Imagine Alice - single woman, no children, getting older, some health issues. Alice decides to take steps to provide for her own care. She has been an independently-minded person all her life and does not wish to be a burden to her extended family.
With some help and following an ACAT assessment, she chooses a low-care home. The facility she finally decides on has great promotional material showing many happy faces. The building is pleasant and one of the features promised by the home is ageing-in-place.
This seems like a good idea. Alice doesn’t want another difficult move at her stage of life...
Fast forward some months.
Alice has slowed down somewhat and she is shakier on her feet. She needs to be reminded to go to meals. Her niece worries that she isn’t receiving the support she needs and inadvertently discovers that the home had Alice reassessed as having high care needs some time ago.
She wonders why she, as next of kin, was not told about this and how the assessment was conducted and by whom. She asks what extra care is being provided to Alice as she has not observed any additional staff or any improved care.
In fact, she observes that the care seems more spasmodic than ever with several staff leaving the home.
In the course of her investigations she finds that almost one third of the residents of this 60 bed facility have been reassessed as high care – although the staff/resident ratio remains low.
Reassessments from low to high care, such as that which occurred with Alice, and which are organised by the provider are now quite common. The above example is one from personal experience.
The statement below is from correspondence we received:
'...My friend worked in a facility where the manager kept a list of residents marked both low and high care. When she questioned it, the manager explained that she was claiming high care funding but considering the residents as still low care; meaning that she got the extra dollars but the residents still paid for things like wound dressings which should be supplied by the facility...'
A while back, it was reported that a 77 year old man who could not speak and could only move his eyebrows was reassessed by the home where he lived as being physically threatening and verbally disruptive by his aged-care provider.
Again, the family only became of this quite erroneous reassessment by accident. One can only wonder how managers of homes can go about redefining a person’s health status without any reference to family members.
Provider-initiated reassessments are readily explained by the large difference in subsidies between low and high care residents.
It is perfectly understandable that if a resident requires extra care then there should be a process for reassessing that person’s needs and care costs. However it is also true that some providers will do or say anything to achieve higher payments.
Remember too, that proprietors of low-care homes keep the accommodation bonds paid by residents – regardless of changes to classification.
In a recent investigation by ‘The Global Mail’, it is stated that the Department of Health and Ageing is aware that there are aged-care proprietors who scam the multi-billion dollar public-subsidy system, by exaggerating the needs of their residents.
The Minister for Ageing recently made some adjustments to the aged-care funding instrument (ACFI). He stated that some providers have over claimed - using the ACFI - and that increases in subsidies have not always resulted in the employment of more care workers.
As of next January 1 next year there will also be changes to increase the evidence requirements when reassessments are made. This seems like a long overdue reform and, most likely, does not go far enough.
At this time, those who check reassessments generally do not visit the particular resident – but only review documentation. How easy then for rorting of the system to occur?
Consider the examples given by another contributor to Aged Care Crisis. Here is one of them.
Resident 1: Totally independent with ALL ADL's, has her driver's license and a car, no mobility problems at all, in fact, her ONLY problem, is that she has an issue with her blood pressure. We monitor it (B/P's x 2 daily), record it, and keep the doctor appraised. She is categorized as HIGH care.
Ageing-in place should have been a good idea. Anything that can be done to prevent frail older people having to make traumatic moves to new locations is highly desirable.
But sadly, it just seems to have become a honey pot for unscrupulous providers who beat the system by making false claims about the health status of residents.