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Shifting focus

Throughout our lives we all contribute to our accommodation and living costs. There is no reason why this should not continue when we age, writes Judith Sloan.

With few exceptions, the initial responses to the draft PC report have been positive. There is widespread agreement that the current arrangements for caring for older Australians are deficient and unsustainable. Not only is the quality of care patchy, there are also serious issues in relation to access to suitable services for many older Australians.

One of the most pleasing aspects of the report is the suggestion that the focus of the system be shifted away from the providers, emphasising instead the central role of consumers.

Of course, many frail elderly Australians will need to be assisted in making appropriate choices. But here, also, the report is useful in the suggestions it makes for simplifying the pathways that need to be navigated to gain access to services and accommodation.

Making a distinction between accommodation and living costs, on the one hand, and the costs of care, on the other, is a further useful idea to come out of the report. Through most our lifetimes, we all cover, or substantially contribute to, our accommodation and living costs. There is no particular reason why this state of affairs should not continue when we age.

As long as appropriate safety net arrangements are in place, there is a strong case for many Australians to contribute to their accommodation and living costs when living in residential aged care homes. In fact, depending on the level of care required, many Australians currently provide the funds for accommodation bonds to live in low care accommodation.

But the trouble is the uneven treatment of elderly Australians in relation to accommodation costs, depending on their assessed required level of care. With many Australians keen to stay in their homes for as long as possible, the next step for many is transfer to high care accommodation, for which accommodation bonds are not applicable.

The system whereby the Department of Health and Ageing allocates bed licences on the basis of perceived need is neither efficient nor effective. In recent times, we have seen providers reluctant even to take up the licences on offer as the overall financial package available is insufficient to cover costs and provide a return on capital.

A shortage of high care accommodation is a very serious outcome and is inferior to a situation in which residents are expected to make a contribution to accommodation costs.

For this reason, the PC’s suggestions about possible equity release options in relation to the family home are welcome. To be sure, the prospect for many older Australians of being ‘forced’ to sell the family home is very daunting. The idea of the government providing a financial service, to enable elderly citizens to draw down some of the equity in their homes without incurring high fees or taking on risks, is one that should be debated.

There are a number of other important topics raised in the report that should not only be discussed, but hopefully implemented without undue delay. One example is improvements to home-based care for elderly Australians and the need for even treatment of the elderly, irrespective of where they live.

Another example relates to the provision of end of life, palliative care arrangements, which are badly handled in many aged care homes, in part because of the relative small number of registered nurses available to provide the care in these settings.

The difficulties of staffing aged care homes, more generally, are also addressed in the report. With the predicted relative decline in the availability of informal care, in part because younger-older women continue to participate in the formal labour market, the pressures to find workers for aged care homes and aged care services will only intensify.

The fact that nurses who work in the aged care sector are paid significantly less than those who work elsewhere, particularly in public and private hospitals, is highlighted in the report.

National Seniors Australia welcomes the release of the report. While not necessarily endorsing every recommendation, NSA will play a constructive role in the processes that lead up to the finalisation of the inquiry. Reform of the system of caring for older Australians is not optional, but it is important to get it right.

Professor Judith Sloan is an economist and chairman of National Seniors Australia. She is a former commissioner of the Productivity Commission.

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