While there’s no indication yet what the residential aged care subsidy will be for 2017-2018, there’s plenty to be discussed as the annual renegotiation of the ARRC (age-related residential care) contract between District Health Boards and residential aged care providers builds momentum.
Equal pay negotiations, palliative care, interRAI, ambulance charges and special equipment are all high on the wish list for providers.
Of course, the big ticket item is the level of funding. Last year, providers received a one per cent subsidy increase, which many did not think fair or adequate. However, many are hopeful after Associate Health Minister Nicky Wagner, who now has responsibility for aged care, has voiced her support for the sector.
“The sustainability of the aged care sector is a high priority for this government, as is the quality of care provided in facilities,” says Wagner. “As with all health sectors, aged residential care is subject to ongoing pressures from increased costs.”
The New Zealand Aged Care Association (NZACA) says it hasn’t been given any indication from DHB Shared Services what the price will be for 2017-2018, although chief executive Simon Wallace says the price will be negotiated.
“We’re just lobbying for the best increase we can get, there’s no particular figure on it,” he says.
Both New Zealand Aged Care Association (NZACA) and Care Association New Zealand (CANZ) have both gone in to battle on behalf of their members, highlighting a number of areas that need to be improved for the 2017/2018 ARRC contract.
Victoria Brown of CANZ says the issues that are causing their members concern are those that increase the cost of care to the sector without remuneration of staff time and ensuing costs.
“Perhaps the most fraught has been the InterRAI,” says Brown, “but there is little hope of convincing anyone that for most providers it has added no value. CANZ has asked that we at least get a care plan populated with the data that is inputted – but even that seems a pipe dream.”
Concessions made on interRAI in last year’s ARRC contract were seen as a win by the NZACA. However, the Association says that while they were pleased to see last year’s ARRC negotiations address a number of issues around interRAI training and data development, there is still concern at the cost of backfilling staff when RNs are on training, as well as disbursement costs to send RNs to training in other centres.
High among the issues raised on the NZACA’s submission to DHB Shared Services is equal pay. It stresses that any agreement that is reached in the equal pay negotiations will have to be reflected in the ARRC contract. The NZACA states that in the event that an equal pay settlement requires members to exceed their responsibilities under the ARRC agreements, “then we may need to consider invoking the A23 variation to agreement clause, especially in cases of a funding shortfall”.
Palliative and end-of-life is also high on the list, with mounting evidence showing that an increasing number of people are dying in residential aged care, with increased presence of frailty and comorbidities including dementia.
The NZACA agrees with the need for palliative care national standards, one of the findings from the Adult Palliative Care Review. However says “such standards cannot be imposed on the sector without the commensurate increase in support and funding”.
Ambulance charges are also back on the agenda. The sector is particularly miffed that in July last year, the Ministry of Health gave St John’s the green light to increase medical emergency ambulance call-out charges from $88 to $98 without any consultation with the sector.
The sector would also like to see the ARRC agreement recognise the extra costs incurred by providers through the purchase or lease of bariatric and special equipment.
Brown says that CANZ is lobbying for refinements to the wording of the ARRC agreement to ease the burden of both cost and auditing.
“An example is the Provision of Dressing Supplies – the bar is set so high that to date no CANZ provider has managed to get funding for high cost dressings.”
The NZACA has also raised timeframes, complaints and auditing process and the burden faced by providers of complying with an increasing amount of red tape.
The negotiation process is now at the discussion stage. Negotiations are usually concluded by the end of April, but Wallace says it may be a little later this year. Everything has to be completed in time for a 1 July implementation.
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