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Pregnant pause

Nine months is a long time – but more and more people in need are waiting longer than that for a place in aged care, and it’s likely to get worse.

The number of people waiting more than nine months for high residential care has risen and it’s adding pressure to an already stretched healthcare system, a recent healthcare reform report found.

The Council of Australian Governments’ (COAG) Reform Council’s Healthcare in Australia 2012–13: Five years of performance report found that the percentage of those waiting increased from 3.3 per cent in 2008–09 to 14.1 in 2012–13. Adding more pressure to the system, it was established that the growth rate of aged-care places has stalled.

“We don’t know why people are taking longer to enter care after their assessments,” COAG Reform Council’s deputy head of secretariat, Michael Frost, said. “It could be because there are not enough places or because people are offered places that don’t suit their needs, or simply because older people decide not to use services for which they are eligible.”

Regardless of the reason, he said the lack of increase suggests there may be issues with the supply of suitable places for older people. If the problem’s not addressed, Frost fears hospitals or carers may be burdened with the responsibility of providing an interim form of aged care.

Jon Wardle, chancellor’s research fellow at University of Technology, Sydney, believes that while it is good that COAG has identified this as an area of focus, the issue has been present for a long time. “Historically there been a lot of blame game between state and federal [government] over who should pay for these services,” he said. “It’s good to see that COAG has highlighted this as something with bipartisan support.”

However he noted previous issues that have been flagged for institutional support have not always been followed up with action. “One of the other big problems is that most of the infrastructure that COAG would have used to actually look at a lot of these actions has been stripped in this current budget,” Wardle said. “It’s nice to have it as a priority – but I don’t know how they’re going to get the resources to do this.”

He said a holistic approach to aged care is needed, which is usually built on strong preventive health programs, community links and community organisations.

Wardle urged COAG to take a whole-of-sector solution more seriously. “If you ignore the rest of the scenario that leads people up to need those services in the first place, then the number will just keep growing and you just have to throw more and more money at it, and it doesn’t really do much,” he said.

Charmaine Crowe, senior advisor in research and advocacy at Combined Pensioners and Superannuants Association (CPSA), said, “Obviously, when you are waiting longer, often people are spending longer periods of time in hospitals because they cannot get an aged-care place or they are struggling in their homes,” she said.

“The other implication is that we’re increasingly asking older people to exercise their choice when it comes to aged care and to shop around,” Crowe said. “That’s not really possible when there aren’t so many places available. Often it’s a matter of the older person just having to take whatever they can get if they’re in desperate need of care.”

Crowe noted that the number of people waiting to receive high residential care is not likely to decline and added the biggest need at the moment is more home-care packages. “There is going to be a slight increase in investment in home care – but I think there needs to be a much greater focus on home-care provision.”

The report confirmed that more elderly Australians are waiting for home-care packages, stating that a higher proportion of people took nine months or more to receive community-aged care.

Another major area that COAG has given attention to is type 2 diabetes. The current obesity rate could serve as a warning flag of a possible increase in the burden of the disease. Around half of those who have type 2 diabetes are not managing their condition effectively, the report found. An increase in potentially preventable hospitalisations for acute and vaccine-preventable conditions was also highlighted.

Wardle believes all these factors have implications for the elderly. “These conditions will make the healthcare needs of aged persons more pronounced than they otherwise would be,” he said, adding the best measure in fixing these problems is a focus on prevention, otherwise it’s akin to “mopping the floor with the tap still turned on.”

“It’s great that they have an aged-care strategy, but without decent primary care and universal healthcare and a real focus on prevention then unfortunately they’re not going to get a lot of bang for their buck.”

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