Keeping community care affordable

Private providers and government must work together to keep costs down in this growing area of nursing. By Mary Casey

There have been many changes in the care and nursing industry in the past 10 years, especially in the community sector. However, there is much more to do to fill the enormous gaps that exist in the system.

There is a silent crisis lurking that the general public do not notice, unless they have someone who requires care; it is only then that people realise how enormous the crisis is.

With an increasing aging population and the concept of keeping the aged community in their homes for as long as possible, doing so does not go without its challenges.

Admissions to nursing homes is not as easy as it used to be because of the criteria that needs to be met before becoming a candidate. There are also long waiting lists, so government incentives to maintain care or assistance to the elderly within the home is much needed. Service provision is often only an hour a day or much less.

Due to society's changes whereby families used to care for sick or aged relatives, this no longer occurs. As a result, many aged citizens are left to fend for themselves and/or their partner and while they manage to survive, in many cases it is with great difficulty.

Service providers are the ones who see the need for aged care, however, they are restricted by lack of funding to meet those needs. Therefore care is only provided on a "high needs" or "dire straits" basis.

The nursing side of things has also changed dramatically in the past decade whereby care provision was once only attended by registered nurses. While this was satisfactory at the time, it was recognised that basic personal care or assistance with menial tasks did not require the need for university trained nurses.

Carers were therefore introduced into the industry, however, there we no guidelines in place as to what training was required. There were many untrained personnel going into homes without proper knowledge, not just in nursing duties, but also safety education, professional boundaries or knowledge of aged care.

For some time it was a case of anything goes and nursing care and assistance were of poor quality. Thank goodness this situation has been addressed and no longer exists. Tougher guidelines were introduced with the training of assistant nurses and personal carers. This of course increased the quality of care and assisted in the nursing shortage in general but it has not resolved the shortage of care.

I lead a nursing service, Nursing Group, which has been operating for 20 years. We have seen firsthand the problems associated with this silent crisis and believe that with some proper planning, the government could resolve the problem.

Nursing Group added an educative component to our service and established Casey College to train and upskill nurses to resolve the shortage of quality staff in the community for our own company.

Assistant nurses and personal carers are in good supply so it is not the lack of staff that is causing the crisis. The training of assistant nurses has increased to such a level that nurses now have a career path whereby they can start with the basic course and choose to continue.

In fact, I believe that we will see a healthcare system receiving a long needed influx of highly trained, competent and confident assistants in nursing that have the knowledge and skill set to jump between community care and our public hospitals.

Once these nurses reach the appropriate level with their training it won't be long before we see them being classed as vital and prominent figures in healthcare industry.

Due to the increase in the need for community nursing and the nursing shortage in hospitals, this pathway to a career might very well be one of the fastest growing professional occupations we have seen in the industry for many years.

More funding is always the answer to additional care provision, however, I think that good planning by both the government and private sector could see a well thought out, comprehensive and structured care plan that will be cost effective - with a high standard of care provision for our aged care community.

Currently there are many community services that provide packages for aged care. These consist of personal care, transport, dressings, medication, palliative care, etc.

The care can be provided by the community service or outsourced to private agencies. The latter of course incurs a "middle man" fee which is not cost effective.

In my opinion this is the reason why both private and government agencies need to work closer to cut out the additional costs that are incurred by not understanding the broader picture of care provision. Coming up with a solution that will work is what is required.

I believe that community care in all aspects is slowly improving but as always the success is in the planning and to consider both private and public sectors to be involved is necessary because just one sector cannot do the lot. We need backup and to build relationships so we support one another and work well together.

It is possible for this to occur because many years ago our company worked alongside a local area health service providing a 24-hour palliative care service. The service worked extremely effectively and efficiently for many years until the funding was cut.

Over those years we (the public community centre and Nursing Group) provided a quality service to those with a terminal illness. The community centre provided the service between 8am and 4.30pm and Nursing Group did the afterhours, weekends and public holidays.

The reason why the service was so successful was because the clients knew that they had access to a nurse at any time. In the beginning, we did numerous call-out visits but the number decreased because we were available via phone and could support and guide the clients or their loved one.

We could tell them what they needed to do and they were satisfied to do many things themselves that they would otherwise be afraid to do.

They mostly needed the support more than anything else; it gave them the confidence to do those things that they hadn't done before. Patients and relatives over time became much more independent and that was because they knew we were there for them. Of course there were times when we did need to visit or there were planned visits for one reason or another, however, overall it was a very cost-effective service and became more so.

A similar model for aged care services would work in the same way. Obviously in the beginning all the leg work needs to be done such as patient or carer education, information packages, visits, etc.

Once implemented the service becomes more streamlined and effective in every regard. The upfront costs are also high, however, by looking at the bigger picture in time we have a service that is cost effective and at the same time meets the needs of all those requiring care in the community.

Dr Mary Casey (PhD psychology) has more than 30 years' experience in health and education. She is founder and CEO of the Casey Centre, an integrated health and education service with more than 250 nurses and carers, and 700 graduates a year in three centres across NSW, see www.caseycentre.com.au.

Through the centre, Casey also specialises in designing and implementing health and education programs and products. She also has qualifications in nursing and applied science.

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