As the post-WWII generation starts to enter residential care, six issues loom large for providers. By John Kelly.
Australia’s population is ageing and as a society we need to examine how we will cope with a rising number of older, vulnerable people. Those of us in aged care may feel as though we have reform fatigue but there are more changes to come and many more hurdles to clear.
The biggest social issue of our time is that 60,000 Australians a year turn 85. The average age of people entering residential care is 85. In 35 years, the number of Australians over 85 will quadruple to 1.8 million.
There are now two generations of Australians in retirement. The 65–69 years age group is on a cusp between two of the major influences on population ageing – increasing life expectancy and the ageing of the Baby Boomers. Increasing life expectancy, due to declining death rates over the past 20 years for both males and females in most age groups, is having its effect on numbers in all the older age groups. The proportional impact is greatest on the two oldest groups, 80–84 years and 85 years and over.
Another significant factor related to our target market is that at the last Census, 500,000 women and 250,000 men over 65 years of age lived alone.
Older Australians have lived through times of great deprivation, including wars and the Depression. They learned early in life not to complain and to go without. The Baby Boomers, on the other hand, have lived a generally affluent and peaceful life, generally able to achieve levels of comfort unknown to their parents. What does all this mean for aged care?
I would like to focus on six issues that I consider central to the effectiveness of our involvement in the community and residential aged-care sector.
Driving policy and debate
How is Australia going to meet its obligations as a civil society to care for its frail elderly in the years and decades to come? This will require leadership from our politicians and those providers in the sector.
Expenditure on aged care in 2012–13 accounted for $13.3 billion, an increase of 6.1 per cent on the previous year. The minister for social services, Kevin Andrews, is responsible for portfolios that cover 35 per cent of Commonwealth expenditure.
Where ACSA leads is in driving public policy and public debate. I have been encouraging families, especially Baby Boomers with, to have a conversation about how the parents would like to be cared for as they get older, both within their home and sometimes, at a later age, within residential care.
Baby Boomers need to get their local politicians to understand the importance of putting appropriate focus on the care of older Australians. They need to drive home that it is not an optional extra to ensure that options for older Australians reach the appropriate levels of care and dignity that they deserve. Only when this debate becomes consistent and regular will politicians be attentive to the messages and the need for appropriate prioritisation compared with other policy options across other sectors.
How to measure quality
What is quality and how do we measure it? Some consumers of aged care will be accustomed to a full life of career, travel and extensive leisure activities, whilst others will be satisfied with a more routine and predictable lifestyle. These varied service outcomes will be further complicated as consumer-directed care becomes more commonplace.
When it comes to aged care, providers do not want to offer lesser quality to anyone. What the industry must ensure is that the core deliverables are agreed to and available to all and are provided in a manner that allows them to be measured. That is what providers are committed to supplying, that is what staff and volunteers are dedicated to giving and that is what families of consumers expect. The provider sector must take an active role in the setting of outcome measures and not allow government to do this.
Access – near and far
ACSA represents the mission-based providers across the country. Many of our members are in parts of Australia where they are the only provider, especially in rural and remote areas. The business case for these providers is different from that of one in an urban environment.
In rural, remote and regional areas, aged care does not operate on its own. In many regional areas, the aged-care service provider is the biggest employer in town. People live longer and are healthier if they can stay in their local community, which is an active and supportive one. It is also cheaper. There is plenty of evidence to support the proposition that it is not acceptable to the Australian community to send people away to distant towns for care that separates older couples and families.
A bigger and better workforce
Every Monday morning for the next seven years, we need to open two 100-bed residential aged-care facilities to keep up with the demand for care, based on the government’s own figures. This presents two problems. One, we need to build these facilities with the appropriate planning lead time and two, we need to have the staff to work in them. The staff must be trained to care for vulnerable people as they reach those later years in their lives with physical frailty and cognitive impairments.
There will never be a shortage of consumers, but without proper workforce planning, there will not be enough people to care for them. Regional Australia has shortfalls in quality and quantity. Having programs at certificate level provides token education of physiological bases of health pathology. For dementia, in particular, this creates challenges for providers in care delivery and funding for education staff.
How to pay for it
Older Australians have significant wealth tied up in the family home and it will require leadership from government to create a stable political and economic environment to make consumers comfortable enough to free up that money so those who have the means to contribute to their care can do so. The Productivity Commission’s report An Ageing Australia: Preparing for the Future (November 2013) reported that most households and individuals already save for their later years, consistently building wealth over their working lives and then using it to fund their retirement.
On the Productivity Commission’s figures, the average 65-year-old has accumulated $660,000 in wealth. By 85, this has diminished to $460,000 (with $440,000 tied up in the principle residence). This highlights why financial solutions must be available to allow consumers to tap into that principle residence asset.
Best use of IT
The use of technology in the sector is still very much in its infancy. The potential for more effective use of technology in administrative and care solutions already abounds – from mobile apps that help consumers maintain a healthy ageing focus, to robots that participate in direct care and supportive clinical management. The use of devices that monitor health status and/or provide risk assessments will substantially affect the way we go about our business. It will affect management systems, workforce numbers and skill sets and empower consumers in the process.
Government can help foster investment in infrastructure for innovation and solutions that can be scaled across the sector. It could also review the scope of information required and streamline reporting requirements and information access to ensure it is useful and affordable to the system.
The limits of consumer directed-care
Providers are completely committed to the empowerment of consumers to understand the choices available to them, how they would like to have those services delivered and how they want to be involved in the care process. There is a close correlation between provider competition in a less rationed market and greater consumer choice leading to higher levels of innovation and quality services.
We do need to understand, however, that market forces need to be monitored where social deliverables are involved. A light touch regulatory framework does need to exist to ensure communities receive the services they deserve in a cost-effective manner. At times this may limit the range of choices a consumer can make, or dictate that it is in the community’s best interest to support providers of services that have the backing of their local community. Community connectedness is an important part of the decision-making equation.
Adjunct professor John Kelly is the chief executive of Aged & Community Services Australia.Do you have an idea for a story?
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