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EVERYDAY LIVING EXPENSES
Preamble
The funding and profitability of aged care providers has been in focus in recent times. With the sector
awaiting a response from Government to a number of reviews into aged care funding, quality
standards, prudential arrangements and workforce strategies the focus has become more intense.
In the past five months there has been strong media attention on aged care and retirement living
providers, including the quality of care provided, financial arrangements with residents, food costs,
registered nursing hours, profitability of providers and the increasing cost to enter the aged care
system.
Whilst each of these issues is clearly important to examine, collectively and individually, sensationalist
and emotive media reporting which provide little balance, objectivity or context has not contributed
to the discussion in any meaningful manner in our opinion.
The most recent example is the media response to the study “What does it cost to feed aged care
residents in Australia?” recently published in the Nutrition & Dietetics Journal. Media headlines such
as “$6 food disgrace for our elderly”; “Prisoners fed better than Aussies in aged care homes”; and
“Nursing home food dubbed a national disgrace” were followed by articles which seemingly paid scant
attention to the basis of the study, the methodology and the conclusions drawn.
Interestingly, this was a second publishing of the study, the first being on 25 July 2017 when it was
more reasonably received by readers due to far less sensational coverage by specialist journals such
as Australian Ageing Agenda. The actual data as compiled by StewartBrown has been in the public
domain since October 2016 and was the basis for a number of response articles such as from Dining
Experience Specialists.
Study: “What does it cost to feed aged care residents in Australia?”
From our perspective, a primary objective of the study was to promote positive discussion in relation
to good nutrition in aged care and the benefits that can bring to residents and providers. The study
highlights the increasing use of oral nutrition supplements and linked this to potential issues in relation
to malnutrition.
The study commenced with, and highlighted, the cost and funding pressures that aged care providers
are under to meet their obligations for providing quality care, including sufficient nutrition, to
residents. StewartBrown contributed data derived from its Aged Care Financial Performance Survey in
the context that this supports the difficulties being faced by aged care providers in today’s funding
environment. This is a major concern and an ongoing trend that StewartBrown has raised in each of
the quarterly Surveys and aged sector presentations and briefings.
The study did not state, nor imply, that aged care providers were reducing the level of care or not
meeting accreditation standards in relation to food.
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Catering Costs ‐ Analysis
The single largest cost associated with the provision of everyday living services to residents is catering
costs. Meals is one of the areas of focus for both consumers, and as a result, providers. This focus on
meals is twofold. Firstly, and foremost, the requirement on providing the necessary nutrition for
residents to ensure their continued wellbeing. Secondly, to ensure that the facility is providing a service
that the residents have choice and are satisfied with.
The actual cost of catering for each aged care resident is not solely the cost of food and supplements.
Catering cost includes staffing (preparation and serving), other consumables (crockery, cutlery, trays,
napkins), component costs (equipment, utilities) and overhead costs.
This results in the actual catering cost being more than $30 per day per resident. We will later contrast
this with the revenue received for this service provision.
From a trend perspective, catering costs have risen at a higher rate than CPI as shown in the following
graph. This increase, well above CPI, has been largely unfunded.
Cumulative increase in Catering costs
70%
60%
50%
40%
30%
20%
10%
0%
Jun‐07 Jun‐08 Jun‐09 Jun‐10 Jun‐11 Jun‐12 Jun‐13 Jun‐14 Jun‐15 Jun‐16 Jun‐17
Catering CPI
The study included data statistics and associated graphics based on the average cost of the 457
facilities where a dissection of additional consumables was obtained. This was as published in the June
2016 StewartBrown Aged Care Financial Performance Survey. These facilities represented 56% of the
total number of facilities in the Survey, being 817.
The data and analysis of the food component of the total catering cost was based on the average of
the 457 respondent facilities that provided additional dissection. This is a representative cross section
and within an appropriate statistical weighting. It includes facilities which prepare the catering in‐
house (70%) and those that utilise contract catering.
We would expect that there will be differences between the allocated food content cost for in‐house
preparation as compared with contract catering, however this is not easily quantifiable.
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It is relevant to consider the total cost of catering when conducting an overall analysis and drawing a
conclusion therefrom. A summary of the cost of catering based on all participants who utilise in‐house
catering (where the costs are more easily dissected) from the relevant StewartBrown Surveys is as
follows:‐
Table 1: Total catering costs for facilities preparing meals in‐house
2016‐17 2015‐16 2014‐15
$ pbd $ pbd $ pbd
Consumables 10.85 10.51 9.95
Staff costs 18.38 17.22 16.61
Total catering costs $29.23 $27.73 $26.56
pbd = per bed day
Consumables include food costs and crockery, cutlery, napkins etc. Staff costs include on costs and
workers’ compensation premiums, but exclude payroll tax for comparison purposes (as payroll tax
relates only to for‐profit providers).
These total catering costs do not include depreciation of equipment, utilities or repair and
maintenance costs to maintain the equipment, all of which would be included in the costs of food in
many of the other comparisons. If these costs were allocated to catering, then the actual catering cost
would exceed $30 per bed day.
The above table also confirms this increase cost of consumables (including food) and staff costs in the
last three financial years.
Basic Daily Fee
The basic daily fee charged to residents is used to pay for everyday living costs such as meals, cleaning,
laundry, utilities and routine maintenance expenses. These costs replicate those that a person would
incur if they were living in their home and maintaining that home in a liveable condition.
The basic daily fee is regulated by the Government and is levied at 85% of the single person rate of the
basic aged pension (currently $49.42 per day).
The graph below shows that there is a funding shortfall between the cost of everyday living expenses
and the basic daily fee. Unless providers can charge a fee for additional services, this funding gap must
be made up from another funding stream. Given that, according to the 2017 ACFA annual report, more
than 50% of residents in residential aged care at 30 June 2016 were supported residents, that is they
made limited or no contribution to their own care due to minimal financial means, the ability to charge
additional fees to recoup the full cost of everyday living expenses is limited.
This serves to further highlight the financial pressures that residential aged care providers continue to
face in the current funding and economic climate, and why all costs, including catering costs, are
constantly being reviewed for efficiency and effectiveness.
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Table 2: Basic Daily fee and everyday living expenses for all facilities
Basic Daily Fee and Everyday Living Expenses
$70
$60
6.21
6.20 5.93
$50
6.23 6.33
10.07
5.36 9.96
4.95 9.81
$40 4.32 8.81 9.11
3.65 8.96
3.26 8.14
3.11 6.85 11.76
6.45 11.04 11.20
$30 6.43 6.06 9.95 10.59
9.80 9.78
8.84 9.06
8.37 49.09
8.09
$20 44.54 46.50 47.49 48.25
40.25 41.71
31.52 32.05 33.41 38.65
26.75 27.48 28.84
22.41 22.89 24.63 24.78
$10 18.92 20.65 21.33
18.00
$‐
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
(4.11) (4.56) (6.18) (2.91) (5.05) (5.29) (5.07) (4.31) (6.31) (6.32)
$(10) (7.80)
$(20)
Basic daily fee Catering Cleaning and laundry Maintenance Utilities Funding gap
By way of explanation, using 2017 as an example, the respective components are as follows:‐
Basic daily fee $49.09
Catering cost $(28.84) This includes in‐house catering and contract catering
Cleaning/laundry cost $(11.76)
Maintenance cost $(10.08)
Utilities cost $( 6.21)
‐‐‐‐‐‐‐‐‐‐‐‐
Shortfall $( 7.80) per resident per day
=======
There has been a shortfall each year, with this shortfall increasing when compared to 2007. Please also
note that the everyday living costs exclude administration expenses which amounted to $35.42 per
bed per day for the 2017 financial year.
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Conclusion
Any analysis of the costs of residential aged care must be cognisant of the overall funding, demography
and resident acuity mix. To make comment on one component only may not be appropriate.
In this instance, speculative and emotive commentary on the cost of food, without considering the
total cost of catering, wastage, process, quality and formal complaints can be misleading.
An incontrovertible fact is that the profitability and financial viability of residential aged care providers
is under extreme pressure. Funding pressures, increased care costs due to higher acuity levels, and in
particular residents with dementia, concessional residents being more than 45% of the resident
population having limited financial resources, quality constraints, and a large capital infrastructure
cost all are contributing to poor financial returns.
More than 30% of all residential facilities in Australia are making operating losses, and the total return
on assets employed (operating surplus as a percentage of total assets) was 1.59% for the 2016 financial
year and deteriorating further in the 2017 financial year.
It is simplistic and misleading to only quote the $6 per day food (ingredients) component in isolation
as has been the case with recent media and associated commentary. Consideration and analysis of
the total cost of providing resident meals each day and the overall residential aged care funding
envelope is required to provide a more balanced assessment.
Further linkage of the supposed profitability of provider organisations as being at the expense of
quality of care outcomes are similarly not responsible or accurate.