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Treat aged care as an emergency service: opinion

What does increased choice mean if you have to wait more than 12 months before you get the care you urgently need today?

As first reported in Aged Care Insite on December 8, the government’s most recent report on the data from the Home Care Packages reform for July–September 2017 confirmed what consumers, carers and service providers already knew from experience. Waiting lists are growing, not shrinking, with the waiting times for the more intensive level 3 and 4 packages blowing out to over 12 months.

Care at home is a popular choice for older people. It is increasingly so – and this should be good news to government seeking to help people live at home longer and reduce the demand for more expensive residential care. From the marketing hype around recent reforms, you’d think they’d actually reinvented, improved and transformed everything.

Home Care Packages, for example, have been optimistically marketed and repackaged as Consumer-Directed Care (CDC) since February 2017. Ambitious claims were made that the reforms were transforming care at home, enabling it to become consumer-driven, market-based and nationally consistent.

Sadly, the most recent figures show that choice hasn’t helped too many yet – waiting lists and waiting times have grown, not shrunk. No wonder the major service provider organisations have called for urgent action. Much more is needed, they point out, than simply fast-tracking government’s promise to provide an additional 6000 level 3 and 4 packages to address the high-level of unmet demand for home care.

Much the same can be said about the problems of respite care – a crucial question for the viability of care at home.

A report from Carers Australia released in January this year documents the extent and consequences of the changes that have occurred in recent years, drastically reducing available respite beds and doing nothing to promote new innovative or alternative models.

Is it all getting better? In the early 1990s, I led a major research study that over three years followed up consumers at home who had been referred to an Aged Care Assessment Service. The ACAT had a standard of service that they regarded as essential: any referral for assessment needs to be treated as urgent. The first assessment should be undertaken the day it was received or, if that was not possible, the following day.

This quick response meant that if an urgent response was necessary it could commence within a matter of hours or days.

Home nursing, for example, was often urgent, as might be the case for Meals on Wheels, daycare or other forms of help available at the time. Of course, this was all in the days before CDC. And it was not always perfect then either. But consumers and their families knew they were being listened to. They quickly learnt that they could count on help being available for anything that was necessary to help them remain at home.

Today, with waiting times being at best unpredictable, with access to services mediated by complex and often mysterious assessment procedures and eligibility determination processes, the message is one of uncertainty and patience. Nothing is urgent.

But you’re lucky. With patience you’ll get to choose which provider you’d like – in the long run!

As the great economist John Maynard Keynes reminded us, in the long run, we’ll all be dead. In the short term, it is time that we learnt to understand that aged care is necessary from the time it is first requested. No one asks to be cared for if they don’t need help in the first place.

Aged care needs to be treated as an emergency service. Sure, it is a different type of emergency service than the medical help provided by the emergency unit at the public hospital. It is different, too, from that provided by the fire brigade and the police.

But, like justice, care delayed is care denied. Quick response needs to be a core feature of our aged care system – not just a memory.

Michael Fine is an honorary professor at Macquarie University.

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