Home | Industry+Policy | On tofu and aged care: the tyranny of choice

On tofu and aged care: the tyranny of choice

I do the grocery shopping in our family. It’s not easy: sometimes I can be found, all alone, in a supermarket aisle confronted by the sheer choice in front of me. For example, take tofu (for my daughter). Which tofu? Organic? Australian? Silky? Chilli, teriyaki or plain? I am paralysed by choice, a situation often resolved by taking home different varieties.

Being paralysed by choice isn’t just a situation confronting fathers shopping for tofu. It also seems to be the plight of many older Australians who are needing home care.

This February marks 12 months since the Australian Government gave older Australians the choice of provider and complete portability of their government-subsidised ‘package’ of care. The philosophy is a great one: let older consumers choose what services they need and from whom they receive services. Let them change providers if they are not happy. Let them control how their allocated subsidy is spent.

The Australian Government has responded to the growing demand for home care by releasing 6,000 more “higher care” ‘packages’. And, yet, the queue of older Australians patiently waiting for home care is growing (over 100,000 as at September 2017) but, ironically, the number of Australians actually receiving home care ‘packages’ declined in the first months of the new My Aged Care system.

Hang on: more supply but longer queues and fewer people actually receiving care! How can that happen?

The answer lies in the tyranny of choice: older Australians are being assessed for home care in record numbers but then being left on their own to choose where and how to access that care. That might be great for the savvy, the well-educated and those who can self-advocate, but pity the older Australians living on their own who have dementia. They receive a ‘snail mail’ letter telling them they have 56 days to decide on a provider. Best of luck and have a nice day.

Our market research shows that almost half of those who had been allocated a home care ‘package’ whom we contacted had not yet decided on a provider. Why? Were they merely carefully weighing up their options not realising that if they didn’t choose within 56 days they would need to re-join the queue? And, remember, these are older Australians who are assessed as needing home care support.

Barry Schwartz in The Paradox of Choice found that while we think that more choice is going to produce greater wellbeing, often the opposite occurs. Rather, confronted by an array of options, consumers often decide not to decide. This resonates with UK research on care in older age which found that ‘the choice discourse’, while resonating with contemporary neo-liberal thinking, often became decreasingly appropriate as people’s agency and capacity declined. In fact it was sometimes at odds with compassionate care (Borgstrom and Walter, 2015).

So, what should we do for the ever-growing queue of older Australians who have been allocated a home care ‘package’ but, for whatever reason, haven’t been able to decide on a provider? Some consumer groups advocate that there should be ‘navigators’ to help older Australians get through the system. A good idea, but with 100,000 older Australians in the queue there is every likelihood that these navigators will be quickly overwhelmed.

A simpler solution can be found in how our superannuation system works: we are free to choose our superannuation provider but, if we don’t choose, then we have a superannuation fund allocated by our employer. Moreover, we can change super funds at any time.

The same can work for older Australians who have allocated a home care package. Confident and capable consumers can make their own choice. However, those who have failed to elect a provider within eight weeks (and surely that should be shortened if they really need home care) would have their need for service provision referred to all accredited providers in the consumer’s location.

If consumers are unhappy with their initial provider they can, as now, always change providers.

After all, providing older Australians with the home care they need shouldn’t be as hard as shopping for a daughter’s tofu.

Dr Stephen Judd is chief executive of HammondCare, an independent Christian charity specialising in health and aged care, with a particular emphasis on dementia care and palliative care.

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One comment

  1. It is particularly difficult for people to chose a provider when they have different ways of calculating costs, and providing this information. You need to know the right questions to ask. It is very difficult to compare apples with apples, and as an educated person advocating for my mother, I found this challenging.

    In addition, it is not as easy as it sounds to “change providers”. It takes awhile for the older person to gain trust and rapport with a service coordinator and workers. Even if they’re not happy, the thought of having to rebuild and start afresh with new people is very overwhelming, particularly if they have complex and comprehensive needs.