Aged care in Australia
25 June 2020 at 5:26 pm
There is an enormous demand for aged care services in rural and remote areas, but the market is failing. It is up to our communities and civil society to work together on the solutions, writes Community Sector Banking CEO Andrew Cairns.
Australia’s population is aging and nowhere more than in rural and remote areas. According to the Australian Bureau of Statistics, 40 per cent of those between 70 and 74 years of age live outside capital cities, compared to only 25 per cent of Australians aged 25 to 29. The Australian Institute of Health and Welfare finds that older people in rural areas are more likely to have lower incomes, greater levels of disability and poorer quality housing.
All of these factors combined create an enormous demand for aged care services in rural and remote areas. Where there is high demand for services you would expect the market to generate the necessary supply to meet the demand, however the market is failing. Due to operational challenges that come from running an organisation in regional and rural areas, for-profit providers are opting out of these locations.
Aged care providers in rural areas are faced with the high cost of attracting and retaining qualified staff, a higher cost of travel and shipments of supplies and reduced access to allied health professionals. Despite the demand, the market can become commercially unattractive for providers due to these challenges.
As a result, government and not-for-profit organisations provide the vast majority of aged care services in rural and remote Australia. In order to be viable, even without a focus on profit, providers are still forced to pass on the high cost of operation to consumers. This high cost results in older people who are in need of aged care being faced with choice, access and affordability challenges.
The Royal Commission into Aged Care Quality and Safety recently released its interim report, which found that many older Australians were neglected and forced to live in unkind and uncaring conditions. It has also been reported that more than 104,000 older Australians are waiting months for home care packages to be approved and even longer for the approved packages to be delivered.
Once an older person is deemed eligible, they must wait before a package of services is “assigned” to them and then must find a service provider to deliver them the care. These early steps in the process to access home care are particularly challenging and can take a very long time. As seen in media reports, these delays result in some people who are in need of higher levels of care and support passing away while waiting for care to be approved. These wait times would be considered unacceptable in any other system or service and should not be considered acceptable for older Australians who are seeking support and care services.
In response to the interim report findings, the Commonwealth government announced $500 million in additional funding to the sector and an additional 10,000 home care packages. While this funding was clearly necessary and welcome, it is not a solution to the challenges of providing aged care in rural and remote areas or ensuring older Australians receive care and support in a timely manner.
It’s evident the government needs to review the application and approval process for home care packages to ensure older Australians face minimal challenges in accessing affordable care services and are better placed to access these services when they are needed.
Though the additional funding announced for the sector fell short of a commitment to make a very significant and ongoing investment in rural support services for older Australians, it’s through collaboration and innovation that we may find a solution.
If we can get support services to work together in partnership, there is scope for them to share infrastructure and resource costs. They could even share staff and improve access to allied health support if they embraced the use of a flexible workforce, combining local and outreach services. Through collaboration, service providers can also share information and strive for best practice outcomes.
Some overseas models have used the construction of cluster-style housing that gives operators the ability to provide services at scale in the community. This could be complemented by an expanded use of telehealth and tele-monitoring services, which may make it easier for older Australians to live safely in their own homes for longer. Research from Flinders University found residents in aged care facilities that accommodate them in this cluster-style housing rate quality of care high.
In extreme cases, particularly when someone is in a very remote location and finding home care support is difficult, it may be worth considering if it might be appropriate to pay family members to care for someone in a home setting. While government might think this type of home care is expected, modern demands on families including full time work, employer attitudes and childcare responsibilities, make it difficult for people to provide care for elderly relatives.
All options need to be on the table because the current situation is not tenable in a country that believes in giving everyone a fair go. It is not fair for any Australian to be left without adequate support, care and dignity in their old age. We may be a large country but we can overcome the tyranny of distance if our communities and civil society work together on the solutions.