Aged Care Roadmap: what will aged care look like in a decade?

Providers should start preparing for a future where the traditional boundaries between home and residential care collapse and new models of care and accommodation emerge, sector leaders say.

Providers should start preparing for a future where the traditional boundaries between home and residential care collapse and new models of care and accommodation emerge, sector leaders say.

The chair of the Aged Care Sector Committee, David Tune said that the key long-term direction of the recently released Aged Care Roadmap was to create a single aged care system.

“The differences between home care and residential care should merge over time. It doesn’t mean that they will totally merge, but it will mean moving towards one system of aged care rather than two separate systems,” he told the Strategic Thinking for Choice and Control conference last week.

Nick Mersiades
Nick Mersiades

Nick Mersiades, director of aged care with Catholic Health Australia, said home care and residential care were terms that were “dreamt up in Canberra” but in 10 years’ time wouldn’t exist.

“It’ll just be places that you go to receive care,” Mr Mersiades told the event hosted by COTA Australia and Criterion.

Services provided where the client wants

The Aged Care Roadmap proposed that a person’s assessed aged care entitlements would be “service agnostic” and would be delivered in the setting of a person’s choosing. To facilitate this choice, a consumer would receive the same government contribution regardless of whether they were receiving care and support in their home or in a residential facility.

Mr Mersiades said these arrangements would create significant opportunities for innovation in service delivery and a shift away from a siloed approach to aged care.

Ian Yates, chief executive of COTA Australia, told the Sydney audience the separation of care and accommodation would open up a wide range of aged care housing options that would challenge traditional models of residential care.

Mr Tune said an integrated system would also create flexibility for consumers to move more seamlessly between services.

Radical change

Mr Tune said the directions outlined in the roadmap, which moved aged care towards a market-based, demand-driven system, were a “radical” set of changes and the risks to providers, consumers and government would need to be carefully managed.

Proposals such as the uncapping of aged care places and the freeing up of pricing would require detailed modelling of the impacts and careful consideration about the pace and sequencing of the changes.

While the market should be allowed to determine the “nature, location and quantity of services provided”, government would need to provide extra assistance “through higher subsidies or block funding for areas or groups where the market is unable to offer the required services,” Mr Tune said.

He said reablement also needed to be fostered as a service type and would be an important part of a more flexible aged care system.

Mr Mersiades said there was a risk that aged care reform would stall at the point of funding being held by consumers and government would not agree to end the rationing of places. However, he warned this would fall significantly short of achieving the goal of delivering consumers choice and control.

He said there were strong arguments in favour of removing rationing in home care first, before proceeding with residential care as part of the phased removal of supply caps.

Increasing user pays

Ian Yates
Ian Yates

Just as the sector built public acceptance for bonds in high care, Mr Mersiades said a similar exercise would need to take place on the role of user contributions in contributing to a sustainable aged care system.

“There will need to be a convincing case made to the community that there is a grand bargain between consumers and what they contribute; for increased contributions you get choice and control over services, that has to be part of the deal.”

Mr Yates said relying on consumer co-contributions for those with capacity as an increasing source of funding would ensure that older people with the least ability to pay would continue to be supported.

He said the changed political environment where funding will follow the consumer in home care from 2017 will put pressure on government to uncap supply. “Consumer ownership of places is going to start to focus attention on unmet need.”

Mr Mersiades said one of the most challenging areas in the roadmap was ensuring that consumers have the capacity to exercise informed choice so that the system could respond to their needs and preferences.

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Tags: Aged Care Roadmap, aged-care-sector-committee, cha, cota-australia, david-tune, ian-yates, nick-mersiades, policy,

6 thoughts on “Aged Care Roadmap: what will aged care look like in a decade?

  1. What will aged care look like in the future? Perhaps one way of responding to this question is to look at aged care today and the past 10 to 20 years.

    Following this perspective we would say that aged care, and I am talking about residential aged care here, is currently characterized by: rampant untreated pain, the over-use of psychotropic medication to manage behavioral displays, depression, loneliness, a high prevalence of delirium, untrained care staff – many who have English as a second language – who have little, if any, knowledge of dementia, mental illness, the principles of behavioral management and little hope of any recognized career in aged care, and a design of aged care facilities that pays little or no respect to providing homes for people with cognitive impairment to successfully navigate. Also, we might add, with these care homes getting larger and larger and accommodating more and more residents from disparate and divergent backgrounds.

    Now as for community dwellers I think we are seeing aged care being shaped by the current (and outmoded I would suggest) adherence to neo-liberal socio-economics, masquerading as choice and freedom. You know I always get nervous when governments say, “we have listened to the community and they want more control over their lives, more choice, more freedom, more independence”. I read this as saying “how can we divest ourselves form paying for these losers who are costing us money – I know, sell them the idea that they will be in control of their destinies – they love that sort of talk – then we can cut funding, close down programs, jettison workers and let the buggers fend for themselves. Who said social Darwinism is dead?”

    So, pretty much business as usual I think.

    Aint life grand.

    Oh yeah, and we really value our old people – such a store of wisdom and knowledge for us all to learn form.

  2. As long as ageing is seen as a medical problem we will never get a real solution that caters for everyone’s needs. Ageing is a natural process and how we handle it is a disgrace. As long as we have these so called experts focusing on the dollar instead of living life it will never improve. As long as the politicians don’t have to use the system or their families I guess we never will get a system that actually does more than spouts rhetoric! Its simple, life is to be lived, all of your life and sickness is not a natural part of ageing, but thats how society is set up, so someone can make a profit it out of it somehow.

  3. C’mon Tony, the last thing we need is an honest assessment of what it’s really like out there. Your insights are obviously drawn from actual experience…and that’s why you’ll never get a seat on the Aged Care Advisory Committee.

    The future of aged care should be shaped by people who have never actually cared for the frail elderly. We need a board full of CEOs, public servants and career bureaucrats to ensure things head in the opposite direction of reality.

    Where do they find these fantasy concepts? Person centered care doesn’t exist (show me a facility without a shower list or one that can serve breakfast any time of the day and prove me wrong). CDC? The assumption that high care residents will know exactly what they need and possess the ability to make complex and informed decisions about their care evidences a misunderstanding of the target market.

    The future of aged care will be decided at Very Serious Conferences where ‘industry leaders’ with furrowed brows rattle out the latest buzz phrase, ditch all the RNs and wrest financial governance away from anyone with a bigger stick than theirs.We’ll have just more of the same facilities, short-staffed with unskilled carers tending the dehydrated and disheveled.

    No need for concern…the experts have everything under control

  4. Residential clients are a very small portion of aged or disabled people – there is a huge number of aged people in the community either living alone, in retirement complexes or being cared by family and or friends. Many of these people have an extremely set idea of where they wish to live and how they wish to live their lives. Sometimes it is from a previous care experience or just an “independent” frame of mind, that influences their decision to remain at home (usually) rather than with others in a residential facility or with family. The majority of these people who wish to live at home have minimal financial prospects and or a “confused” mental disruption.

    Most statistics cited detail that the aging population will significantly increase in the next 5 – 10 years and that current service provision will not be able to sustain care services.

    With the latest reforms into aged care I am certain that service provision for aged people will actually be deficient within the next 2 years: services providers outside of residential facilities are being forced to employ minimally trained personnel to provide care without structure or purposeful information to clients and their families.

  5. Tony and Dave are spot on – what we need is advisory committees made up of people who actually deliver hands-on care, so that Treasurers, Ministers and policy makers can find out what really is happening to our residents.

    Anyone who provides hands-on aged care knows – the almighty dollar trumps quality care – and no-one at the top level has the intestinal fortitude to change that.

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