productivity commission draft reports 2011 carers nsw conference 17 march 2011
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Caring for Older Australians and Disability Care and Support. Productivity Commission Draft Reports 2011 Carers NSW Conference 17 March 2011. Structure of presentation. Carers in Australia – a snapshot Overview of aged care report Overview of disability report Questions. - PowerPoint PPT PresentationTRANSCRIPT
Productivity Commission
Productivity CommissionDraft Reports 2011
Carers NSW Conference17 March 2011
Caring for Older Australians and
Disability Care and Support
Productivity Commission 2
Structure of presentation
• Carers in Australia – a snapshot• Overview of aged care report• Overview of disability report• Questions
Productivity Commission 3
Carers in Australia – a snapshot
• Over 2.6 million carers in 2009• 771 000 were primary carers• Most primary carers are female (67%)• Fairly even split between primary carers
for disabled under 65 and over 65• Value of informal care services
estimated to be $42 billion in 2010
Productivity Commission 4
Overview of Caring for Older Australians draft report
Robert Fitzgerald
Productivity Commission 5
Current weaknesses
• System complex, difficult to navigate• Quantity limits• Discontinuous care, not tailored to need• Constrained pricing• Financial inequities• Workforce shortages, low wages, regulatory
burdens• Complaints handling lacking independence• Poor interface with health system
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Demand pressures
• Population over 70 to rise from 2m in 2010 to 6.2m 2050
• People receiving care to rise from 1m to 3.6m by 2050 − 3m to receive community care
• Residential care to grow from 160,000 places to 600,000 places by 2050
Productivity Commission 7
What has the Commission proposed?
• A coherent set of draft recommendations:− Care services− Catering for diversity− Funding (including user co-contributions)− Age-friendly housing− Informal carers, workforce, volunteers− Regulatory reform− Policy research and evaluation− Costing the system− Reform implementation
Productivity Commission 8
The gateway to aged care
Assessment & Referral
Australian Seniors Gateway Agency (ASGA) (with regional delivery)
Care coordination and care records
Information to communities and
individuals
Needs Financial capacity
Entitlement to approved care and support
Productivity Commission 9
Needs Assessment Framework
Personal Care (Community and Residential)
Personal hygiene, dressing, feeding, pressure area care, health monitoring
Specialised Care
Carer Support
Respite, carer counselling, carer education & training, advocacy
Health & Nursing
Dementia & challenging behaviour
Restoration & Rehabilitation
(including transitional and
sub-acute)
Palliative & End of Life Care
Continence
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Community – home cleaning, maintenance and modification, meal preparation, mobility and transport
Residential – domestic services
Productivity Commission 10
Enhancing choice, responsive competition and equity
• Remove limits− Care services and bed licences− Progressively over 5 years− Quality regulation remains
• Remove residential care distinctions− Low care and high care− Ordinary care and extra service care
• Supported resident quotas retained− Set by region and tradeable within regions− To be reviewed in 5 years
Productivity Commission 11
Funding principles
• Care (personal and health)− Co-contribution according to financial capacity (5%
to 25%)− Safety nets and hardship provisions
• Accommodation, everyday living expenses− Personal responsibility− Consumer chooses daily charges or
accommodation bond that reflects cost− Subsidised access for supported residents
Additional care and accommodation services -as consumer choose and pay for
Productivity Commission 12
Government Schemes to assist
• Australian Government Aged Pensioners Bond Scheme
• Australian Government Equity Release Scheme
Productivity Commission 13
Informal carers
• Carers will benefit from mainstream reforms:− navigable information− single gateway− flexible care services
• Assessment of older person’s needs to include capacity of carer to provide ongoing support through Gateway
• Entitlements to planned respite • Referrals to proposed Carer Support Centres for
emergency respite, peer support, training, etc
Productivity Commission 14
Structure of independent regulator
Australian Aged Care Regulation Commission (AACRC)FMA Act
Pricing Compliance & Enforcement
InformationComplaint Handling &
Review
Productivity Commission 15
What does this mean for consumers?
• Increased access to aged care − Expansion of assessment services− Assist consumers to make informed decisions
about providers• Greater care continuity- ongoing assessment • Greater capacity to receive care in the home• More options to allow older people to move
into appropriate housing without penalty• Fairer co-contribution system
− Catastrophic costs limited by stop-loss− Don’t have to sell your home
Productivity Commission 16
What next?
• Submissions by Monday 21 March• Hearings from 21 March• Extensive consultations
− System design− Financial modelling
• Final Report to Government June 2011
• Report tabled within 25 sitting days
Productivity Commission 17
Overview of Disability Care and Support draft report
John Walsh
Productivity Commission 18
Key messages
• Poor current system• Two new schemes are proposed• There are practical solutions to
complex design issues• Many groups of stakeholders can be
positively involved• Costs are affordable (cost estimates
are preliminary)
Productivity Commission 19
Key problems with current system
• Poor national insurance• Inequitable (the ‘lottery’)• Underfunded• Failures to intervene early• Fragmented• Lack of clear responsibilities• No real choice or power (a ‘barber for a bald man’)• Unsustainable (the ‘death spiral’)• Inefficient & poor governance• Uncertain future• A maze or ‘confusopoly’• Poor evidence base
Productivity Commission 20
Key features of the NIIS
• Federated model• No-fault• All catastrophic injuries• Lifetime care & support• Build on well-run schemes• Start only with new cases (800 a year – but
growing to 20,000 stock)• Costs $685m a year• Mixture of state revenue sources• Starts in 2013
Productivity Commission 21
Key features of the NDIS
• Universal insurance cover• ‘Reasonableness’ tests permeate the report• 360,000 people covered• Annual costs lie between:
− net $4.6-8.0b (with median of $6.3b or $280 per Australian)
− gross $10.8-$14.2b (with median of $12.5b)• Funded from consolidated revenue according to a
strict formula• People start getting NDIS supports in 2014, but more
funding in the mean time using the existing system
Productivity Commission 22
3 tiers
3b 3c
3a
Tier 1
3d
Social participation and minimising the impact of disability (target=Australian population) 22 million
Tier 2
Information, referral & web services, so people get clear information about support groups and assistance available (target = all people with disability) 4 million
Tier 3People receiving funding support from the NDIS (target = people aged 0 to the pension age with sufficient needs for disability support and early intervention)
(3a) Significant core activity limitations (225 000) (3b) Intellectual disability not already included (50 000)(3c) Early intervention group (80 000)(3d) Others optimally supported (unknown, but modest)
Total = around 360 000
Productivity Commission 23
A consumer perspective
People with disabilities
private, for- profit firms
non-government
organisations
paid individuals
eg neighbours
other government
services
state and local
government providers
Disability Support Organisations (DSOs)if people with a disability wish, they could choose an intermediary to be a service broker, provide management services, personal planning etc
NDIA case managers would provide case
management services and liaise with the NDIS and other government
services
Service providers (SPs)$ funding
National Disability Insurance Agency
Assessment, plans
& supportpackages
specialist disability service
providers
their needs and approved spending plan determine the types and nature of services
from the groups below
Productivity Commission 24
What’s in and out?
• In: − Traditional disability supports - attendant care;
community access; aids, modifications; supported accommodation; respite; taxi vouchers, supported employment
− New supports: early intervention
• Out: − public housing, education, health (except early
intervention therapies), Income support, open employment
• Uncertain: aspects of mental health
Productivity Commission 25
Many parties play a role in the NDIS
• National Disability Insurance Agency− federated model− Independent (board & rules)− CAC not FMA− Proper governance
• Specialist service and support providers• Links to other government-funded services• Disability Support Organisations• Mainstream services• Governments• Courts
Productivity Commission 26
What are the impacts for….
• Australians generally?• People with a disability?• Carers …… the “death spiral”?• Providers?• Workers?• States & territories?• Australian Government?
Productivity Commission 27
Timetable for NDIS
• 2011-12 MOU and taskforce• 2013 Intergovernmental agreement &
appoint board of NDIA; recruit & train key staff, build some infrastructure; provide information
• 2014 Rollout in a region• 2015-2018 A path to full coverage for all
significant disability Australia-wide• 2017 and 2020 reviews of self-directed
funding and schemes respectively
Productivity Commission 28
Timetable for NIIS
• 2011-12 COAG agreement• 2013 Vehicles and medical• 2015 All catastrophic injuries• 2020 Independent review
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www.pc.gov.au
Productivity Commission 30
Productivity Commission 31
$1719m
$6300m
$4481m
$1719m
$10781m
$904m SPP
$815m for own
$4481m
$815m
$5385m
Spending
Funding
States & territories transfer $ to the NDIA
States & territories lower tax rates
$12500m
National Disability Insurance agency
revenue
Australian Government spending
State & territory spending
Now Under the NDIS
Option A9 funders
Option BOne funder (preferred)
Total $6200m Transfers to the NDIA Total $12,500m
States & territory funding
New Australian Government funding
Old Australian Government funding
Funding across jurisdictions
Productivity Commission 32
Alternative financing options
• Private insurance• Social insurance• State & LG taxes• GST• Levy on personal income tax• Earmarked consolidated revenue• State role vs Australian Government???• The 5 options:
− The ‘free ride’− The GST give up− Write a ‘cheque’− A razor to SPPs− A tax swap