Indigenous aged care – towards better policy

Two closely linked research reports have found the government’s planning ratio for indigenous people too simplistic, and that it has not worked as intended.

By Stephen Easton

Recently published research suggests the aged care planning policy used by the Department of Health and Ageing to provide Indigenous Australians with a fair share of resources is based on a problematic assumption and has not worked as intended.

One paper, published recently in Australian Health Review, casts doubt on the rationale behind the target ratio of 113 aged care places per 1000 Indigenous Australians aged over 50, which is based on the simplistic idea that Indigenous people age prematurely.

“Only some conditions associated with ageing appear to affect Indigenous people earlier than other Australians and the construct of ‘early ageing’ based on this explanatory framework is uncertain,” the researchers conclude.

The team, which included researchers from Charles Darwin University, the University of Melbourne and the Australian National University, also suggested that while more research is needed, a more evidence-based approach to aged care planning would take into account the higher prevalence of preventable chronic diseases among middle-aged Indigenous Australians, but not assume they become ‘old’ once they turn 50.

“Indigenous people in their fifties are not old,” the paper states. “A decline into dependence at this age is not inevitable. … The lower age criteria may [also] contribute to the stereotyping of this group as passive and irreversibly reliant on care.”

A second paper by the same research team, published in the Australasian Journal on Ageing, found that the policy of using Indigenous people aged over 50 as a target population for aged care funding has not been effective.

“While seemingly sympathetic to Indigenous people’s excess burden of disability, [the policy] has not increased the share of resources across the whole target population,” it concludes.

“The existing planning framework has not achieved its aims in regard to the Indigenous population; it has not ensured equitable distribution of services across jurisdictions and remoteness areas and has not set the right balance between different levels of care, particularly the need for more community-based care options.”

“Our findings suggest that Australia’s aged care policy should target the Indigenous population differently to other Australians, but not based on a simplistic age criterion alone.”

The coordinator of the interdisciplinary research team, Philippa Cotter, stressed that the planning ratio cut-off age was not used to determine any individual person’s eligibility for aged care services, but could still reinforce negative stereotypes.

“It’s not an eligibility criterion, but in some communities [it is seen] that way,” Ms Cotter said. “For example, it may be seen as normal that you turn 50 and you sign up to get your meals on wheels.”

Ms Cotter said that the policy, developed during the Hawke government in the mid 1980s and based on well-intentioned social justice values, was designed to create equity in recognition of the lower life expectancy among people of aboriginal and Torres Strait islander descent.

“With small numbers of Indigenous people aged over 70, they would not have got much aged care funding otherwise. But the choice of age 50 was fairly arbitrary, as is the age of 70 [for non-Indigenous people].

“Our thoughts are that it can reinforce some negative stereotypes. Your readers would know that even [knowing about] the age criteria of 70 can have a homogenising effect; suddenly everyone over 70 gets bundled together.”

Ms Cotter said the study suggested a new policy should avoid age as a simple criteria and use a more complex approach, based on numbers of people with a certain level of disability, for example, but that more research would be needed to develop one.

“Building on local planning and making sure good quality assessment is used would be a really good direction. But we should also ask why aboriginal life expectancy is lower, and that’s due to a complex interplay between socioeconomic, health, social and geographical factors.”

The research team concluded that a different approach would not change who provides aged care to Indigenous people, but “should make more explicit links between community care and other Indigenous chronic disease policy and services such as primary health care, rehabilitation and housing”.

“Indigenous people do not need less services or resources, but do need these to be better targeted,” the authors stressed.

According to Ms Cotter, the Productivity Commission (PC) had access to the team’s research last year when it developed its recommendation to switch from a capped number of aged care places to universal entitlement for all Australians over retirement age (65), but was unable to reference it in its aged care report because it had not been published.

The PC’s aged care report recommended that Indigenous people aged 50-64 also be eligible for aged care entitlements, but also considered that “the age limit for Indigenous Australians should be reviewed if evidence becomes available which suggests that the current age limit is no longer appropriate”.

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