The quality of aged care is the issue

Community aged care is still a basket case in many ways despite three years having elapsed since the Royal Commission into Aged Care Quality and Safety handed down its scathing report.

The commissioners identified horrific cases of neglect and numerous instances of physical, sexual and psychological abuse.

While the government is to be commended for getting nurses into nursing homes more than 95 per cent of the time by last August, just a month after the original deadline set by the Prime Minister during the election campaign, this is just the tip of the iceberg.

An unintended consequence has been the closure of a significant number of nursing homes which couldn't comply with the nurse-on-site requirement. A disproportionate number of these were in regional areas where it is difficult to source qualified staff.

The catalyst for the latest debate over aged care funding was the report of a special taskforce, chaired by Aged Care Minister Anika Wells, released on Tuesday.

It will come as no surprise to many retirees, in view of Ms Wells's previous statement on aged care funding, that the taskforce favours a beefed-up "user pays" model.

While home care clients and care home residents already contribute to the cost of the support they receive the taskforce argues this is insufficient.

All in-home care recipients can be asked to pay a basic fee of about $12 a day. Those with an income of more than $62,000 a year can be charged up to $35.95 a day.

Assistance is not provided directly by the government. The home-care sector is serviced by a variety of religious, charitable and private organisations which receive subsidies of between $28 and $163 a day per patient (depending on the level of care required).

This system is far from perfect. Investigations into the NDIS, which operates on similar principles, have shown just how easy it is to charge for services which are not provided.

The user charges for residential aged care are, as one would expect, significantly higher. Almost all aged care home residents pay a daily fee of $60.86 (or 85 per cent of their pension). There is also a means tested service fee of up to $416.05 a day for those who exceed the income threshold.

These fees do not count towards the cost of accommodation; room and board so to speak. That is covered either by a cash deposit, to be refunded on death or departure (to another facility), a daily accommodation fee or a combination of the two.

Under the current arrangement the means-tested fee is capped at $78,524.69 over the resident's lifetime.

It seems inevitable, given both the royal commission and the taskforce say the deposit model isn't working, the caps will either be increased or scrapped altogether as people are moved to a rental model. This would take the form of a "fee supplement" on top of the existing daily charges.

Given this would shift the cost burden away from the government to the aged care resident, the elderly and their families will rightly expect an improved level of care in return.

A suggestion residents could pay even higher fees in order to receive extra amenities is both cynical and open to abuse.

Those with the means can already book into expensive private nursing homes that offer levels of luxury and care far removed from those in most aged care facilities.

Experience has shown it would only be a matter of time, given many homes are businesses operating on a for-profit basis, before the "extra amenities" charge was rorted by unscrupulous operators who would take the money and give little or nothing in return.