Home | Industry+Policy | The long wait: assisted living model can fill the service gap

The long wait: assisted living model can fill the service gap

Government figures show there are more than 69,000 older Australians waiting for their approved level package, and who are without an interim package, as at 30 September last year.

Although the Federal Government announced an additional 14,000 higher care packages as part of the 2018–19 budget and the recent delivery of 10,000 packages, it falls well short of meeting ever-increasing demand based on the government’s target ratio of 4.5 per cent for people over the age of 70 by 2022.

Our Brisbane-based agency has found that it can take up to two years to access a government-funded home care package in some areas. This shortfall in supply may result in unnecessary early entry into residential aged care for some of those eagerly waiting.

Outside of government provided home support and care packages, piecemeal assistance services are often provided by the operators of seniors’ living communities. However, coherent, tiered, fee-for-service support and care that addresses the spectrum of care and support needs are not commonly available in these communities.

Assisted living packages

Fee-for-service assisted living packages are one way of addressing the service and care needs gap between independent living and residential aged care.

Many people are used to the government being ‘the payer’ for care and health needs. However, there is a growing segment of older Australians with a capacity to pay for care and support driven by societal factors such as newfound wealth from the sale proceeds of their homes, greater superannuation, a lessening of the intent of past generations to ‘leave money for the kids’ and a desire to live as well as they can now. Most of all, they wish to defer admission to residential aged care.

I propose a model of tiered assistance and care delivered in seniors’ communities which would provide certainty of continuous care for those with deteriorating wellbeing who cannot wait months, if not years, for a government-funded assisted living package.

Such models of service are available in Canada and northern Europe, for example, but have not been implemented to a considerable extent in Australia. The handful of operators who have done so have found this approach meets market demand, customer needs and fills a major gap in the continuum of care.

Box:  Tiers of accommodation aligned with care and support  

At two modern campuses, at Wheelers Hill in Melbourne, New Zealand-based Ryman Healthcare provides assisted living, fee-for-service packages to fill the support and care gap and enhance the consumer experience offered by traditional lifestyle retirement villages. Ryman Healthcare responds to the spectrum of residents’ assistance and care needs with tiered packages and optional occasion of care services between the tiers, such as help with medication and wound management. Another example is Aveo’s recently opened higher-end development in the Brisbane suburb of Newstead which offers modern independent living, assisted living and residential aged care. Like Ryman Healthcare, Aveo offers a mandatory base package which includes mainly assistance services, laundry and meals with some care services. Additional services and care are available as an optional package – up to 14 hours per week and on an hourly basis.

The table below summarises some fees and benefits associated with government delivered home care packages and a selected fee-for-service package delivered into a seniors’ living campus:

Table: Home care package vs a selected fee-for-service package

Notes:

    1. The government funded home care packages come with a lifetime cap on fees of $65,357.65
    2. The selected fee for service package is one currently available in the market place at seniors’ living communities

The main takeaways from the above table are:

  • At levels 1 and 2, depending on income levels of a care recipient, the cost to a consumer of government funded and the selected fee-for-service packages are similar.
  • Immediate availability of packages and 24/7 onsite care in the event of emergency are compelling features of the fee-for-service packages.

Coherent, tiered assisted living packages delivered within a seniors’ living environment offer advantages for both consumers and providers compared with government funded at home care and such services delivered into the broader community:

Consumers

  • 24/7 onsite support in case of either an emergency or a simple, but immediate, need for assistance
  • Ready and timely assistance with daily living tasks, assistance and care
  • More long-term relationships with the care giver – the shift to consumer selection of the providers with government-funded packages has led to dis-integration of delivery among service providers
  • Less administration – if residents are living in a seniors’ community compared with seeking care services from different providers
  • More personalised care with more likely fewer provider staffing changes
  • Greater value for money with providers in a seniors’ community not needing to recoup downtime through travelling
  • Greater chance to remain in their home for as long as they can and defer or prevent a move to residential aged care.

Operators of seniors’ communities

  • Meaningful assistance and care offering – to provide the compelling proposition for a move to a seniors’ living environment – not just companionship, activities and accommodation
  • Lower cost delivery – with care recipients located close together in a village/apartment building
  • Another revenue stream from care and support services
  • Greater range of accommodation choices – laundry and full kitchen areas are not necessarily required as these services are provided to residents as part of bundled services which may enable operators to achieve potential a higher per square metre sale price for apartments.

The concept of assisted living is not new. In my view, it seems that retirement village operators with an assisted living offering have not:

  • Asked the right questions at point of sale to potential residents about care and support needs, but rather focus on the transaction as being all about real estate. The care component, which could be the most important decision-making factor for some residents, is often missing in the conversation, or
  • Effectively communicated with potential residents and families the additional benefits from a coherent suite of assisted living options.

We find that consumer trust is established from the very first interaction by providing detailed, clear and transparent information. We know one provider that endeavours to understand consumers’ needs, wants and requirements and suggests services accordingly which is crucial to making the assisted living model successful.

It is important to cater to the changing care needs of consumers by undertaking regular health assessment of residents and monitoring care plans.

Operators offering the three levels of accommodation and care – independent, living-assisted and living-residential aged care – on one campus are well placed if a resident’s care needs become high and provide a value proposition for conversations with potential residents and families.

Designing an assisted living offering

For operators planning to offer fee-for-service assisted living private packages, some design elements for consideration include:

Location and target audience: What location and what customer segment?

  • In-depth primary and secondary market and customer research are crucial to gain a deep understanding of the markets, residents’ behaviours, motivations, attitudes, needs and wants. This will assist in developing an offering which responds to residents’ needs and expectations.

The offering: What assistance and care services are delivered and in what environment?

  • Should they be tiered private packages covering the assistance and lower care spectrum or limited by hours?
  • Explicit service lists with options?
  • Technology – what to employ – movement sensors, virtual reality?
  • Apartment mix, sizing, concentrated or spread across independent living?

Pricing:

  • Mandatory base package pricing?
  • What is the pricing structure that would be competitive in the market?
  • Pay as you go?
  • Offset funding from government home care packages against the private packages?
  • Explicit, transparent and fair – not shrouded by accommodation costs (such as accelerated, punitive deferred management fees)?

Customer sales conversations:

  • Ask the right questions at the first customer interaction to gain critical insights and not just address the real estate transaction.
  • Clear, transparent and detailed information including resident contracts to be shared up-front.
  • Is there seamless, priority entry if there is co-located residential aged care?

StewartBrown’s recent financial survey revealed average residential aged care and daily living funding in the order of $84,000 per annum, indicating the average resident is high care status. The days of the hostel solution for low level care is thus long gone. Combined with long waiting lists and income tested fees for government funded home care packages, there is an opportunity for clever operators of seniors’ communities to fill the service gap with carefully structured, value for money fee-for-service assisted living packages.

Safdar Ali is the director and founder of The Ageing Equation, a consultancy specialising in quantitative and qualitative market catchment studies to support business cases for independent living, assisted living and residential aged care developments.

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