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Opinion: Housing is the missing piece in the reform puzzle

The looming problem of whether Australia’s housing stock is fit to enable older people and people with disability to age in place demands new leadership, writes Michael Bleasdale.

As we move further into aged care reform it is clear that the changes taking place in the provision of support and care will be profoundly different to what has been on offer in the past. The restorative principles of wellness and reablement place the ongoing capacity of the individual at the heart of care plans and support arrangements, and consumer directed care makes service providers accountable for the quality of the support they provide and the style of interaction they adopt with their clients.

However, perhaps the most significant element of the shift in approach in aged care is that it will primarily be delivered in the person’s home, with significantly more resources focused on support to keep people out of residential care. Whilst much of the focus of reform has been on the way that services need to change in order to deliver supports in the home, not enough attention has been paid to the nature and suitability of the home itself.

The home environment will be critical to the success of aged care and other strategies, such as the National Disability Insurance Scheme (NDIS), which aim to provide individuals with the support they need to access or remain in regular housing in the community. Health policy is also moving toward diverting people away from hospital as much as possible, and looking to provide diagnostic and other preventative and ongoing treatment within the home. This places a significant responsibility upon regular Australian housing to deliver not only the optimal functioning environment for people to live in, but also to operate as a place where a significant number of health and social services are performed.

Given this imperative, it is the view of Home Modifications Australia (MOD.A) that there needs to be more scrutiny on the state of the Australian housing stock. The change from HACC to the Commonwealth Home Support Programme (CHSP) at the start of November 2015, together with the changes brought about by the My Aged Care (MAC) system in July, have altered the client experience of the home-based support system, but has not addressed the looming problem of whether or not current properties are up to the task of enabling older people to age in place, and to receive the supports they require to do so.

Housing suitability

Australia has a high percentage of home ownership, 67.5 per cent according to the 2011 census. However, this figure is falling as the cost of housing becomes out of the reach of many people in the workforce.

As a result, government policy plays little role in determining the functionality of the housing that is built and lived in.

Whilst the National Construction Code may stipulate that standards of building be followed, and offer a line of appeal should this not occur, there is nothing which determines the suitability of housing for the purpose it is intended, in this case, enabling people to age in place, or providing suitably accessible homes for people with disability.

The need to provide regular housing for people with mobility impairments places scrutiny on how we manage the housing stock in Australia. Firstly, there are little data available to indicate the quality of housing and whether it is fit to enable people to function independently as they age and/or their mobility declines. In 2011, a study of older people and people with disability in Victoria carried out by Department of Human Service and Archicentre, indicated that 31 per cent of the households which it inspected would require some modification if people were to remain living there safely and independently. It has long been established that for people with disability the design and construction of housing represents a significant barrier to their participation in community life. As people live longer and experience age-related mobility and sensory impairments, the more likely it will be that poor design, construction and maintenance of homes will have a negative impact on their safety and ability to function without assistance.

Secondly, although this is clearly an issue of housing supply there is no one arm of government in Australia which is charged with monitoring and addressing the readiness or capacity of the housing stock to meet these needs. Availability of suitably accessible housing has become part of the discussion about affordable housing and alleviating homelessness. However, the primary responsibility for supply falls to states and territories, and being limited in the main to social and community housing, this means that we need new leadership, preferably at the level of the Commonwealth, to coordinate the challenge of making our housing stock fit for the purpose these new policies require.

We have currently a voluntary agreement to build all new housing to Livable Housing design standards from 2020 with slow progress being made toward this. But given that new housing represents between 1.5-2 per cent of the stock each year, we also need leadership and strategies to retrofit existing housing to enable people to take advantage of the good designs and products which will enable them to enjoy living in their houses as they age.

OT imageWhat is needed?

Clearly leadership is required to address a significant housing issue, and this needs to take place at the Commonwealth level, across government departments and between levels of government.

Up until now we have been concerned with getting the administrative changes of MAC and CHSP in place and operational, but there needs to be a greater focus in future on the quality and coverage of supply of home modifications.

Current providers have a wealth of knowledge and expertise, and the growth in the diversity of need which will accompany the growth in the ageing population will require the adoption of new techniques to meet new challenges, and a system which will make this available as and where it is required. We need to look at supply issues in home modifications, particularly where innovation and new clients are concerned.

Future reform in aged care seems destined to remove home modifications and other service types from specific programs, and instead make them accessible to individuals who require them as part of packages of care. The home modifications industry is concerned that the extension of current package arrangements may serve to make clients choose between having important modifications done, or receiving the ongoing support that they need. Given the noted benefits of home modifications and their capacity to reduce or negate the need for ongoing services, MOD.A is of the view that they should be available to people outside of (and before) the allocation of an individual package. The recent consultation about the Short Term Restorative Care (STRC) program has highlighted how interventions up front may divert need away from ongoing support. The STRC in its current form would not be suitable for funding all home modifications, but early intervention would appear a sensible approach to adopt for home modifications as we move toward the amalgamation of home-based programs in 2018.

MOD.A continues to work with its members and its stakeholders to share innovation, establish quality standards for the industry, and to increase the levels of skills attainment for occupational therapists and builders and tradespeople. We are also aiming to work closely with government on the best administrative system for home modifications, and possibilities for funding, including tax incentives for individuals and partnerships with industry to guarantee this important work into the future. We are fortunate to have the Home Modification Information Clearing House at UNSW, which has been established for 10 years and serves as an excellent resource for the industry. MOD.A will be holding its inaugural conference as Home Modifications Australia in Canberra on 28 and 29 April, 2016.

Michael Bleasdale is chief executive officer of Home Modifications Australia (MOD.A), the national peak body for home modification providers. For more information visit: www.nswhmms.org.au. References used in this article are available upon request.

This article appears in the current edition of Community Care Review magazine (November 2015 issue).

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