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We can have the aged care we need: opinion


More than 16,000 elderly people died waiting for home care in 2017-18. We can and must do better, writes Dr Olivia Ball. 

The aged care royal commission in Mildura this week focused on the experience of informal and unpaid carers of elderly people in our community – most often partners and daughters.

It heard from family members frustrated and at times devastated by caring for ageing loved ones without adequate support. And people assessed by professionals as needing home care are dying as they wait for assistance.

Dr Olivia Ball

Barbara McPhee from NSW told the public hearing that she got a call from the Commonwealth Home Support Program saying her mother had finally reached the top of the waiting list – 14 months after her mother had died.

It’s clear from this week’s evidence and the data that Australia’s system of home care is failing them.

The federal government chooses not to provide enough home care packages for the number of people who need them. It could and should choose otherwise. Older Australians and their carers need urgent action to make home care services available and affordable when they’re needed.

The media tends to focus almost entirely on residential aged care, when in fact the great majority of aged care is support provided to people who are living in their own home. And that is a good thing.

Most of us want to age in place at home and avoid going into residential care for as long as possible or at all. That outcome is the “very strong preference” of most older Australians, according to the royal commission, and from a public policy perspective, supporting people to age in place is far less expensive than 24-hour residential care.

Home care services support people to remain living safely at home and, importantly, they also help older people maintain their social connections, with home visits, support to get out and attend group activities, and assistance with online communication.

Withholding home care support by arbitrarily capping the number of packages available risks the health and safety of vulnerable elderly people.

They are more likely to fall waiting for a grab rail to be installed or while struggling to do their own cleaning; they are at risk of harm from not taking medications correctly, less able to eat well if they have trouble shopping and are more likely to be lonely and isolated without social support.

And home care helps keep people out of residential care. Delays in providing home care increase the likelihood someone will have to give up their home and independence and move into costly residential care.

The latest government data show there are over 93,000 people receiving home care and a further 75,000 people needing and waiting for it. The shortfall is huge.

The government is cagey about waiting times, but people assessed as needing care wait months for any in-home support to commence, before waiting an average of “12+ months” more for the level of care they need. The royal commission has heard that people assessed at the lowest level wait an average of 22 months.

In the 2017-18 financial year, more than 16,000 people in the queue died waiting, the royal commission heard.

There are real limits to the number of home care packages we can have in Australia and they are not budgetary.

The real constraints on the amount of home care we can have – and the amount of healthcare, residential care, dementia care, mental healthcare and palliative care we can have – are the number of doctors, geriatricians, nurses, personal care workers, gardeners, cleaners, cooks, podiatrists, psychologists and other allied health professionals we have in Australia and can train for our future.

We must expect more of our government. We do not have to accept substandard care. Our goal as a society should be to provide the care we need when we need it. Not 14 months after our loved one has passed away.

We ought to redefine fiscal responsibility as spending to meet community need. There is no excuse for $158 billion of tax cuts when our elderly are dying in need of adequate care.

Dr Olivia Ball is a policy adviser at Victorian aged care provider Benetas and a specialist in human rights.

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11 Responses to We can have the aged care we need: opinion

  1. Susan Hayes August 2, 2019 at 12:43 pm #

    I left the second year of a job sponsored University Degree Course I was nearly through, to care for my mother. I now find I am in the waiting line for my own Home Care package and my Grandson is helping me at home. This is not fair when my husband who is in a wheelchair gets all the help he needs from his NDIS package funding. Not that I resent the NDIS for our disabled getting the assistance needed to improve their lives, I worked with them for over 20 years I know it was long overdue. It does frustrate me that since my mum’s death in 2002 nothing has been done to improve the system for aged care at home. It is hard to understand why a system can be established for the disabled virtually overnight and yet the old system for caring for the aged at home is still stuck on capped numbers of Aged Care Packages way behind the demand after assessments have been carried out. During this time of waiting, aged people do not stay at the same physical condition as when first assessed. There are 4 levels of packages apparently to be assessed for the 4th level you have to be on death’s door So a person assessed on Level 3 by the time they reach the time to receive the package (if still alive) would actually be in a lot worse health and disabled position than when first assessed.

  2. MIM August 2, 2019 at 4:09 pm #

    An excellent article. A focus on fiscal responsibility that ignores the well-being of the elderly is irresponsible at best. Private affluence achieved at the cost of public squalor is false economy; it detracts from the well-being of us all.

  3. Anton Hutchinson August 2, 2019 at 5:08 pm #

    What a lot of nonsense. Besides the outrageous cost of Home care it simply doesn’t and cannot provide adequate hours of care to enable many people to remain in their homes. If a person was told that we could provide 6-8hours a week for cleaning etc and it would come out of their own pocket they would say No Way!!
    When did society decide it was taxpayers that should pay for your parents cleaning or gardening?
    Family should look after aged parents as they always have previously. What happened to the grandkids going to see grand and mowing the lawn? That is real care and you don’t get that from having strangers pop in.
    Home care as a system is simply unsustainable and families should get off their lazy bums and take care of their own!

  4. Joanne August 2, 2019 at 5:45 pm #

    I totally agree. I am a professional working a full time job and wanted to help the elderly. I have been studying a dual Cert III and Cert Iv in aged care online and will finish this month. I am hoping to contribute on weekends.

    To attract more people to a nursing career the pay needs to be better so Nurses can live and be paid in recognition of their skills. It took me to spend 3 weeks work placement to truly recognise the knowledge, skills and hard work of the nursing staff. It was hard, fast paced and comes with heavy responsibility’s.

    The government has to wake up!

    Nothing worse than offering services you can’t deliver.

  5. Sue smith August 2, 2019 at 9:25 pm #

    I am watching the enquire with interest as I believe I be left alone to manage my own life I am 75yaers old

  6. Caroline August 6, 2019 at 10:59 pm #

    YES – we can have the aged care we need but there are just too many barriers that stop effective care and at the right time. As an example, if psychological support services is going to be funded in residential care, then we need to make it equally available to older people at risk living in community. The argument is that people in community can access PSS but that’s not always true as there are access and cost barriers.

    We need Government to talk to more than academics, national advocates and providers. We need broader conversations that include a diversity of voices. This is one space where passionate people comment.

    My mother passed away just 2 weeks ago. Her L2 HCP, allocated in Oct 2018, was inadequate for her needs when diagnosed with advanced cancer in the last 6 months. She wanted to remain at home but went on to respite care (at cost) and then palliative care. We have a system that is not responsive to changing needs. The system needs to change!

  7. Ted Wards August 8, 2019 at 11:01 am #

    As someone who has recently lost a parent I can say that until a politician experiences this first hand not much will change. The government is great at talk but when it comes to actions…well their actions speak louder that their words!

  8. Caring Son August 8, 2019 at 11:17 am #

    Lets keep Home Care Packages for people who need case management and just provide services to the rest to meet their needs. Home Care Packages once the fee’s are deducted don’t provide the services needed to support the person to remain at home.

    My mother under CHSP has one day of Social Support per week and one hour of Domestic Assistance per fortnight.
    She suffered a crush fracture of her lower spine and this required her to need Personal Care three times a week.
    Her CHSP provider said this was to much service and so referred her for an ACAS assessment with the view to obtaining a Home Care Package.

    The ACAS Assessor said she would recommended a level 2 HCP. When I converted this to hours of service it would provide once management fee’s were removed it would not pay for her current services. When I raised this with the Assessor she said she would have to give up some services or pay full cost recovery for them. This would result in her having to give up Social Support, the one outing she has each week.

    If CHSP just provided the services my mother needs it would cost much less than the cost of a level 2 HCP. Once her crush fractures have resolved she will be able to discontinue the Personal Care and allow those funds to be used by someone else where as if she was on a HCP these unspent funds would continue to accumulate in her package.

  9. Ruth Hosking August 8, 2019 at 1:24 pm #

    The Home Care Package scheme urgently needs either increased Government funding or the available funding being allocated to those folk who cannot afford to engage private services. The present method of allocating packages, including people being given 56 days to decide whether or not to accept the HCP offer is ridiculous.

    The shortage of HCPs is adding to the basic care needs, Community Home Support Scheme , as clients appreciate having some help. Where do those who cannot enter CHSP go for assistance ?

  10. Anon August 8, 2019 at 1:55 pm #

    Unfortunately Caring Son, CHSP services are entry level services and are not designed to be for more than an hour or so a week.

    CHSP are ‘bucket funded’ for all customers and are designed to drip feed a little bit of service to as many people as possible.

    Unfortunately CHSP is the bandaid for the national queue as well!

    Being ‘bucket funded’ means all of the costs to delivering your mothers services (such as rostering staff to deliver the service, their training, managing the funding, managing care plans and assessments etc) are taken out of the bucket and therefore are invisible to you. The reason why it is cheaper for your mother is that the funding is not seen by you (or allocated to your mother only)

    Under a home care package the bucket is much much smaller and contains only your mothers funding package. So the costs of delivering her services comes wholly and solely out of your mothers funding bucket – there is no other source of income to manage the service.

    Perhaps if the service was only required short term your mother could consider paying for her own services instead of requiring subsidised ones?

  11. Gael Walsh August 15, 2019 at 7:48 am #

    I see this all the time in my line of work as a Palliative Care Social Worker. One needs to think of Palliative patients who want to die at home but these cohort of older people do not get access to packages of care at all. The government should consider separate funding for packages of care for palliative patients, as the services and timeframes waiting for in-home supports is hugely inadequate.

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