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Coronavirus highlights the strengths and weaknesses of aged care

Better than any consultant’s review, maybe even the royal commission, the coronavirus is highlighting the strengths and weaknesses of the current aged care system.

In the last month we have really appreciated that aged care is substantially resourced for all citizens, has globally recognised infection control, stands by vulnerable people in tough times, has unbelievably dedicated staff across the board, and will make extraordinary efforts in a crisis. And that’s pretty impressive.

But the virus has also exposed three significant weaknesses:

1) Occupancy is dropping in both residential and home care, suggesting that some older people don’t think it’s safe. Add to this that many have never really liked it, and they stop buying.

2) Visits and outings in residential care have stopped as part of the highly successful infection control, but this further reduces quality of life in a service model that’s already not very good at it.

3) All this is exposing that some of the sector has become too rigid or too leveraged to be able to respond to this pandemic event.

It appears that consumers may be pivoting faster than providers. They have been unnervingly quick to social distance from both residential and home care. We’ve seen a corresponding rapid uptake (21 per cent using technologies for the first time as a result of the virus) of alternative generic and specialist technologies that buy them bigger networks, communication, information, home deliveries, security, monitoring, socialisation, games, care and healthcare, combined with a renewed energy from the community to pitch in.

Growing our understanding of why some consumers have stopped buying and what they would prefer is the ‘coronavirus bonus’. We need this information quickly so that we can pivot the substantial aged care capacity to what consumers want. We are not starting from scratch here. Existing research (that we have largely ignored) tells us it’s likely to be more flexibility, more at home, more technology, more of how they’ve always lived, more joy, less of the aged care that was designed for their parents and grandparents.

Perhaps not surprisingly, providers aren’t seeing much bonus in the current situation. They’ve always valued quality of care over quality of life, and they aren’t really in the mood to hear that quality of life just got a whole lot worse. If there is a bonus, they say, it will be more funding to ensure survival of financially stressed providers.

Provider financial stress is caused by more than the increasing cost of coronavirus management. There is a real cost in containing infection well – staffing, cleaning, PPE, new technology, inefficiencies of isolated operations. We are told about $10/resident/day in both residential and home care. And this exceptional cost absolutely does need to be found in a sector with thin margins.

But the big financial stress is being caused by more consumers deciding not to buy, and that’s not the virus’s fault. It’s simply that more consumers don’t want what the providers are offering. That is a tough lesson for providers, because changing the current monolith is no nimble exercise, and some transition support will be needed.

What we don’t want is to use this time just to weed out the financially weak providers, we also want to weed out the inefficiencies of approach: over-servicing, inflexibility, low life-quality, non-inclusive care, no re-enablement, and the lack of imagination of what a maximised frail life could look like. Inefficiencies that far outweigh the inefficiencies of lack of scale. We will lose the biggest ‘virus opportunity’ if we think we have to choose between backing consumers’ pivoting preferences or backing provider financial strength as a way forward. We clearly need both, and the potent combination of the two is the only option we should settle for.

So, we need to be wary of the financially stronger providers who see the ‘virus opportunity’ as a way to achieve the consolidation they have always wanted. The argument goes like this. Larger providers have economies of scale, stronger balance sheets and better access to capital. This financial strength means they can better sustain in downturns and invest in strong governance and systems. This resource means they are better able to provide affordable care that older people want. This is all fine, but not if it favours providers to survive without changing their service models, and that’s what we’re seeing. That we’re landing the efficiencies of scale, but not the holy grail: the efficiencies of approach. And maybe we shouldn’t rush to euthanise the small providers until we know how much they embody these approach efficiencies.

The pivoting consumers don’t stand much chance in this game without strong intervention from government – first understanding modern elders, then procuring from the sector what these modern elders want.

This is really an exercise in the disruption of the current service models that providers are so attached to. We had pinned our hopes on the consumers demanding this, empowered through individualised budgets. More of a nudge than a disruption. Then the virus arrived…

Responding to disruption is not an exercise in consolidation. It’s an exercise in cooperation between consumers, providers, suppliers, universities and governments to design, build and test community and service prototypes that can imagine a maximised frail life. And that the consumers think are safer and less restrictive when the next pandemic arrives or this one hangs around.

Put simply, as an example, how could we build a residential facility that’s not a petri dish and lets people live the way they want to. Can’t imagine it? Well try some co-invention with consumers like Strathalbyn Aged Care did.

We have never seen so much cooperation to care for customers, staff and suppliers in other sectors, so why wouldn’t we also see this in aged care? Well, mostly because, as competitive as we are, we have all aligned with an ageist view of the world: that care quality matters, life quality doesn’t. This bond is strong and deep and has been very successful in resistance to change. But the virus is inviting us to align with what consumers want, what staff want to be empowered to do, what suppliers have in their kit bags, like we have never done before. Can providers pivot on this one as quickly as consumers have?

What we do next will set the scene for the next 10 years.

Mike Rungie specialises in the intersection between good lives and aged care. He is a member of a number of boards and committees including ACFA, Every Age Counts, Global Centre for Modern Ageing and GAP Productive Ageing Committee.

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