The much-awaited report from the National Health and Hospitals Reform Commission has just been released.   The Prime Minister and the Minister for Health and Ageing are now engaged in a 6 months consultation process with various health bodies and stakeholders.

There are 123 recommendations.  Some of them pertain to how we care for people at the end of life. One that has received much publicity relates to the possible introduction of bonds for high care – 'that consideration be given to permitting accommodation bonds or alternative approaches as options for payment for accommodation for people entering high care'. This did, of course, immediately send everyone to their entrenched positions. Providers see bonds as the answer to all their problems. Others are worried about people having to sell their homes at a time of crisis and great trauma...

So it is now timely and important to have a respectful community debate about the kind of aged care we should provide for Australians at the end of life and how it should be funded. Providers, in both the for-profit and not-for-profit sectors, are telling us that they cannot provide the care required under current arrangements. And aged-care residents and their families know that the current staffing levels do not allow for the full protection and care that frail people require.

There are many questions. Where do responsibilities lie for funding aged care – with the government, with residents themselves, with families? And should caring for vulnerable people really be a profit-making affair?  If so, how much profit?

A good place to start would be for us all to know how the aged-care subsidies are being spent now – before any further decisions are made. How much is spent on staffing, on food or on consultants?  There is much about the current aged-care system that seems to be secret provider/government business.

Without valid data, it is impossible to make a decision as to whether providers do, or don't, have enough money to do the job.  

We should note that prior to the introduction of the Aged Care Act 1997, a fixed percentage of funding received by owners of aged-care facilities was dedicated to care - including the salaries of nursing staff.  Funding could not be diverted to non-care staff, to capital expenditure, maintenance or to profit. This requirement was removed under the 1997 Act. 

A further issue relates to the average length of stay in a nursing home? When I last looked it was about 7 months. Would bonds really provide the revenue providers say they need over such a short period of time?

At the moment bonds for low-care facilities are very unpredictable for families. When a family first selects facilities they generally have little idea of just how much the bond will be. Most people do not realise that there is no stated maximum bond.

The recommendation in this Report from the National Health and Hospitals Reform Commission does not state that bonds for high-care residential care should be introduced. It recommends that consideration be given to bonds or alternative approaches as options for funding.

That consideration should be underpinned by full disclosure of how the funds currently provided to aged care are being spent and by a serious analysis of the level of care we wish to provide for frail Australians. 


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