Thousands of people living in Bupa aged care homes will not receive cooked breakfasts unless they sign up for a $42-a-day meal package under a contentious new fee schedule rolling out across the sector.
The Higher Everyday Living Fees (HELF) program, introduced as part of the government's "once in a generation" changes, means residents will need to sign up to Bupa's "Enhanced Dining Experience" at a cost of $15,330 per year.
That entitles them to two hot breakfasts a week, a daily, extra-hot meal option at lunch, a dessert at lunch and a beer, wine or soft drink with lunch and dinner.
Bupa, which has more than 5,000 aged care residents, confirmed that those who do not pay the $42 daily fee will receive a continental breakfast only.
It said it would "provide additional cooked protein options for residents if recommended by a dietitian, irrespective of whether the resident has opted for our enhanced dining options".
Dietitians Australia president Fiona Willer said many providers did not have dietitians on staff and that it was worrying that residents could need to be diagnosed as malnourished to get simple protein at breakfast.
"We're not talking about high dining here — most people expect an egg at breakfast as normal and it's not acceptable that it's now seen as a luxury," she said.
But according to the Aged Care Quality and Safety Commission, "legislation does not prescribe particular foods, such as cooked eggs, or require every resident to receive a cooked breakfast each morning".
Almost $12k a year for 'barista-style' coffee
Following a story last month the ABC received HELF price-lists for almost a dozen providers and sent the details to the commission.
One provider was charging $25 a day for one extra lunch and dinner option, as well as a fee of $1,900 for a choice of pharmacy different to the provider's choice.
There was also a charge of more than $500 to safety-test up to five electrical items belonging to the resident.
The commission said it would "review the information" and "assess whether further enquiries are required".
Oryx Communities, which markets itself as a premium aged care provider, is charging $32.43 per day — more than $11,800 a year --for "barista-style" coffee from its coffee machine, along with "petits fours".
An FAQ document from the West Australian provider says residents who do not pay will not be allowed into the cafe area because it "is reserved for residents who participate in the applicable HELF service". It says those who do not pay will have access to other communal areas.
Oryx's Queenslea facility has aged care rooms that require deposits of more than $2 million, but TV is not included. The pay TV and on-demand entertainment package costs all residents $39.75 per day, or $14,508 per year.
If people do not pay the fee, Oryx says the "flat screen TV will be disabled but not removed", according to documents.
Bundles up to $20k extra per year
HELF was meant to provide greater choice to elderly Australians while making fees more transparent. It replaced "additional service" fees that some providers charged in parts of their facilities, separating those who paid additional fees from those who did not.
But families, advocates and people in the industry say the change is creating confusion and inequality in nursing homes.
Peak body Ageing Australia declined to provide a statement to the ABC, but last month chief executive Tom Symondson told an industry publication that the scheme was not working.
"We need the government to be honest and open with the community that it does not pay for the things contained within HELF," he said.
"We have seen government spokespeople and some ministers saying, 'Well, TVs should be included.' Well, TVs are not paid for."
Advocates say providers should supply in-room TVs, phones and wi-fi as standard and that HELF is creating a two-tiered system that compromises the dignity of residents.
"You've got people sitting down next to each other in the dining room, and one has a hot breakfast and the other has Weetbix and it's unfair that the staff are the ones trying to explain why," David Thompson of WA peak body Advocare said.
Some providers continue to provide many services at minimal or no extra cost, but some are charging up to $20,000 extra per year for bundled packages.
$70 for a BBQ, $4.50 for meal delivery
Not-for-profit provider Warrigal has more than a dozen facilities and is charging $70 for a monthly BBQ, $70 for a high tea and $4.50 for meal delivery to a resident's room. It says there will not be a delivery charge for those who have a "clinical or specific care reason".
Elizabeth Smith, whose mother lives at a Warrigal home, is worried that providers will provide the bare minimum and charge for what used to be standard inclusions.
"My strong concern is these packages — expressed in daily terms — seem affordable but are actually enormous additional costs for very vulnerable people and families and there is no requirement, legislatively or through oversight, that they represent value for money," she said.
"Providers are already getting a giant a bucket of government money and then they are charging for things which are fundamental."
Warrigal told the ABC its "priority is that every resident receives high-quality standard care, meals, and activities, whether or not they choose optional services".
A brochure for the Royal Freemasons' Benevolent Institution (RFBI), also a not-for-profit, indicates that residents wanting the option of using a pharmacy other than its contracted one will be charged $1,900 a year.
It is also charging $570 a year, as an option, to clean mini-fridges in residents' rooms.
RFBI did not respond to specific questions about its prices but said in a statement: "If governments believe certain services should be available to every resident as a universal entitlement, then those services should be clearly defined and adequately funded."
Anyone with concerns about HELF is encouraged to contact the Aged Care Quality and Safety Commission on 1800 951 822 or online.
