Ageing – Alice Mantel

Financial reforms under the new Aged Care Act

The new Aged Care Act 2024 is expected to commence from 1 July 2025. This article attempts to explain the changes that are likely to happen in relation to residential care focusing on consumer contributions and means testing.

The intention of this major revision of the existing Aged Care Act is to:

improve the lives of older people accessing aged care services in their homes, community settings and residential aged care homes;
encourage aged care providers to deliver high-quality care.

The proposed rights-based law:

addresses approximately 60 Royal Commission into Aged Care Quality and Safety recommendations;
incorporates feedback from several public consultations about proposed aged care reforms;
responds to the Aged Care Taskforce about sustainably funding aged care into the future.

However, for most people, the most important, and not finalised, changes will relate to the expected cost of receiving care – whether that is at home or when resident in an aged care facility. The proposed changes appear to focus on the resident’s financial disclosure responsibilities and an onerous assessment process that are likely to result in a very large increase in the cost of receiving aged care services. At this stage (February 2025) the details have not yet been finalised and it is likely that more changes will be made.

Means testing reforms

The reforms consist of:

means testing the hotelling supplement which is currently paid in full by government;
abolishing the current means tested care fee and associated annual and lifetime caps;
introducing a new means tested contribution to non-clinical care, including a new daily cap on payments and a new lifetime cap;
mandatory reporting to keep residents’ means assessments current.

The no worse-off principle

A no worse-off principle will apply to everyone in residential aged care on 30 June 2025.
Existing residents retain their existing contribution arrangements for the entirety of their stay in residential care.

What will stay the same

The government will continue to fund the majority of aged care. All residents will continue to pay a Basic Daily Fee. The way different types of income and assets are assessed in the residential aged care means assessment will not change. Current financial hardship assistance arrangements will continue.

What will change

Means testing – Current means tested care fee will be abolished • Introduction of Hotelling Contribution • introduction of Non-Clinical Care Contribution • Mandatory reporting • accommodation costs • Grandparenting of fee arrangements.

Changes to means testing – A resident’s means tested amount is based on their assessable income and assets. It will continue to be the sum of their income tested amount and asset tested amount. Income and asset taper rates are changing.

Hotelling Supplement contribution – Starting 1 July 2025, the Hotelling Supplement will be means tested for new residents. Residents who can afford to pay their full accommodation costs will contribute to daily living costs such as food, cleaning, laundry and utilities.

The means test will require a contribution from residents with:

assets over $238,000, or
income over $95,400, or a combination of both.

The contribution will be up to the maximum Hotelling Supplement of $12.55 per day (20 September 2024 rates). The government will pay providers the difference.

Non-Clinical Care Contribution – The Government will fully fund all clinical care costs in residential aged care. For new residents from 1 July 2025, the new means-tested Non-Clinical Care Contribution (NCCC) will replace the Means Tested Care Fee. This contribution will be for non-clinical care costs such as bathing, mobility assistance and lifestyle activities. It will only apply to residents who can afford to pay the full Hotelling Supplement contribution.

The non-clinical care means test will require a contribution of 7.8% of assets over $502,981 or 50% of income over $131,279 or a combination of the two up to a daily limit of $101.16. It is paid until the resident has contributed $130,000 or been in residential aged care for 4 years, whichever occurs first. The government will pay the difference.

Mandatory reporting – Providers will regularly report individual refundable deposit balances. Residents will be required to report changes to their personal and financial circumstances. Residents can elect to be classified ‘means not disclosed’ and consequently won’t be asked to report financial circumstances, will not be eligible for government support with accommodation costs or Non-Clinical Care Contribution. They can later elect to complete a means assessment but this cannot be back-dated to their entry to care.

Grandparenting for current residents -The current fee arrangements will continue for residents already in care before 1 July 2025. This includes the: pre 1 July 2014 cohort and the post 1 July 2014 cohort. Individuals will be able to ‘opt out’ of their grandparented fee arrangements at any time.

Dying to know day was a lively event

Panel members at the DYing to know day COTA organised Dying to Know Day (August 8th) COTA under the auspices of North Sydney MP, Kylea Tink. NSW member and dying well advocate Jill Nash co-organised a fantastic line up of speakers to discuss Death, Dying and Grief.
Jill spoke poignantly about the loss of her baby daughter and then her husband when she was just 41. Informed by these traumatic experiences, Jill is taking control of her future by gathering information and documents and starting personal conversations now, so that her family are prepared for her death and dying when the time comes.

Alice Mantel, another COTA NSW member, also shared her specialist legal expertise on how to go about getting your affairs in order many years before you may think you will need to.

Alice is also the featured expert in the Planning for the Unexpected series produced by OWN NSW.

Over half a million older people experienced abuse in the last year

Latest data released by the Australian Institute of Health & Welfarehttps://www.aihw.gov.au/family-domestic-and-sexual-violence/population-groups/older-people#:~:text=In%20institutional%20settings%2C%20Yon%20et,and%20sexual%20abuse%20(1.9%25). (AIHW) has made some key findings that show people in Australia are at increased risk of abuse in their later years. This abuse can take many forms, including psychological or emotional abuse, financial abuse, physical abuse, sexual abuse, and neglect.

Key findings of the most recent data:

1 in 6 (15% or 598,000) people in Australia experienced elder abuse in the past year.
psychological abuse is the most common form of elder abuse.
1 in 2 people who perpetrate elder abuse are a family member.
1 in 3 people who experienced elder abuse sought help from a third party.

As Australia’s population ages, the number of older people in Australia experiencing abuse is likely to increase over time. A key aspect of the definition is that elder abuse occurs in relationships where there is “an expectation of trust”. Such relationships include those with family members, friends, neighbours, and some professionals such as paid carers.

Prevalence estimates are likely to underestimate the true extent of elder abuse. This is because victim-survivors can be reluctant to disclose ill-treatment by a family member, or because they are dependent on the abuser for care. Older people with cognitive impairment (for example, dementia) or other forms of disability may also be unable to report abuse.

Evidence from international studies show that abuse estimates are higher for older people in institutional settings than in the community. A 2017 review found that there is a greater likelihood for women being abused (17%) than men (11%) with sons also more likely to perpetrate abuse than daughters.

What kind of abuse is perpetrated?

The AIFS National Elder Abuse Prevalence Studyhttps://aifs.gov.au/research/research-reports/national-elder-abuse-prevalence-study-final-report estimated that, in 2020:

around 1 in 6 (598,000 or 15%) older people living in the community had experienced elder abuse in the past year
471,300 (12%) had experienced psychological abuse in the past year
115,500 (2.9%) had experienced neglect in the past year
83,800 (2.1%) had experienced financial abuse in the past year
71,900 (1.8%) had experienced physical abuse in the past year
39,500 (1.0%) had experienced sexual abuse in the past year
a slightly higher percentage of women than men had experienced any form of elder abuse in the past year. This pattern was also evident for psychological abuse and neglect.

Who are the perpetrators?

Around 1 in 2 (53%) perpetrators of elder abuse were family members (includes ex-partner/spouses). Perpetration by family members was highest for financial abuse (64%) then neglect (60%), psychological abuse (55%), physical abuse (50%) and sexual abuse (15%). Sexual abuse of older people was primarily perpetrated by friends (42%), acquaintances (13%) and neighbours (9%).

Support for abused persons

The AIFS study estimated that:

1 in 3 (36%) older people in Australia who experienced abuse sought help or advice from a third party such as a family member, friend or professional;
help seeking was most common after physical abuse, followed by psychological abuse, financial abuse, sexual abuse and then neglect;
of those seeking help, the most common sources of help were family members (41%) and friends (41%), followed by a GP or nurse (29%), a professional carer (24%), the police (17%) and lawyers (15%). Around 1 in 20 (5.3%) contacted a helpline.

Around 8 in 10 (82%) older people who experienced abuse had taken action to stop the abuse from happening again. These actions included informal actions (such as speaking to the person) and formal actions (such as seeking legal advice). The most common actions were speaking to the person or breaking contact with them.

If you, or someone you know has been abused, you can call 1800 ELDERHelp.

What is the cost of dying?

Like everything else, the cost of dying is increasing as much as the rising cost of living. A study commissioned by Australian Seniors and CoreData in August 2023, The Cost of Death Report 2.0 found that estimated funeral costs have increased by more than 20% for burials and cremations since 2019. In 2023, the average burial costs $11,039, compared to $9,055 in 2019. Similarly, the average cremation now costs $8,045, compared to $6,334 in 2019.

The study revealed that we are paying up to $18,652 for a basic burial funeral, and up to $5,953 for a basic cremation funeral. This is due to the rising costs of funeral services – including embalming, viewing, transportation, and professional fees – along with the cost of coffins and burial plots to name a few.

A third of the responders who recently helped pay for a funeral experienced some form of financial hardship. Two-thirds of those who experienced financial hardship said that it took months to financially recover.

Saying goodbye to those we hold dear should be a time of love and unity. Regrettably, this is not always the case. It’s no secret that funerals can exact a heavy financial toll, but they can also create tension between family and friends. Unfortunately, more than a third of responders encountered arguments with loved ones over funeral finances, adding weight to an already heavy situation.

Further, the study suggests that a trend is emerging where families are pressuring us to spend more on funerals than initially planned, a trend which has more than doubled since 2019.

Consequently, it seems our funeral preferences are changing. Many of us are now opting for simpler services (26%), being more cost-conscious (24%), and choosing cremations or cheaper alternatives to traditional burials (22%). Some of us are even getting creative and considering a DIY funeral (9%).

Tradition is taking a back seat as we focus less on mourning and more on celebrating life. In fact, most (83%) of us now prefer the celebratory approach. We want a funeral that reflects us – who we are and what makes us, us. An example of this are our changing music preferences, moving away from conventional funeral songs. Instead, iconic artists like Elvis Presley, Queen, Frank Sinatra, and Elton John emerged as the most common choices.

On the other hand, many of us are yet to discuss our wishes with loved ones. In fact, only 1 in 2 (53%) of us have made our families aware of our funeral preferences. For those of us who are yet to have this conversation, it’s important that we communicate our funeral wishes to our nearest and dearest to ensure we receive the farewell we desire.

Australian Seniors: The Cost of Death 2.0 Report, November 2023, https://www.seniors.com.au/documents/australian-seniors-series-cost-of-death-report-2023-whitepaper.pdf

Law Council calls for more action on elder abuse

The Law Council of Australia has continued to call for measures that will better protect older Australians.

“Elder abuse is insidious and more prevalent than I think any of us would like to believe,” Law Council of Australia President, Mr Tass Liveris said.

“Incidents of abuse may be physical, social, financial, psychological or sexual and can include mistreatment and neglect.

“What makes it most devastating is that the perpetrator is often someone the older person trusts and relies on, such as a family member, friend or carer.

“We must stamp out elder abuse and protect vulnerable members of our community.”

The Law Council is calling for:
• Appropriate, sustained and increased funding for specialist legal assistance and aged care advocacy services, government agencies, and relevant State and Territory tribunals that work towards reducing elder abuse.
• Implementation of outstanding priorities identified in the Australian Law Reform Commission and Royal Commission into Aged Care Quality and Safety (Royal Commission) reports and the National Plan to Respond to the Abuse of Older Persons 2019-2023, including:
• developing a new Aged Care Act which is consistent with the recommendations of the Royal Commission report by 1 July 2023; and
• ensuring that those in residential aged care facilities have legal redress to protect them from abuse, whether perpetrated by care providers (including in the use of restrictive practices) or fellow residents.

At the end of last year, the Law Council of Australia welcomed the decision by Commonwealth, State and Territory Attorneys-General to prioritise enduring power of attorney (EPOA) law reform to reduce the risk of older Australians being subject to financial abuse and looks forward to this work coming to fruition.

EPOA arrangements are intended to ensure a person’s interests are protected when they lose capacity to make decisions for themselves. However, in the absence of adequate legal safeguards, financial elder abuse by appointed decision-makers may be facilitated by such arrangements.

Law Council of Australia, 15/06/2022, https://www.lawcouncil.asn.au/media/media-releases/australia-must-address-elder-abuse

FIRST NATIONAL STUDY FINDS MORE ELDER ABUSE

In the year prior to the first national survey conducted into elder abuse, one in six older Australians reported they had experienced abuse most often committed by family members.

The National Elder Abuse Prevalence Study (NEAPS) survey, carried out between February and May 2020, showed that the most common subtype was psychological abuse (12%), followed by neglect (3%), financial abuse (2%), physical abuse (2%) and sexual abuse (1%). Some of the 7,000 participants aged over 65 years reported several types of abuse occurring, usually psychological abuse and neglect.

Types of elder abuse

Nearly one in five elder abuse perpetrators are children (18%), or their partners or grandchildren and about one in 10 elder abuse perpetrators are intimate partners. Children (most often, sons) are most likely to perpetrate financial abuse as well as friends and service providers.

Children are also the largest group of perpetrators of psychological and physical abuse while friends, acquaintances and spouses were most likely to perpetrate sexual abuse.
Children and intimate partners are both significant perpetrator groups (24-25% for each) of neglect. Professional carers (14%) and service providers (13%) are bigger perpetrator groups for neglect than for other abuse subtypes.

Psychological abuse is not always recognized by either victims or perpetrators. It includes insulting, belittling or threatening behaviour towards a person. Family and friends are the best protection for a person experiencing abuse rather than the person who is unlikely to directly confront the perpetrator.

Factors that increase risk of abuse

While women were slightly more likely to be the subject of abuse than men, other factors increased the risk of experiencing abuse, namely, being poorer, being single, separated or divorced and living in rented housing or owning a house with a debt against it. Having poor physical or psychological health also increased the risk of experiencing abuse.

The study did not include people living in aged care or suffering cognitive decline which could increase the identified prevalence of elder abuse in the community.
The federal government has announced additional funding to build on the National Plan to Respond to the Abuse of Older People. This announcement follows on from recommendations made by the Aged Care Quality and Safety Commission to increase funding to home care packages and create new training places for aged care staff.

AIFS, National Elder Abuse Prevalence Study, https://aifs.gov.au/publications/national-elder-abuse-prevalence-study