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Push to keep indigenous funding

Researchers and providers are concerned at any moves to change aged care planning ratios for Aborigines. By Megan Stoyles.

Indigenous aged care services are worried at suggestions the 50-years-plus population ratio used for planning services, compared with the general 70-years-plus, might be amended following research showing indigenous Australians may not be ageing prematurely.

While they do not dispute the research, some worry that a change could lead to fewer funded services, or that new bureaucratic requirements to recover care funding for those who might be judged as having a chronic rather than an ageing condition, will add to their already onerous reporting requirements to different funding programs.

Philippa Cotter from Charles Darwin University, the study’s lead author, said such a policy response would be a misinterpretation of their findings.

“We found a number of problems with the current policy measure, but the solution is not as simple as dismantling it.”

“We concluded that aged care policy should target the indigenous population differently to other Australians. Our research raises a number of challenges for policy: how to capture higher need without reinforcing negative stereotypes or ignoring the diversity within the indigenous population. How to set up meaningful accountability of government for the provision of the right types and level of services.

“How to strengthen the focus on improving function and improve the links with other areas of policy affecting indigenous people. How to broaden access to quality assessment to help both younger and older indigenous people get the right care.”

Cotter and colleagues from the University of Melbourne, ANU and Menzies School of Health Research published detailed research examining the implications of life expectancy and health conditions of older indigenous people for health and aged care policy in the Australian Health Review, and Australasian Journal of Ageing.

They cast doubt on the assumptions behind federal government policy, which uses 50 years and over for population-based planning for indigenous people compared with 70 years for non-indigenous people.

The research analysed population demographics, aged care assessments, admissions and usage, need for assistance and expenditure. It showed that indigenous people aged 50-69 have much lower utilisation, and a different pattern of utilisation, of aged care services than either indigenous, or non-indigenous people aged 70 and over.

The researchers believe the planning framework conflates the diverse needs of indigenous people across a wide age range and does not set a meaningful target for service provision. It has not ensured the right balance of services across geographic areas and between different levels of care. In particular community-based services are much more important for indigenous than non-indigenous people, regardless of age.

Inclusion of indigenous people aged 50-69 distorts planning and reporting of services for the whole indigenous target population, Cotter said.

“Going on the current planning ratios, over 5200 additional residential care places would be needed to bring provision up to the current target. While there may be some unmet need, it is unlikely to be of this scale as there are only around 1300 current indigenous recipients currently in residential care.”

“The lower planning age for indigenous people better matches the use of CACPs [Community Aged Care Packages] than residential care. This may be compensating for failure in other sectors. The major indigenous affairs initiative, the Closing the Gap strategy, includes a focus on chronic disease but does not acknowledge the community care services that indigenous people with chronic diseases may need in addition to primary health care.

A different approach to indigenous aged care may not change who provides services and could build on existing indigenous aged care infrastructure and more locally planned flexible care service models.

It should make more explicit links between community care and other indigenous chronic disease policy and services such as primary health care, rehabilitation and housing.

Indigenous people do not need less services or resources, but do need these to be better targeted, Cotter said.

Indigenous care providers are concerned at the implications of any change.

Millie Ingram, CEO of the Wyanga Indigenous Aged Care Service in Redfern, Sydney said: “In my experience, any tinkering at the edges with Aboriginal policy eventually results in dismantling.

“Governments will not address health related problems in the age group as described, but will remove or increase the age of 50 as a qualification for aged care, without introducing health measures needed in the areas described. Indeed they cannot address the health issues that affect all Australians citizens now, let alone specialised areas for Aboriginals.

The regional manager for Frontier Health Services in the Northern Territory and Western Australia, Sharon Davis, agreed that they are providing services for indigenous people in aged care who do not require residential aged care services.

“It’s a problem of isolation, if you’re in Tennant Creek or Mutijulu there’s only one service whoever is running or funding it. It’s up to the Commonwealth not the service to recoup funding from another program, ideally without making the local service go through more hoops, filling out more forms,” she said.

Matthew Moore, the aged care manager at Jymbilung House in Queensland, believes the federal government should treat indigenous care service provision – including aged care – as unique. “If the ratio age split was changed, we would have less money to use on programs with only one or two clients, and would miss out on the growth component of aged care funding,” he said.

Venessa Curnow now National Aboriginal and Torres Strait Islander liaison officer for Alzheimer’s Australia in Queensland said the Aboriginal and Torres Strait Islander (ATSI) long-term care industry welcomed more research. “But I hope the government does not view these research findings narrowly, and change only a chronological age in planning ratios.”

“The reality of aged care service provision in ATSI communities is reflective of a small population base; inclusiveness, cultural responsibilities, viability issues; and holistic outcomes such as employment, skill mix, and client-centred care.

Curnow said that compared with non-indigenous services they had more middle-age people accessing long-term care services for a number of reasons. This includes social issues, cognitive impairment, physical disability caused by trauma or strokes, and poor diagnosis or access to health services. All of these are reasons for admission in the context of overall poor outcomes such as, lower socio-economic status and higher unemployment rates.

When the original planning ratios were introduced, social justice ideals – not premature ageing – were the primary motivation and setting a lower age for indigenous people as a reasonable solution to the problem of them not getting a share of aged care resources.

There was an underlying pragmatism and recognition that needs weren’t being met by other sectors, however the former Commonwealth aged care planner and now consultant gerontologist Anna Howe, has stressed the need to reassess the policy measure’s relevance.

The government may be forced to consider the issue of ratios in its consideration of the Productivity Commission report. The commission had access to the team’s research when it developed its recommendation to switch from a capped number of aged care places to universal entitlement for all Australians over 65 years.

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