Issues
Victorian public sector residential aged care services appear to be caring for residents with higher complexity within the same AN-ACC funding classes as other providers, creating a mismatch between Commonwealth funding and actual care effort. This has implications for service sustainability, equity of access, and the viability of public sector aged care as a provider of last resort.
Why this matters
The policy issue is not only that public sector providers care for more complex residents overall. The more significant finding is that residents assigned to the same AN-ACC class are not necessarily comparable in practice. Within those classes, Victorian public sector services appear to be carrying residents with higher behavioural, cognitive, psychosocial and clinical complexity.
This suggests AN-ACC may be too blunt to capture meaningful variation in care effort within classifications, particularly where residents present with complex dementia, behavioural and psychological symptoms, serious mental illness, bariatric needs, complex wound care, discharge urgency, or multi-agency coordination needs.
Evidence
Our work combined interviews, site visits, care-minute data, financial analysis and time-in-motion studies across Victorian public sector residential aged care providers with contributions from 51% of the sector, and tested findings against a group of non-government providers (private and non-profit).
Key findings include:
- 86% of participating services reported managing residents with complex dementia and behavioural and psychological symptoms
- 86% managed complex mental health conditions
- 71% managed complex wound care
- 67% managed bariatric care
- 57% cared for NDIS participants with dual disability-aged care needs
- every metropolitan site involved reported taking residents who had been refused elsewhere.
The project also found that public sector homes delivered 243.9 care minutes per resident per day, with materially higher registered nurse input than comparator provider groups.
Most importantly, the project identified evidence that residents in the same AN-ACC class could require substantially different levels of care. One time-in-motion study found a Class 11 resident receiving 501 minutes of care per day against a funded target of 253 minutes. This indicates that classification sameness does not necessarily mean care complexity sameness.
Risk
If AN-ACC does not adequately recognise variation within classes, providers caring for the highest-need residents face structural underfunding relative to actual care effort. For Victorian public sector providers, this risk is amplified because they often function as providers of last resort, particularly in rural and regional communities and in cases where residents have already been declined elsewhere.
The consequences include:
- sustained financial pressure on public sector services
- reduced capacity to maintain high-cost, high-complexity care models
- growing inequity between providers with different resident risk profiles
- potential access barriers for residents with the highest needs.
Implications
The Victorian evidence supports a stronger policy argument that current Commonwealth funding settings may not adequately fund the true complexity profile being managed by public sector aged care services.
This has direct relevance to:
- Commonwealth aged care pricing discussions
- future AN-ACC refinement
- recognition of provider-of-last-resort functions
- sustainability of rural and regional public sector aged care services.
Key message
The core policy issue is that AN-ACC class membership does not necessarily reflect equivalent care complexity in practice, and Victorian public sector providers appear to be disproportionately caring for the more complex residents within the same funded classes.