Aged Care Legislated Review – GWC Community Services (Greek
Welfare Centre NSW)
Table of Contents
1.
Tell us about you ............................................................................................................... 2
1.1
What is your full name? ................................................................................................ 2
1.2
What stakeholder category do you most identify with? .............................................. 2
1.3
Are you providing a submission as an individual or on behalf of an organisation? ..... 2
1.4
Do you identify with any special needs groups? .......................................................... 2
1.5
What is your organisation’s name? .............................................................................. 2
1.6
Which category does your organisation most identify with? ....................................... 2
1.7
Do we have your permission to publish parts of your response that are not personally
identifiable? .................................................................................................................. 2
2.
Response to Criteria in the Legislation ............................................................................... 3
2.1
Whether unmet demand for residential and home care places has been reduced..... 3
2.2
Whether the number and mix of places for residential care and home care should continue to be
controlled ...................................................................................................................... 3
2.3
Whether further steps could be taken to change key aged care services from a supply driven
model to a consumer demand driven model ............................................................... 4
2.4
The effectiveness of means testing arrangements for aged care services, including an assessment
of the alignment of charges across residential care and home care services .............. 4
2.5
The effectiveness of arrangements for regulating prices for aged care accommodation
2.6
The effectiveness of arrangements for protecting equity of access to aged care services for
different population groups.......................................................................................... 6
2.7
The effectiveness of workforce strategies in aged care services, including strategies for the
education, recruitment, retention and funding of aged care workers......................... 7
2.8
The effectiveness of arrangements for protecting refundable deposits and accommodation bonds
...................................................................................................................................... 7
2.9
The effectiveness of arrangements for facilitating access to aged care services ......... 8
3.
5
Other comments ............................................................................................................... 9
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1. Tell us about you
1.1 What is your full name?
-
1.2 What stakeholder category do you most identify with?
Service provider
1.3 Are you providing a submission as an individual or on behalf of an organisation?
Organisation
1.4 Do you identify with any special needs groups?
People from culturally and linguistically diverse (CALD) backgrounds
1.5 What is your organisation’s name?
GWC Community Services (Greek Welfare Centre NSW)
1.6 Which category does your organisation most identify with?
Aged Care Provider
1.7 Do we have your permission to publish parts of your response that are not personally
identifiable?
Yes, publish all parts of my response except my name and email address
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2. Response to Criteria in the Legislation
2.1 Whether unmet demand for residential and home care places has been reduced
Refers to Section 4(2)(a) in the Act
In this context, unmet demand means:
•
•
a person who needs aged care services is unable to access the service they are eligible for
e.g. a person with an Aged Care Assessment Team / Service (ACAT or ACAS ) approval for residential care is
unable to find an available place; or
a person who needs home care services is able to access care, but not the level of care they need
e.g. the person is eligible for a level 4 package but can only access a level 2 package.
Response provided:
(Please note residential care issues fall beyond the boundaries of the services and programmes provided by GWC
Community Services – Greek Welfare Centre NSW (referred to here as GWC). Our comments below, therefore,
focus mostly on home care places and aged care services in general, rather than residential care)
In GWC’s experience, the demand for home care places remains unmet and, in fact, this demand is steadily
increasing as more and more aged people become more familiar with the benefits of home cares places. Quite a
few of GWC customers (similar to some customers of some other aged care service providers) find themselves in
desperate circumstances and choose to take a Level 2 Package, because (although they are eligible to receive a
Level 3 or a Level 4 Package) such higher level packages are not available to them. At this point in time GWC has
at least 25 customers on Level 2 who had been assessed as needing Level 3 or 4 Packages. These customers
remain on long waiting lists for Level 3 & 4 Packages. This places extra pressure and financial stress on the
customers’ carers, their family members and/or the service providers (e.g. GWC) to cover for the gaps in need
between a Level 2 and Levels 3 / 4 services. During the last eight months, GWC had at least 10 Level 2 Package
customers who never made it to their assessed Level 3 or 4 Packages because either they died or they moved to a
nursing home. In their interactions with GWC staff, family members and/or carers continue to raise concerns and
express their frustration about the lack of available Level 3 & 4 packages that could more efficiently and effectively
meet their needs. More often than not, family members pay a top up amount to meet the needs. GWC receives
many inquiries for Level 3 & 4 Packages, on average 10 per week. Day after day, it is evident that people prefer to
remain in their own home as long as possible which makes a strong case to release more of the higher level
packages to meet the growing needs of the ageing population, and this of course is in addition to meeting the
ongoing need and demand for Level 2 Packages.
2.2 Whether the number and mix of places for residential care and home care should continue to be
controlled
Refers to Section 4(2)(b) in the Act
In this context:
•
•
the number and mix of packages and places refers to the number and location of residential aged care places
and the number and level of home care packages allocated by Government; and
controlled means the process by which the government sets the number of residential care places or home
care packages available.
Response provided:
Based on daily feedback we keep receiving from GWC customers, their carers and/or family members, GWC
strongly believes there is a great need to review and reconsider the way home care packages become available,
with a particular emphasis on ensuring the availability of an increased number of Level 3 & 4 Packages while
maintaining Level 2 Packages. The process also needs to be reviewed in terms of how such packages are
determined for specific regions and geographical areas. A key outcome of such a review ought to make it more
equitable for consumers who happen to wait for extended periods for Level 3 & 4 Packages. A key challenging
question that must be confronted in this context is this: Are Level 1 Packages viable at the present moment
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considering the Commonwealth Home Support Programme (CHSP) provides these services at a lesser cost, to the
customer?
2.3 Whether further steps could be taken to change key aged care services from a supply driven
model to a consumer demand driven model
Refers to Section 4(2)(c) in the Act
In this context:
•
•
a supply driven model refers to the current system where the government controls the number, funding level
and location of residential aged care places and the number and level of home care packages;
a consumer demand driven model refers to a model where once a consumer is assessed as needing care,
they will receive appropriate funding, and can choose services from a provider of their choice and also
choose how, where and what services will be delivered.
Response provided:
If changing key aged care services from a supply-driven model to a consumer-demand driven model is to be fully
successful, greater consideration (both in terms of policy development and policy implementation) needs to focus
on what actually the consumers increasingly demand, namely, Level 3 & 4 Packages. Similarly, in daily practices,
there is some confusion about the delineation between Level 2 Packages as compared to support and services
provided under the CHSP framework. Both customers and service providers would benefit from receiving more
clarity about the boundaries between these two frameworks. Although there is a lot of merit in the consumerdemand driven model with its increased emphasis on choice and flexibility, some customers struggle with the
concept and need assistance to understand the process. Culturally and linguistically diverse (CALD) communities
need assistance to be able to access the services and to be able to navigate the system. The system would need to
be better resourced and adequately equipped to deal with some practical implications and consequences deriving
from these improvements. As pointed out below, access to My Aged Care is difficult for many members of CALD
communities. Similarly, service provision becomes challenging with direct care staff as these staff members do not
have security in work hours and often operate within increased broken shifts.
2.4 The effectiveness of means testing arrangements for aged care services, including an assessment
of the alignment of charges across residential care and home care services
Refers to Section 4(2)(d) in the Act
In this context:
•
means testing arrangements means the assessment process where:
o the capacity of a person to contribute to their care or accommodation is assessed (their assessable
income and assets are determined); and
o the contribution that they should make to their care or accommodation is decided (their means or
income tested care fee, and any accommodation payment or contribution is determined).
Response provided:
In general, from the customers’ point of view, means-testing arrangements are currently still not understood
and/or appreciated by many customers, especially aged people from culturally and linguistically diverse (CALD)
backgrounds. For instance, although it is important to maintain hardship provisions, accessing them continues to
be a difficult and complicated process for many customers. The overall lack of understanding and appreciation of
means-testing arrangements among service recipients has been constantly evident in most interactions between
CALD customers and GWC staff, since such arrangements were introduced to this day. This has been the case
among various groups of CALD Australians (e.g. GWC customers of Greek, Spanish, Russian, Chinese, Assyrian,
Arabic and Italian origin). CALD communities struggle to understand the means-testing arrangements as there is
an expectation that people are entitled to access services without payment or at a minimum cost. In general,
customers refuse to fill the Aged Care Fees Income Assessment Form, often resulting in significant delays in caring
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for the elderly person and often forcing the service provider (e.g. GWC) to take financial risks in looking after a
customer before the financial arrangements are sorted out. More often than not, customers require assistance to
fill the form, that is, assistance they end up receiving from GWC as the service provider rather than help which
they were supposed to receive from Centrelink for instance. Providers spend unpaid time explaining the form and
assisting customers to complete them. A key issue in this context is the challenge for the provider to more easily
identify if a consumer is a full or part pensioner.
Apart from the anecdotal evidence deriving from GWC’s daily interactions, this lack of understanding about the
means-testing arrangements was also highlighted in a relatively recent research study carried out by GWC. In
particular, this study involving more than 400 GWC aged customers pointed to the need for education to achieve a
cultural shift among the Greek-speaking and other CALD elderly about means testing and about the benefits of the
newly-introduced aged care approach encouraging a greater choice of services. The same study also suggested it
was “critical for the Australian Government to financially support GWC and other organisations further in order to
promote a better appreciation and understanding of the means-testing process and the advantages of a greater
choice of aged care services. Only about a third of the elderly participants in this study strongly agreed that the
higher the income one receives the greater the financial contribution one should make to the aged care services
one receives”. The study found many of these elderly customers (over 80 per cent) were not willing to pay any
extra fee that may be involved in enjoying a wider choice of aged care services either because they expected those
services to be free or because they felt they could not afford them or simply because they felt they did not need a
wider choice at this stage of their lives. This finding pointed to the view by many Greek-speaking and other CALD
elderly Australians for instance that the processes of accessing and using high quality aged care services often
involved a relatively high cost that they felt they could hardly afford (Cited in Ageing in New South Wales – A 2015
perspective on the needs of Greek-speaking elderly, their families and carers, GWC Community Services: March
2015). It is GWC’s experience that more needs to be done in this area by the Australian Government. GWC believes
(as argued for in the March 2015 study), inevitably, means-testing approaches are employed to make such
services more affordable and accessible to those in greatest need; such approaches are unlikely to disappear from
the Australian social policy system in the future. The more the customers understand what ‘means testing’ is, why
it is necessary and how it works the better not only for those involved in delivering means-tested programmes and
services but also, and more importantly, for the general wellbeing of the customers themselves.
2.5 The effectiveness of arrangements for regulating prices for aged care accommodation
Refers to Section 4(2)(e) in the Act
In this context:
•
regulating prices for aged care accommodation means the legislation that controls how a residential aged
care provider advertises their accommodation prices.
Response provided:
As mentioned above, residential care issues fall beyond the boundaries of the services and programmes provided
by GWC. Inevitably, however, GWC staff often interact with aged customers who happen to be in a transitional
stage from a home care to a residential care environment. From this experience, it is clear that many customers
continue to be confused and unaware of how the residential care system works, pointing to the need for more
education among the customers about the overall aged care accommodation system.
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2.6 The effectiveness of arrangements for protecting equity of access to aged care services for
different population groups
Refers to Section 4(2)(f) in the Act
In this context equity of access means that regardless of cultural or linguistic background, sexuality, life
circumstance or location, consumers can access the care and support they need.
In this context different population groups could include:
•
•
•
•
•
•
•
•
•
people from Aboriginal and/or Torres Strait Islander communities;
people from culturally and linguistically diverse (CALD) backgrounds;
people who live in rural or remote areas;
people who are financially or socially disadvantaged;
people who are veterans of the Australian Defence Force or an allied defence force including the spouse,
widow or widower of a veteran;
people who are homeless, or at risk of becoming homeless;
people who are care leavers (which includes Forgotten Australians, Former Child Migrants and Stolen
Generations);
parents separated from their children by forced adoption or removal; and/or
people from lesbian, gay, bisexual, trans/transgender and intersex (LGBTI) communities.
Response provided:
The comments made under Questions 2.4 & 2.9 are also relevant to this question (2.6).
As highlighted in GWC’s 2016-2020 Strategic Plan, GWC’s experience derives not only from providing services to
the community at large but also and particularly from serving the NSW Greek-speaking community and other
specific CALD groups (e.g. elderly of Spanish, Russian, Chinese, Assyrian, Arabic and Italian origin). Based on this
experience, GWC is of the firm view CALD communities in general continue to find it extremely difficult to access a
centralised system such as My Aged Care either on line or through telephone, primarily due to linguistic and
cultural barriers. They rely on GWC staff to follow up the process for them. This has been evident in day-to-day
interactions as well as in two recent research projects carried out by GWC, one completed in 2015 (referred to
above) and other in 2016, both of which significantly questioned the usefulness of such IT facilities to diverse CALD
customers. In particular, in the case of the 2015 research project, only two (2) per cent referred to My Aged Care
website or other Internet facilities for information on aged care services. Most of the participants in this study
used either GWC (75%), family or friends (39%), the family doctor (38%), the Parish priest (32%) or ethnic
newspapers/radio/TV (17) as the main source of information and advice about aged care services (Cited in Table
11, in Ageing in New South Wales – A 2015 perspective on the needs of Greek-speaking elderly, their families and
carers, GWC Community Services: March 2015). Similar evidence was highlighted in the GWC research project
completed in 2016, which showed the vast majority of a sample (84% out of 151) of elderly attending GWC’s Aged
Centre Based Day Care (CBDC) Programme enjoyed participating in the activities is this GWC Programme because,
among other reasons, they received information about aged care and other services especially in a linguistic and
cultural context most relevant to them (derived from GWC’s Aged Centre Based Day Care (CBDC) Programme: A
summary of Client Feedback; The 2015 Report – March 2016).
In addition, GWC believes the Home Care Placement Assessors need to work more closely with the referring officer
involved before finalising their assessment. My Aged Care system calls the customer three times after a referral
and if the person does not respond, the system does not pursue either the customer or the person who made the
referral. Privacy laws make it difficult for the staff member making the referral to pursue inquiries regarding the
progress of the referral unless the customer is with the staff member, which is not always possible. There have
been examples of GWC customers missing out because the assessors decided to decline a request after receiving
no reply to phone calls they had made to customers relatively late in the evening (well outside working hours). In
such circumstances, the customers were reluctant to answer the phone so late in the evening (some too scared to
respond to a stranger asking personal questions), which resulted in GWC staff having to address negative
assessments in the interests of caring for the elderly involved. Also, in terms of access and equity, other customers
have missed out on comprehensive assessments because MAC Assessors directed them to a RAS assessment
without any consultation with the referring organisation. Similarly, in such cases, more often than not, GWC staff
would have been the ones who met the customers face-to-face, the ones who understood the customers’ specific
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circumstances, the ones who spent time with the customers helping them to navigate the system and the ones
who actually completed the referrals in the first place. It would be to the interests of the customers, therefore, to
achieve a fuller and more accurate assessment if the Assessors directly communicated with the referring
organisation in such cases.
2.7 The effectiveness of workforce strategies in aged care services, including strategies for the
education, recruitment, retention and funding of aged care workers
Refers to Section 4(2)(g) in the Act
In this context aged care workers could include:
•
•
paid direct-care workers including nurses personal care or community care workers, and allied health
professionals such as physiotherapists and occupational therapists; and
paid non-direct care workers including: managers who work in administration or ancillary workers who
provide catering, cleaning, laundry, maintenance and gardening.
Response provided:
A fundamental premise of the Consumer Directed Care (CDC) model of service delivery is the absolute
advancement of the consumers’ choices. Given this context emphasising the importance of meeting and
adequately responding to the customers’ choices, an ongoing challenge for service providers is to recruit, train and
retain adequately qualified paid direct-care workers within a framework that allows enough flexibility to meet the
diverse customer choices, especially in relation to the potential need to provide various services at very diverse
times and days of each week. Service providers need increased support to achieve greater workforce flexibility,
minimise insecurity for workers and more effectively manage fragmented work schedules and insecurity with work
times so that such direct-care workers are enabled to better function from within a more consistent and
systematic approach, especially with regard to rostering and minimal-hour demands. In this context, the funding
provided for engaging care workers is arguably inadequate resulting in very low level positions making
recruitment and retention particularly challenging. In GWC’s experience, formal (and highly costly) advertisements
for employing direct case staff were not as successful to attract suitable applicants – instead, GWC direct-care
workers were primarily recruited through informal ‘word of mouth’ processes and local community networks.
2.8 The effectiveness of arrangements for protecting refundable deposits and accommodation bonds
Refers to Section 4(2)(h) in the Act
In this context:
•
arrangements for protecting refundable deposits and accommodation bonds means the operation of the
Aged Care Accommodation Bond Guarantee Scheme.
Response provided:
No comment – As mentioned above, please note residential care issues fall beyond the boundaries of the services
and programmes provided by GWC. Our comments in this submission, therefore, focus mostly on home care places
and aged care services in general, rather than residential care.
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2.9 The effectiveness of arrangements for facilitating access to aged care services
Refers to Section 4(2)(i) in the Act
In this context access to aged care services means:
•
•
how aged care information is accessed; and
how consumers access aged care services through the aged care assessment process.
Response provided:
Some of the comments made under Question Nos: 2.4 and 2.6 apply to this question (No: 2.9) too.
Overall, GWC believes that, although some significant improvements have been made, accessing aged care
information through My Aged Care website and accessing aged care services through the aged care assessment
process remain difficult and complex for the average CALD elderly person. Although such processes may become
much more user-friendly in the future, this is not the case at this stage - especially if CALD elderly people continue
to be expected to ring a telephone number or go on a website for basic assistance. The current generation of
elderly, especially of CALD background, find it difficult to access information on services as they lack computer
skills and access to computers. Language and cultural issues can become additional barriers to accessing services.
The assessment process remains overwhelming and time consuming for many customers. As suggested above, as
a whole, CALD elderly Australians rely heavily on their service provider, their carers and/or family members for
accessing basic aged care information and for navigating through the aged care assessment process. Part of this
problem can be addressed through a greater collaboration and engagement between the Assessors and the staff
of the referring organisation who interact with the customers more directly. MAC Assessors may require further
training to enable them to direct the customers to the best suited services and to the most appropriate processes
to access those services. Aspects of this problem can also be addressed by an Australian Government educational
campaign in CALD communities (through adequately resourced community organisations with direct customer
links) advancing a better understanding of the means –testing arrangements , how these work and how the
current aged care reforms provide more choices benefiting elderly Australians.
Undoubtedly, during the last six months, My Aged Care facility (primarily due to the advocacy and direct
involvement of many local community organisations) has improved access for many elderly people, their service
provider and their carers / family members. For example, in the case of the assessment process, service providers
find it easier to read the summary provided concerning the needs of a customer rather than having to go through
numerous pages to get a picture of the customer’s circumstances (as it used to be the case). Also, a great deal of
the assessment /ground work is already done by the system which makes the service provider’s role rather easier.
The system allows for referrals to be made through the internet which is clearly an advantage. Similarly, as the My
Aged Care system determines who would get a particular referral, arguably, this perpetuate a fairer system (and
indeed through this process GWC gets some customers who would not have otherwise known about GWC services
and programmes). Despite these advantages, however, overall full access to aged care information and services
continue to be a challenge for many CALD elderly, as outlined in this submission.
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3. Other comments
Response provided:
GWC is the welfare and community services arm of the Greek Orthodox Archdiocese of Australia. GWC is an
established and solid organisation with over 40 years experience as part of the community welfare sector in NSW.
GWC is a highly respected peak ethnic specific and general community welfare organisation in NSW. Greek
Welfare Centre NSW appreciates the opportunity to lodge this submission as part of the 2016-17 Aged Care
Legislated Review. GWC is also grateful to the Review Team for having granted an extension of time for the
submission to be lodged. In recent years, significant improvements have been made in the aged care sector,
encouraging service providers to more effectively pursue their supporting role resulting in improved and more
engaged living standards for elderly Australians. Such improvements have benefitted CALD elderly, including
Greek-speaking and other linguistic and cultural groups in New South Wales – many of whom happen to be GWC
customers. Our constructive comments in this submission, derive directly from GWC’s experience and research in
the provision of community welfare services, including community aged care services. In this capacity, we seek to
advance further improvements and strengthen even further an effective service delivery system to elderly
Australians, taking into account their diverse demographic and other characteristics.
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