Productivity Commission Draft Reports 2011 Carers NSW Conference 17 March 2011

1. Caring for Older Australians and Disability Care and Support Productivity Commission Draft Reports 2011 Carers NSW Conference17 March 2011

2. Structure of presentation • Carers in Australia – a snapshot • Overview of aged care report • Overview of disability report • Questions

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

4. Overview of Caring for Older Australians draft report Robert Fitzgerald

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

6. 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

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

8. The gateway to aged care

9. Needs Assessment Framework

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

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

12. Government Schemes to assist • Australian Government Aged Pensioners Bond Scheme • Australian Government Equity Release Scheme

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

14. Structure of independent regulator

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

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

17. Overview of Disability Care and Support draft report John Walsh

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)

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

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

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

22. 3 tiers

23. A consumer perspective

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

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

26. What are the impacts for…. Australians generally? People with a disability? Carers …… the “death spiral”? Providers? Workers? States & territories? Australian Government?

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

28. Timetable for NIIS 2011-12 COAG agreement 2013 Vehicles and medical 2015 All catastrophic injuries 2020 Independent review

29. www.pc.gov.au

31. Funding across jurisdictions

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