What are you entitled to? A very common question!
Are you aware of the Residential Aged Care Schedule of Specified Care and Services?
Residential aged care providers must provide the required care to any resident as set out in the Schedule of Specified Care and Services for residential care services (Quality of Care Principles 2014). However, it is common that residents or their representatives are not aware of or familiar with the specified care and services.
There are plenty of information sheets relating to the Charter of Residents’ Rights and Responsibilities and info sessions on other topics, but discussions relating to Specified Care and Services is lacking.
The My Aged Care website is the official government source for information relating to care and services in aged care homes, but it does not have the full list of items you may be entitled to. Whilst information can be found on the Federal Register of Legislation, most people will most likely experience difficulties navigating and finding the Schedule of Specified Care and Services.
Specified Care and Services
A list of items that you may be entitled to is under Specified Care and Services
Residential aged care homes are assessed against the Accreditation Standards which are detailed in the Quality Care Principles 2014. Included is the Schedule – Specified Care and Services for aged care homes. These services need to be provided in a way that meets the Accreditation Standards.
Many areas of the Specified Care and Services can be confusing to residents, but also easily misunderstood by aged care providers and even by other health professionals such as doctors.
A good example of this is Item 3.11 Therapy services such as recreational, speech therapy, podiatry, occupational, and physiotherapy services.
It is common for residents, their family members or representatives, to not be aware that if a resident is assessed as needing and entitled to a therapy service, the aged care provider must provide the service at no cost to the resident, unless intensive, long-term rehabilitation services is needed such as, due to a serious illness, injury, surgery or trauma.
However, unfortunately, this is not always the case. There may be some providers who misinform residents that they only have access to these services through the Medicare CDM - Chronic Disease Management (previously known as Enhanced Primary Care - EPC).
My family member needed to see a speech therapist as requested by doctor. The aged care provider informed me they were not responsible to organise and pay for the speech pathologist to assess the resident and that the only way that some of cost of service may be covered, is by using the Medicare EPC Allied Health Services. After researching the Aged Care Act, I contacted the Aged Care Complaints Commissioner as well as the aged care advocacy for more information and I was made aware that indeed residential aged care providers were responsible to provide this service as specified under Item 3.11 Therapy services.
Source: Quote by a community member
The CDM Allied Health services (Medicare rebates for 5 allied health services in a calendar year) is available to residents who have a chronic condition and are on a GP care plan. Residents are able to choose which provider they prefer to provide the service. Detailed information is on the prior version of the Department of Health and Aged Care website also.
However, it does not guarantee that the provider or the health professional will bulk bill for the service or therapy, and the resident may have to pay the remaining cost or gap of the service. In the past, it was more suited to low care residents as only residents receiving a high level of residential care were entitled to some of these services at no cost.
The Department of Health Chronic Disease Management - Individual Allied Health Services Under Medicare - Residential Aged Care Facilities factsheet (2017) stated that:
Medicare-rebateable allied health services should not replace services that are expected to be provided to residents by the facility, as a requirement under the Aged Care Act 1997 (the Act). Under this legislation, approved providers of residential aged care services are required to provide therapy services, such as recreational, speech therapy, podiatry, occupational therapy, and physiotherapy services, to certain residents (as defined by the resident's funding classification) at no additional cost.
It went on further to state:
"... If residents are entitled to receive the allied health services noted above at no additional cost to themselves through the RACF, those residents should not routinely be referred for allied health services under Medicare ..."
Source: Chronic Disease Management Individual Allied health Services Under Medicare
If you look further into the updated Specified Care and Services, some of the items were altered or removed to prevent further confusion. An example is in relation to item 3.7 Basic medical and pharmaceutical supplies and equipment. This has now been deleted and all specified goods to support treatments are now in Item 2.4. However, you will find that pharmaceuticals items were removed such as Analgesia, which was also known as a 'hot topic' and caused misinterpretation, confusion or other issues, especially in relation to when a resident is charged for the use of Analgesia.
In 2014, the Department provided a factsheet for providers (Version 1.0) relating to the Specified Care and Services as there were requests for clarification. They also made some minor changes to items under it which residents or community members are not aware of. Version 2 of the Care and Services in Aged Care Homes – Information for Approved Providers was updated 2022/2023 with minor alterations, specifically in regards to additional service fees.
The Guide to Aged Care Law is an online resource in a plain-English format that was composed to help approved providers and consumers to understand their responsibilities and obligations under the Aged Care Act 1997. The Guide replaced the Residential Care Manual, but was ceased 2 January 2017. Unfortunately you are now directed to the Federal Register of Legislation website, which again may be difficult to understand.
The distinction between low care and high care classification of residents has now been removed so there isn’t restriction to a particular level of care. However, from a consumer or resident prospective that may not be entirely understood, so therefore may not be clear what they are entitled to.
How can information for aged care residents be improved?
Confusion and gaps in the system could be resolved by providing info sessions to residents, family members or representatives in relation to the specified care and services (preferably by the related advocacy services), as well as providing factsheets in plain English and in a format that is easy to understand. Providing example scenarios can also help them to understand what they are entitled to.
It is important that residential aged care facilities follow the necessary requirements and staff members are educated about the specified care and services. Residents should be made aware that the CDM Allied Health is not a 'Must'. Inaccurate info could be unintentional but even so could still be considered misleading.
Doctors should also play a role in ensuring that facilities are providing the necessary care to residents. If they are unsure whether a patient requires a service that should be provided by the RACF under the Act, rather than a service under Medicare, the GP should obtain clarification.
Providing education to staff and information to residents (written in a format that is understandable) can ensure that confusion is prevented and residents or representatives can make appropriate informed decisions.
For example, the Schedule of Specified Care and Services should be:
- Accessible
- Clear and simple
- Easy to find
- In different formats
- Included in factsheets or information kits
- Covered in educational sessions for staff and community members
So next time you ask what are you entitled to? Keep in mind that the Schedule of Specified Care and Services is what you should have on hand.