The 2016 election has been a fractious event, splitting political parties, challenging commonly held beliefs and challenging community perception. The following is an interview held with Pip Carter, Chief Executive Officer of Saint Andrews just prior to July 2nd.
Rover Consulting (RC) Good morning Pip, when did you join the aged care sector?
Pip Carter (PC) I Joined aged care in 1998 and have been the CEO at St Andrews from 2001 until present. Prior to this I was regional manager at UPA Central West from 1998.
RC What do you believe has been the largest reform during your tenure as CEO?
PC When I came in they changed from the CAM SAM funding model, I came in a year or two after that introduction. The largest reform I think would be the Living Longer, Living Better (LLLB), its been the biggest. There’s been reforms to the ACFI, these have been huge reforms for us as well.
RC How do you observe the LLLB reforms, do you see them as a positive, a negative or a mixture?
PC I think it’s been a negative for the public and a positive financially for Saint Andrews and other providers. I think basically it’s been a cost shift from the Government to the people with a smokescreen saying that it is consumer driven and that more is being done for the consumer. I can’t say care has improved, the quality of care has always been high but they are using this as an excuse to shift the revenue stream from the Government to the people. They have used a whole bunch of documentation, smoke and mirrors and all the rest of it to achieve that. Including this myagedcare website that is an absolute joke as people find it hard to get onto it. They should have assessed the introduction of this more my aged care website more thoroughly. If it was an aged care facility and you sent the accreditation agency in to do an assessment on it, I would hate to say how many non-compliance items you would get, but hey this is OK as it is the Government. So if the Government have made a mistake about the operation of the myagedcare website imagine the other mistakes they make such as making cuts to the ACFI of $1.2 Billion plus!
RC The point is that they do keep funding it and pouring more and more money into which isn’t expected to change.
PC I think that the concept is great, but it doesn’t work for the target market, one lady had 13 goes, another 7. Then you get on and you lose touch with people who don’t get what’s going on. A lot of people are from the age before computers, and they don’t understand it. I don’t think the Government is very sympathetic, I know they want to make change but they are trying to get people from a previous era to utilise modern technology. Their children and grandchildren know how to use computers but our prospective residents don’t for the most part.
RC The reality is that some don’t even know or want to know how to click a mouse, technology can be frightening. They’ve never had to, so why at this stage in their life would they need to?
PC At one stage where you would going to a doctor for an ACAT assessment, now you have to go through the website and you’ve got to organise it and some simply don’t understand that. Very compassionate don’t you think!
RC Are your staff assisting people through the website.
PC We have not been asked to assist people; what we have had is people complaining to us about how difficult it is to get onto someone on the site and then understand what is going on. These people have already had a negative experience with the website which will make them cautious in using it again. If there is someone that is unsure we will assist.
RC It is something we have seen with other providers, needing to provide this level of assistance. Some providers are needing to help people through it.
PC I went onto the [myagedcare] and recorded our beds and information in 2014. Then in 2015 you had to transfer your details across to a new system, this is so sloppy the information should have been transferred automatically across. As for the Auskey you need to access or make changes to Government info, that can be difficult to get as well.
Let’s face it, people want a service and they are happy to contribute alongside the Government. They want to pay something, but I think the Government is pushing the envelope when you think of other things they fund and what they now expect people to pay for age care and it will get worse in the future.
We have policies aimed at increasing our aid and assistance to other countries and refugees, whilst forgetting about our own people who have contributed their entire lives and built our nation. I am very cynical about the whole thing and we are a provider that is on the side of the consumer and in saying that, we have certainly benefited financially from the reforms at the expense of the consumer. Fortunately, they did not agree to the reverse mortgage change for where the consumer can go to the bank and mortgage their house and pay in this particular manner.
RC This leads us to the next question, have you had the opportunity to review the Strategic Aged Care Roadmap?
PC Look I have been through it once, it’s pretty bland. I can say that the motherhood statements that they’ve got in there are great. It will open discussion which is good about the future of Aged care and it funding. I hope that the community actually does get represented fairly. The Government of the day when the LLLB reforms were being pushed through said that the consumer were on side with this. Well Ballina weren’t on side with nor anybody that has come through this facility. So who checks the Governments information on this sort of thing to have it verified. I believe this is what they wanted and this is what you will get. All right for many of the Politicians who will continue to get a lifelong super from the Australia Government. There children will be looked after, easy to make decision that wont affect you.
RC I’ll pause you Pip, that leads to our next point. In the Roadmap itself, in the ‘Who Pays’ section at 3-5 years, quote ‘new financial products to support consumer choice (Home Equity release)’. This is exactly what you were talking about earlier. New financial products to ensure the consumer pays more from their own assets and that’s within 3-5 years they are advocating. Then when you look at 5-7 years, I quote ‘means test all assets and income equally’.
PC I am worried that they will ask for a reverse mortgage when one person remains in their home and the other partner goes into the Aged Care facility. The last thing that this working person has left in their life to give to their children is the house and the Government take it, hang your head low Government. Under the new system introduced in 2014 people who have a house and savings between $46,000 and the advertised bed price will pay a RAD and a daily accommodation contribution (DAP) this will just keep eating away at the lump sum (RAD) until nothing is left.
You have this, the 85% pension charge and then the Means Tested Fee (MTF). I have one example, an individual has $14,000 in the bank, and she earns approximately $1,150. Per fortnight. She currently pays 85% of the pension, $47.25 a day and a MTF of $13 a day. This is legalised theft from where I look at it. I think there has got to be common-sense in this approach to fees. Of course money is getting harder, but Governments need to think more about where they are allocating funds instead of punishing the aged person who has worked hard in their left to achieve what they have.
The other thing I would like to say, is we have bond money that comes in and you can’t touch it unless you are going to build or refurbish a facility. I think all providers need to be more entrepreneurial and the Government has to think that way. Aged care places need to look into other areas to make money. They need to diversify, what would happen if they said you can use some of your protected bonds if you provide a business case on what ever venture the organisation is looking at and then sends a business case supporting this venture to a Government department to scrutinise the figures and give it the tick or not. Then utilise funds for this and diversify revenue streams. The Government won’t be able to fund us forever and our consumers will struggle, so we need to be entrepreneurial. Look at inside and outside the aged care area.
RC This is an extension of where we have been talking, discussing macro levels of Government policy. Do you believe in Government objectives and funding – what has been in the news etc., where is aged care?
PC Aged care isn’t on the radar, if you look at it ACFI is 70% of our income. So alright they are now going to cut $1.2billion from the Age Care Funding Instrument. This is a comment that supposedly a Government Politician has said I or words like it, “we can’t understand why the budget for ACFI has blown out, the frailty can’t be that high when they go into age care? Well it’s so high because we have people staying at home longer (which is what the Government wanted) and now they are coming into Residential Care. You are replacing someone say that has been on $160 a day with someone who is coming in with a care need around $140 a day and higher, which is way higher than it used to be, so of course it is going to cost more to look after these people. Once upon a time you might have brought someone in much lower, now they tend to start at $140 and higher when they come in. Low care is gone and people come in at a higher frailty rate I thought the Government would have realised that with the LLLB Reforms.
You might have some providers (1%) that have done the wrong thing in claiming ACFI, however, all the other providers could have had ACFI officers who are either claiming the correct amount or not claiming what they can due to their knowledge base and the Government changing the goalposts frequently. I have a lady who is very good in managing the ACFI, she came in and replaced another ACFI Officer and straight away found an annualised amount of $325,000. Then I have put a CSE2 staff member in for 16 hours per week to do a lot of documentation work office type work and this has led to an annualised increase of $66,000 because the RN can spend time to look at every resident more closely for upgrades. Then we’ve brought in an external third party and we think we might be able to get somewhere in the vicinity of and extra $80,000. The reason I am saying this is that the ACFI officer we have is extremely astute, and many providers out in the country may not have someone with this skill level to achieve these uplifts and as such are under-claiming NOT over-claiming. Many organisations are under claiming – maybe in the millions of dollars. The Government are really saving money under ACFI due to people’s lack of knowledge and inability to find suitable ACFI officers to understand the system.
They are now going to cut $1.2billion, yet they are saving millions if not billions because people don’t understand the system. Money that the Government are not going to give to providers, including lost interest and indexation might be closer to $1.8billion or $2billion.
The problem is we have politicians making judgements which will likely never affect them. For many of the Politicians, they don’t have to put money aside, the Government will support them for the rest of their lives. Yes, I understand they have difficult jobs, but, it would be different if they were making policies that would affect them when they leave Canberra. Especially like super.
RC Thank you for those comments, do you think that an upcoming ACFI review would lead to any improvements or would it be much of the same? Or would it lead to cuts, cuts, cuts?
PC I think that if a review is to occur it must include both Government and Providers, so that is fair and equitable or give it to an outside group that isn’t under the control of the Government so that they do it without bias. That is my honest opinion.
We haven’t seen the workings of all this change or how they will arrive at a new system. I am unaware we’ve seen this or whether the peak bodies have, that is why we are fighting it. A lack of communication.
RC There is information in the budget papers, not holistically detailed nor listed, they were generalised statements about the budget conclusion.
PC They have come in and seen that the money going out is more than they thought, and people could be genuinely claiming and they are underestimating the financial cost of looking after the elderly. So what they’ve done is recoiled and searched for an excuse to claw back money and they’ve done some costings to bring it back to where they want, that is my assumption. The Government will do it in the best interest of the Government not the aged.
RC This point leads us to the next question, do you think the frail and aged are respected by our Government?
PC No I don’t, I think its lip service and I personally feel they care more about the money than the person. The problem how I see it is you have bureaucrats that work in Canberra, all good people but have no real idea of Aged Care. They just don’t understand the resident or the relatives or Staff needs in aged care. If they take $1.2billion out, they don’t understand aged care. They don’t understand the basic needs of people. I know there is a reduced amount of money in the future due which will come about as a result of reduced tax payers, however I feel they need to look at other areas to try and cut. The silly part of the $1.2billion cut plus in Aged Care is that they are turn much of that money back into validators of the ACFI system and accreditation staff. So the Government cut money in Aged Care and then put that money into hitting the Aged Care system with a big stick.
RC Nation build virtually, rather than import problems.
PC I think we are big noting ourselves on the world stage. We need to look after our own people and improve our livelihoods. In this world we need to get tougher and look after our own. The people who are making decisions, need to talk to the person on the street or in the country at present I believe they have no idea, money is their focus.…
RC It’ll never affect them realistically.
PC They have plenty of money, they’ll never need Government assistance per se’. Let’s get down to the grassroots and find out what’s going on.
RC Moving forwards, do you think the political class will change? Do you believe the rotation of the political class will change? Do you think the current media coverage of the aged care sector will continue, for example only articles in aged care specific media? Do you think we can move the focus back into the limelight?
PC Politics in this country will continue to evolve. They knock each other and then they use that’s parties Policies when they get into Power. I think that more independents will come into our politics unless the big parties can get consistent and reach out to what the people really need.
RC How do we make aged care sexy? How do we get people talking about it? At the moment we have very few talking about it, currently there is a new political party focused on the elderly. How do we get it out there? Nobody is talking about it.
PC How have we got fringe groups in the media? How have we got peoples rights groups movements gaining momentum? How are they doing that? More advertising, more airtime? More money funnelled into advertising? There are retirement homes that advertise a lot and that seems effective. You need media and communications, what do you do? We have people that are in our homes who hold varied, special stories. These are true Australians and they hold notoriety, lets use these stories in the media. Why aren’t we using their stories for the sector? Many past politicians, Judges, theatrical people to name a few are residents in our home etc. – lets use some of those people stories? We don’t utilise what we have very well!
RC At the moment we have such a diverse talent pool of those who have shaped our countries, and they are in our facilities. They may be our best asset. They have that wealth of knowledge and it could be utilised to push aged care sector itself, and they hold younger generation’s respect.
PC We have had famous band members come in and visit their relatives or friends in our home. Aged care affects every single person, sons, grandsons, aunts, uncles – everyone. We have celebrities everyday walking into our aged care homes. You take the homes away, where do these people go? Who will do it?
They will remain in their own home, in little towns etc. – they won’t have the money to pay for a Nurse so family will have to look after them.
Aged care is so important, look at the industry it has become, it employs people, builders, trades men suppliers etc. How many people are involved in aged care directly or indirectly?
RC Approximately 100,000 directly or indirectly at the least.
PC Where would we be without aged care? How important is it for everyone and the economy? You get some rogue facilities but that’s why you have accreditation. Look at the effects of taking away residential aged care, I wouldn’t have 150 people employed here in this facility. The effect would be great on the community.
RC The community and the economy, it would be catastrophic.
PC I believe that there are around 3000 homes around Australia, can you imagine if they were not there. The people looking for welfare and jobs and tradesmen and suppliers lost business. The Government would be in a worse situation without the aged care facilities.
RC Unemployment would go up, savings would go down, stability would go down, the need for family carers would dramatically increase.
PC More rental houses. It’s an industry to itself. How many with their mum or dad at home would be able to pay for their care?
RC Very, very few.
PC Take their homes away, how many people, including politicians, would be affected? Where would people go? Aged Care is huge and it is growing. There are People of a sound mind in aged care, who can vote, now, if they knew the Liberal Government wanted to cut $1.2billion and the knock on effects it has, I don’t think they would be happy. How many people really know about that and Labor in the past didn’t put indexation into the mix for one whole year. Over the years we have been cut and cut and cut.
RC Well if the funds kept increasing, some facilities that struggle financially would have the ability to invest more funds into education, training and their staff.
PC When it comes to our facility, our resident is always number one and we continually look for improvement in systems. Accreditation and complaints schemes meet the need. The only thing I disagree with is the accreditation turning up after being announced. I believe unannounced visit would give accreditation assessors a better picture of what is happening, of course they would have to be more lenient as the extra staff would not be there and you would see it as it is. They have to be broad in their understanding of how people are stressed on the floor and then they will understand aged care.
We do get some surprise visits, but I know in any organisation that the accreditation agency would understand how difficult it is to work for an aged care organisation. I don’t think Governments really understands, they just pay lip service.
RC Yes, this is true. How else do you see things moving forward?
PC I strongly believe there should be an incentive system for people to become volunteers and continue to contribute to our country. Volunteers need to be supported. In my annual report I commend our volunteers, but, this to an extent is shallow as I don’t have anything to give them.
I believe that every place should have a register like a blue book that a nurse use to have and this records all of the hours of service the volunteer gives. The Government should give an incentive to these volunteers, for example, every 500 hours the individual works they would get a $1 off a day off an aged care bed or another type of Government-related expense. If you work 50,000 hours in a life time, that’s a big incentive – for what the individual has contributed. This could be anywhere, such as hospital or aged care home. We will need more volunteers in the future and this may be a way of attracting them. This could be the incentive to fill a gap in the workforce.
RC Thank you Pip for your time today.
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