivery
for residential age services. However for those
people with severe Behavioural and Psychological
Symptoms of Dementia (BPSD), their families and
carers, additional support is required.
With the removal of the Dementia and Severe
Behaviour Supplement for residential services and
following the Dementia Forum in late 2014, Minister
Fifield announced the introduction of the Severe
Behaviour Response Teams (SBRT)6
. These teams
are seen as additional to the work undertaken by
the Dementia and Behaviour Management Advisory
Service (DBMAS) and will be accessed through
referral from the DBMAS. LASA is concerned where
the workforce will come from for the specialist
teams and their ability to respond in a timely
manner, especially in rural and remote regions.
LASA is also concerned with the recent
announcement that further funding is to be cut,
following the Budget announcement that the
current Aged Care Service Improvement and
Healthy Ageing Grants Fund will be redesigned and
cut by $20.1million dollars over four years7
.
There is a substantial body of research into areas
such as dementia which now requires investment
into translating this research into practice, through
enhancing staff capacity, knowledge and capability.
It is hoped that with the introduction of the SBRTs
that the DBMAS will be able to support capability
building within the industry, to ensure the
additional funding supports the people who require
additional services, rather than paying for
infrastructure that does not strongly support an
outcomes based focus.
Access; Economics & Workforce Access to Care; Repealing Red Tape; Provision of Quality Care and Services;
Workforce; & Supplement Inequity
REFERENCES
1. http://www.dss.gov.au/sites/default/files/documents/07_2014/eligibility_ guidelines_february_2014.pdf
2. Department of Social Services (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-funding/residential-care-subsidy/basic-subsidy-
amount-aged-care-funding-instrument/aged-care-funding-instrument-acfi-user-guide)
3. Department of Social Services (DSS)/ Aged Care Funding/ Residential Care Subsidy (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-
care-funding/residential-care-subsidy/supplements#08)
4. http://mitchfifield.dss.gov.au/media-releases/121
5. http://www.fightdementia.org.au/media/key-facts-and-statistics-for-media.aspx
6. Media Release (http://www.mitchfifield.com/Media/MediaReleases/tabid/70/articleType/ArticleView/articleId/864/MEDIA-RELEASE--More-support-for-
people-with-severe-symptoms-of- dementia-in-aged-care.aspx)

July 2015 (V.1.1)
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POLICY STATEMENT
Supplement Inequity
AIMS
An age services industry that reflects population need via facilities, accommodation and services that are fit
for purpose.
An age services industry that safeguards quality and innovation, enjoying a high level of confidence without
unnecessary regulatory red tape and compliance.
Equity of funding for all aged care recipients, irrespective of the type of organisation in which they choose to
receive their care and/or accommodation services.
LASA WILL
 Continue to advocate the federal Government restore the Payroll Tax Supplement or work with the State
Governments to exempt aged care providers.
 Seek for the introduction of Payroll Tax exemption for home care providers.
 Advocate the State Governments act to restore the principle of competitive neutrality in relation to payroll
tax to approved providers of age services.
 Continue to seek for the age services industry, and in particular the private (tax paying) sector, renew its
commitment to build and commission allocated residential places, thereby providing quality care services
for older Australasians and employment opportunities for a growing workforce.
 Advocate for the State governments to amend relevant Tax Acts to broaden the existing exemptions for
Health Care Services Providers to include all Aged Care Providers.
The Aged Care Payroll Tax Supplement was
abolished on the 1 January 2015 to make a net
saving of $652 million to the Commonwealth
Government over the next four years. The removal
of this supplement was implemented with no
industry consultation and results in an average loss
of approximately $2,350 per annum per resident, or
around $155 million for the 66,000 people affected1
.
The original principle of the supplement was to
remove the significant inequity in the age services
industry which results from the levying of state
payroll taxes on private providers only. This was
seen as an important principle, given that all
providers operate under the same Commonwealth
subsidy payment and fee structures, and all are
required to provide the same high standard of care
and accommodation to care recipients.
Payroll tax is a State/Territory-based tax levied upon
employers whose costs exceed the relevant
threshold in their particular State/Territory. Many
aged care providers are exempt from the tax,
however 37% of all residential providers and 10% of
home care providers2
are not. The removal of the
supplement will result in the competitive neutrality
of the age services industry being compromised and
places the Aged Care Sector Committee’s Statement
of Principles3
in jeopardy, whereby providers will be
unable to compete on an uneven playing field
where quality, value and performance are the
criteria for service delivery.
There has always been an uneven playing field for
private Home Care Package providers as they have
never received a supplement, however this
inequality will only be exacerbated with the growth
of Home Care places, introducing additional stress
on the industry.
There is concern that the loss of this supplement
will result in inequality for the consumer due to a
higher proportion of the provider’s budget being
required to meet operational costs. Whilst the full
extent of this issue is not yet know, given the
recency of the change, it is expected that budget
constraints may start to impact on less critical
services available to the resident.
The consumer has an expectation of services that
meet their wishes in an affordable manner, however
the loss of this supplement means that the dollars

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that a consumer may put forward to a private
provider may not stretch as far as the dollars put
forward to a provider that does not incur payroll
tax.
A significant proportion of sector costs go towards
the workforce salary, but the remuneration
differences for the people in the industry in
comparison to their professional counterparts in
other industries is still significant. For an industry
that is now one of the fasting growing in Australia,
the loss of a supplement can have large flow on
effects, whether that be in direct services available
to consumers or ones that may indirectly affect
them (e.g. workforce structure).
The decision to remove the supplement for
residential providers will negatively impact on
investment confidence, local employment, and
place a burden on the public hospital system - one
that is quantifiable into the tens of millions of
dollars in NSW alone4
.
The investment environment for tax paying
providers has been significantly impacted with the
removal of the supplement and has created a
disincentive to invest for private providers
prompting concerns within the industry that the
pace of development of new places may be under
threat.
The recently developed CIE report4
suggests that in
NSW, if the growth in private operational places fails
to keep pace with recent experience, between 940
and 2,440 places per year will need to be serviced
by other means, most likely to divert to NSW public
hospitals. Any unnecessary diversion of residential
care to public hospitals would represent an
inefficient use of scarce sub-acute bed capacity in
NSW Health, when more cost effective and equally
appropriate alternatives should be available within
the age services industry.
Access, Workforce & Economic Provision of Quality Care and Services; Specialist Funding (Supplements); &
Workforce
REFERENCES
1. Operation of Aged Care Act for 2013-14 (https://www.dss.gov.au/sites/default/files/documents/12_2014/2013-
14_report_on_the_operation_of_the_aged_care_act_1997_081214_0.pdf) and Report on the impact of the 1 July 2014 financial reforms on the aged care
Sector
2. Australian Department of Social Services, 2013-14 Concise Fact Sheets in Aged Care p9 (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-
care/tools- and-resources/ageing-and-aged-care-research-and-statistics/general-ageing-and- aged-care/2013-14-concise-facts-figures-in-aged-care)
3. Aged Care Sector Statement of Principles (https://www.dss.gov.au/our- responsibilities/ageing-and-aged-care/aged-care-reform/aged-care-sector-
committee/aged-care-sector-statement-of-principles)
4. The Centre for International Economics February 2015: Economic Costs of failing to supply allocated residential aged care places in NSW

July 2015 (V.1.0)
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POLICY STATEMENT
Supporting Independent Living
AIMS
Older Australians are supported to live independently and have a choice of high quality age services when
and where required.
Timely and accurate data and information is sourced in order to anticipate ongoing and future care needs.
An age service industry that supports and responds to the needs of all Australians regardless of their culture,
LASA WILL
 Advocate for the on-going evaluation of current and future programmes, using consumer outcome
measures that are not just related to cost.
 Support and contribute to evaluations of existing programmes delivered in the community.
 Support evidence based innovation and continuous improvement in service delivery and the use of assistive
technology.
 Assist providers to use innovative ideas in providing care and services which further supports independent
living.
 Lobby for review and policy reform on equity release, annuity arrangements, pension arrangements,
retirement income and accommodation and housing issues.
 Actively promote the direct linkage between retirement income security policy and the consumers’ ability
to exercise choice in the selection of age service needs.
 Continue to advocate policies to address the needs of the homelessness or those at risk of homelessness,
especially for older Australians.
LASA supports the Government policy regarding the
expansion of Home Care Packages to assist older
Australians to remain in their homes for as long as
possible, which introduces more choice and
flexibility for the care available1
. The Government
intends to increase the total number of Home Care
Packages to 100,000 by 2017, an increase of around
34,000 packages, with a further commitment of
another 40,000 from 2017 to 20221
.
In the last 20 years the proportion of older people
staying in their homes has significantly increased2
whether the ‘home’ is the traditional house,
retirement village or other design. There is strong
evidence that assisting people to ‘age in place’ has
many benefits for the individual, including
maintenance of their independence and health, and
avoidance of costs associated with residential care.
However, to successfully age in place, sufficient
support must be provided, including care.
The Productivity Commission’s report from 2011
identified a number of requirements to assist
people to age in place, including the provision of
relevant and understandable information to allow
people to make informed decisions; increased
Government accountability on the services that
are/are not available; access to appropriate medical
services, both generalist and specialist care; as well
as considerations regarding carers and volunteers3
.
These support services need to be responsive,
appropriate and sensitive to people’s needs,
however this is not without significant challenges
for providers and Government.
The use of assistive technology has been shown to
increase people’s independence and improve
people’s safety, whilst maintaining an individual’s
dignity and social connectedness. The use of this
technology also has a positive impact on workforce
requirements and hospital admissions as well as
decreasing family anxiety.
LASA recognises that care is not a concept that can
be provided in isolation, rather it is part of a much
broader, multi-faceted process. According to AIHW,
outright home owners are more likely to age in
place, however data suggests that the percentage of
people who own their own home is decreasing and
the number of lone-person households is
increasing4
.

July 2015 (V.1.0)
www.lasa.asn.au
A barrier to older people living independently is
appropriate housing. There is a need to expand age
appropriate housing and alleviate the inadequate
supply of affordable housing, especially for those
who do not own their own home and/or are reliant
on the full aged pension. There is significant data
that supports the premise that those who do not
have adequate housing are impacted in the way
they participate in the community and on their
health and well-being5
.
Concerns have also been raised regarding the
decreasing availability/affordability of rental
housing (e.g. Anglicare Australia’s Rental
Affordability Snapshot reports). These trends, whilst
perhaps not directly related to care, do significantly
impact on people’s budget, impacting on their
ability to pay for care services, whether that be
partial or full payment. For a person to maintain
their independence, care should be able to be
delivered where and when a person requires it.
Currently there is vigorous debate around the
treatment of pensions, equity release and
opportunities for people to maximise their income
superannuation and other forms of savings to
enable them to live independently. Review and
reform is required on retirement incomes
particularly to policy and regulation around the
retirement phase of superannuation, and
supporting people’s ability to access affordable and
secure home equity arrangements. LASA supports
the development of improved financial products
that enable better access to financial equity in a fair
manner.
LASA supports the policy announcement combining
the Commonwealth Home Support Programme and
Home Care Packages Programme6
, however these
initiatives will not have the intended benefit if
people are precluded from accessing them due to
an inability to pay or afford consumer contributions.
The occupancy levels for Packaged Care may well
suggest that consumers are already voting with their
feet.
Access to safe and secure housing is a basic human
need. However, many people who should be able to
live independently are affected by homelessness or
the risk of homelessness. LASA supports the concept
adopted by the Australian Bureau of Statistics in
recognising that homelessness is more than roof-
lessness and therefore includes elements of
connectedness with family, friends and the
community, as well as considerations to access and
security7
. Better policy reform is required with a
bipartisan approach of Governments to support
people to access safe and secure housing.
LASA supports the Government in their full
evaluation of the introduction of Consumer Directed
Care into the Home Care Packages Programme, and
advocates for a comprehensive follow up evaluation
of these changes post-implementation prior to any
further significant changes, with the inclusion of
appropriate measure of quality of life/experience
measures, in conjunction with cost data.
LASA seeks for the principles of service delivery,
including quality of care, to be defined in a
meaningful and measurable manner, with a strong
focus on continuous improvement and independent
living. This would allow for accountabilities and
responsibilities of consumers, providers and
Government to be identified and evaluated by an
independent body, which could result in evidence-
based changes to the existing system/s.
Access; Quality & Economic Access to Care – Consumers; Provision of Quality Care and Services; &
Commonwealth Home Support Programme
REFERENCES
1. Department of Social Services (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/home-care-packages)
2. Australian Bureau of Statistics – 2011 Census (http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/2071.0Main%20Features602012–
2013?opendocument&tabname=Summary&prodno=2071.0&issue=2012–2013&num=&view=)
3. Productivity Commission’s ‘Caring for Older Australians’ (2011) (http://www.pc.gov.au/inquiries/completed/aged-care/report)
4. AIHW ‘The desire to age in place among older Australians’ (2013) (http://www.aihw.gov.au/publication-detail/?id=60129543093)
5. The Senate – Out of reach? The Australian housing affordability challenge
(http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Economics/Affordable_housing_2013/Report)
7. Australian Bureau of Statistics – A Statistical Definition of Homelessness (2012)
(http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4922.0Main%20Features32012?opendocument&tabname=Summary&prodno=4922.0&issue=2
012&num=&view=)

July 2015 (V.1.0)
www.lasa.asn.au
POLICY STATEMENT
Transition from Acute to Sub-acute
Care
AIMS
An age services industry which supports and responds to the needs of all Australians regardless of their
culture, background, location or entry point.
An integrated health and age services system.
Establish a seamless journey for the older person from acute to sub-acute services.
LASA WILL
 Support a transfer system from the acute system to sub-acute residential aged care that recognises a
person’s immediate and short term goals of care.
 Advocate for a system that provides sufficient detail to enable the receiving facility to undertake immediate
care and responsibility for the care recipient.
 Work with State and Territory governments to improve the links between health and aged care.
 Advocate for the development of advance care plans for older people.
 Advocate for Government consultation of industry prior to introducing the proposed changes for short-
term restorative care places.
LASA supports the recent Government announcement
of the incorporation of short term restorative care
places into the aged care planning ratio, commencing
July 20161
. The increase of 2000 places by 20212
is a
welcome increase however LASA recognises that this
increase may need to occur in conjunction with other
measures to ensure industry needs are met.
Furthermore, LASA encourages Government to consult
the industry prior to the introduction of any changes
around restorative care places.
With the Government’s response to the Productivity
Commission’s Caring for Older Australians Report
resulting in the changes to the age services industry
introduced in 2013-14, the focus has been to make
the structural changes needed to ensure the future
sustainability of Australia’s aged care system.
Some of the key elements of the new system are
designed to provide for:
 Greater choice and control over aged care
arrangements for consumers;
 New and more equitable ways of meeting the
ever increasing costs of aged care;
 Ensuring that the most vulnerable in our society
are fully protected; and
 The age services industry works more closely
with the wider health system to tackle key
health challenges in particular, the increasing
prevalence of dementia, and support for end of
life care3
.
It is widely accepted that it is more desirable to have
shortened lengths of stay in hospital as hospital
inpatient services are geared towards shorter periods
of care aimed at addressing serious illness or injury, or
diagnosis, and are a less effective form of care for older
people who cannot live independently in the long
term3
. There is also a financial imperative on State
Governments to ensure people are discharged from
acute services as soon as possible.
Mechanisms to support people once they have
discharged from an acute hospital include the
Commonwealth Home Support Programme and the
Home Care Packages Programme, along with other
flexible care programmes. These programmes are
designed to maintain a person in their own home
and assist to alleviate premature admission to
residential services.
However not every person is ready to return home
following discharge from hospital, and there are a
range of programmes that can support a person
transitioning from acute care, including the Transition
Care Program (TCP) and Respite. The TCP was
established to assist older people in regaining physical
and psychosocial functioning following an episode of
inpatient care, to maximise independence and to help
avoid premature entry to residential aged care.
Services are delivered to patients in their own homes
or in dedicated, home like residential facilities for a
period of up to 12 weeks. To be eligible, patients must
have been assessed by an ACAT as having the potential

July 2015 (V.1.0)
www.lasa.asn.au
to benefit from Transition Care, be eligible for
residential aged care, and they must begin to receive
Transition Care directly on discharge from hospital.
Respite care4
(also known as 'short-term care') is a
form of support for carers. It gives the carer an
opportunity to attend to everyday activities and
have a break from the caring role. Respite care may
be for a few hours or days or for longer periods. It
can happen in a person’s home or at facilities such
as an overnight respite cottage, a day centre or aged
care home.
The difficulty is that these programmes may not be
used for their intended purpose, especially residential
respite, where there is more frequently a common
theme of ‘try before you buy’ by the potential resident,
rather than for the benefit of the carer.
No matter the mode of transfer, the most important
aspect of a person moving through the health and
age services systems is that the journey be
seamless; a laudable objective, but not always
achievable.
A study undertaken some years back found that the
transition between acute health care and residential
aged care settings was impacted by four key factors:
there were shortfalls in information and
communication processes, cooperative care, and
discharge planning procedures5
. In a submission to
the National Health and Hospital Reform6
it was
stated that there was a perception that hospitals are
desperate to get elderly people out of acute care,
and some of the findings reported that prior to
transfer from hospitals, aged care residents appear
to suffer significantly from nutritional deficiencies,
and compromised skin integrity is most widespread.
These are old reports, however more recently it has
been shown that 10.4 of 1,000 patient days
nationally (for overnight separations only) in 2012-
13 were used by patients who were waiting for
residential aged care3
.
Despite the aged care industry having the capability
to offer more complex health, wellbeing and
reablement services, a residential provider of age
services has a myriad of issues they need to
consider when accepting a transfer from the acute
hospital system to residential aged care. Regardless
of which way the person is admitted the duty of
care commences the moment a person enters care.
The transition can be upsetting for both the care
recipient and their family, but should occur with as
much information as possible from the transferring
acute service.
Important considerations required prior to
acceptance of a person from the acute sector
include:
 Whether the person will be admitted on a
respite or permanent basis.
 A comprehensive history review, including
current diagnoses which should highlight any
complex clinical needs and treatment regimes.
This should be undertaken in a pre-admission
clinic format including:
- An understanding of the current
medication regime; and
- An understanding of family involvement.
 Whether the service has the capacity and
capability to offer the care and services
required to support the person. This includes
whether staff require additional training and
skills enhancement to meet the needs of the
person.
 An estimated cost of care and consideration to
whether ACFI and other subsidy payments will
cover the cost of current and ongoing care.
 Whether there will be appropriate clinical
supervision available to support the person.
 Whether a service has the resources and
consumables required on a 24 hour basis.
 A comprehensive and effective handover process.
 Whether the person has an advance care plan
in place or, at the very least, has the discussion
commenced to support advance care planning.
It is vital to consider how a person will adapt to a
new environment and if there is any concern over
whether care and services can be provided that
meet both accreditation responsibilities and
requirements under the Quality of Care Principles
then consideration must be given as to whether the
place is offered to the potential care recipient.
Quality, Economic & Capability Provision of Quality Care and Services; Workforce; & Planning Ahead
REFERENCES
2. DSS – Expansion of flexible care initiatives: 2015 Budget (https://www.dss.gov.au/about-the-department/publications-articles/corporate-
publications/expansion-of-flexible-care-initiatives)
3. Report on Government Services 2015 (http://www.pc.gov.au/research/recurring/report-on-government- services/2015/community-services/aged-care-
services/rogs-2015- volumef-chapter13.pdf)
4. http://www.myagedcare.gov.au/caring-someone/respite-care
5. Improving resident transfers between hospital and residential aged care facilities (http://www.bsl.org.au/.../MeesePoole_Improving_resident_transfers_
2008.pdf)
6. Submission National Health and Hospital Reform (http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/280/$ FILE/280%20-
%20SUBMISSION%20%20Prof%20Tracey%20McDonald%20Individual%20Submission.pdf)

July 2015 (V.1.1)
www.lasa.asn.au
POLICY STATEMENT
Workforce
AIMS
Sufficient people and resources are available to meet industry demand via a workforce that is available,
inspired, skilled and valued.
An age services industry workforce equipped to best meet the changing needs of all older Australians
regardless of their circumstance or background.
An age services industry funded and structured to perform highly in the areas of worker skills, health, safety
and positive work life balance via consistent and appropriate education and training delivery ensuring worker
capability.
LASA WILL
Workforce Development
 Seek a qualified and skilled age services workforce to address the growing and diverse needs of Australia’s
ageing population delivering:
̵ The development of a mandatory clinical placement in age services as part of undergraduate education or
an age services clinical stream;
̵ Creation of new graduate programs (similar to the LASA Aged Care Nurse Graduate program);
̵ The age services industry be considered a priority area for displaced workers and recipients of
Government funded and led transitional industry re-training programmes;
̵ The development and delivery of a standardised management skills and training package; and
̵ Registered Training Organisations should have robust, evidence based curriculum to ensure a strong
standard of competence for students.
Workforce Attraction and Retention
 Work cooperatively with key stakeholders to develop a package of initiatives to attract and retain a skilled
workforce to meet the needs of Australia’s ageing population through:
̵ Government funded financial incentives to attract a workforce to areas and occupations of need;
̵ Sufficient Government financial support that ensures competitive wages are offered for similarly skilled
workers in similar sectors;
̵ A targeted review of rural and remote workforce issues;
̵ Strategies to enhance age services as a profession and the image of the age services workforce;
̵ A National Code of Conduct for aged care workers be supported and administered through a body such as
the Australian Health Practitioners Regulation Agency (AHPRA);
̵ Government issued financial incentives for innovative workforce practices;
̵ Government assistance for the development and introduction of new and improved technology; and
̵ Government assistance to promote aged care as a career of choice.
Review of Workforce Constraints
 Work cooperatively with key stakeholders to review current constraints and barriers to the efficient and
sustainable delivery of age services, including:
̵ A review of innovative, sustainable and multi-disciplinary workforce models of care in response to a
changing aged care environment based on an assessment of client outcomes;
̵ Facilitating an industrial framework that supports responsive and flexible work practices appropriate to a
consumer directed care operating environment; and
̵ A review of Australian immigration laws to include age services positions in the skill shortage list and a
corresponding review of an applicable Temporary Skilled Migration Income Threshold for these
occupations.

July 2015 (V.1.1)
www.lasa.asn.au
Australians are living longer and continue to have
one of the longest life expectancies in the world.
The number of Australians aged 65 and over is
projected to more than double by 2055. In 2055, it
is predicted that around 40,000 people will be aged
100 and over1
. By 2050 the aged services workforce
(workforce) is expected to grow from an estimated
352,100 (2012 estimate) to 827,100 employees2
.
This projected increase in demand for age services
cannot be overlooked. Actions and strategies need
to be developed to ensure the age services industry
has the resources necessary to meet the needs and
demands of all older Australians.
More than 240,000 workers are employed in direct
care roles in the age services industry. Of these,
147,000 work in residential facilities, and 93,350 in
community outlets3
.
LASA is concerned with the recent budget
announcement that the Government planning to cut
15% of the Aged Care Workforce (Development)
Fund, which may jeopardise innovation and put
quality at risk. With forward estimates predicting
that the age services workforce needs to triple in
size by 2042, the reduction of available funding to
support training and education, in conjunction with
the decrease of Aged Care Service Improvement and
Healthy Ageing Grants Funds, the concerns around
the Severe Behaviour Response Teams4
and the loss
of supplements is not supportive to the industry. An
available, accessible and appropriately skilled
workforce is a fundamental requirement of the
growing age services industry. Sourcing and
maintaining a sustainable workforce is therefore a
significant issue.
Residential, home and community care providers
continue to struggle to access appropriately skilled
and available staff. All providers need support,
funding and new initiatives so as to adequately fulfil
current and future staffing needs.
Research indicates three quarters of residential
facilities and half of the community outlets report
skill shortages in one or more occupations. It is
anticipated that the increasing demand for nursing
and allied health professionals in the age services
industry will be further exacerbated by increased
competition for staff with the staged introduction
and upscaling of the National Disability Insurance
Scheme (NDIS).
The Intergenerational Report predicts that the
proportion of Australian’s aged over 65 participating
in the workforce will increase strongly, from 12.9%
in 2014-15 to 17.3% in 2054-55. As the report
states, “this provides significant opportunity to
benefit from the wisdom and experience of older
Australians”. As stated in the NILS report5
, older
direct care workers are seeking ways to maximise
the length of their work-lives and contribute to the
aged care industry. Further investigation of
strategies required to retain older workers for
longer may assist in addressing some of the skill
shortages in the industry. However, alternative
models of care and service delivery also need to be
developed to attract a sustainable workforce fit to
undertake the tasks required to support older
Australians receiving age services. This may include
extending the scope of practice of those working in
the industry, alongside a review of the workforce
skill requirements.
With the clear move towards consumer directed
care and client determined service outcomes LASA
advocates for a national industrial relations
framework that will protect and preserve measures
that enable maximum workforce flexibility.
With an expected increase of assisted technology to
support the delivery of care and services LASA
supports employment laws that allow aged care
employers to be agile and adapt to the changing
demands of their clients. While aged care
(specifically residential) remains working under a
medical model, consumer focused flexibility work
practices may not eventuate.
As identified by the Australian College of Nursing,
nurses may take on leadership roles beyond the
nursing domain, and nurse leaders are needed in all
settings and across all levels of the organisational
hierarchy. Nurses (including Nurse Practitioners)
may be well placed to take on the clinical leadership
role, which involves delivering and monitoring
evidence-based best practice, evaluating outcomes
within a continuous improvement framework,
assessing and mitigating risks, improving efficiency
and coordination at the point of care while
advocating for those they care for6
.
The NILS Report5
also states that there is significant
variation in the management skills and training
between care providers. A direct correlation has
been noted between these skills and the workplace
satisfaction of the direct care workers. A specific
issue of note is the concern that the training
generally provided is focused exclusively on
residential care and does not address the
community sector appropriately.
With more care being delivered in the home, with a
total number of packages increasing from 60,000 to
100,000 by 2017 and more than 40,000 additional
packages from 2017-18 to 20217
and under a
framework of consumer directed care, care delivery
models and those delivering care will need to
change to meets the growing demand.

July 2015 (V.1.1)
www.lasa.asn.au
LASA has identified a number of pathways that can
assist in meeting the identified expanding
requirements of the workforce. The industry calls
for a review of workforce constraints and improved
access opportunities with respect to Australian
immigration laws. Sensible adjustments and
amendments to immigration laws that provide
greater access for overseas workers to join the age
services industry and opportunities for age service
providers to increase their labour pool must be
considered. Secondly, transitional funding for
displaced workers to encourage and target
opportunities within the age services industry must
become a priority focus.
All pathways and workforce considerations must
ensure sufficient training is available to bridge any
language, cultural or other barriers to attracting and
retaining a workforce and initiatives need to take
into account that the age services workforce needs
to be mobile and resourced to meet age service
needs in rural, remote and other specific needs
areas.
As part of LASAs advocacy for employment laws that
enshrine workforce flexibility and equity, LASA
supports and encourages fairness and equity across
the industry. LASA encourages Federal and State
Governments to ensure all aged care employers are
given an equal opportunity to receive/apply for
grants, concessions, supplements and exemptions.
Quality; Economic; & Capacity Provision of Quality Care and Services
REFERENCES
1. 2015 Intergenerational Report (http://www.treasury.gov.au/PublicationsAndMedia/Publications/2015/2015- Intergenerational-Report)
2. http://www.myagedcare.gov.au/
3. The Aged Care Workforce 2012 Report (https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/publications-articles/ageing-and-aged-care-
reports/2012-national-aged-care-workforce-census-and-survey-the-aged-care-workforce-2012-final-report)
5. Richardson S & Martin B, The Care of Older Australians: A Picture of the Residential Aged Care Workforce, National Institute of Labour Studies, 2004
6. Australian College of Nursing – Nurse Leadership White Paper
(http://www.acn.edu.au/sites/default/files/leadership/ACN_Nurse_Leadership_White_Paper_FINAL.pdf)
7. (http://www.flinders.edu.au/sabs/nils/publications/reports/the-care-of-older-australians-a-picture-of-the-residential-aged-care-workforce.cfm)
8. Department Human Services – Home Care Packages (https://www.dss.gov.au/our- responsibilities/ageing-and-aged-care/aged-care-reform/home-care-
packages)

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