Poor public awareness about the aged care reforms has affected the implementation of the changes and impeded seniors’ capacity to make informed decisions, a Productivity Commission report concludes.
A survey of 1,524 Australians aged 60 and over conducted for the PC’s Housing Decisions of Older Australians report, which was released yesterday, found “low awareness” of the reforms.
Just 20 per cent of respondents were aware of the aged care reforms, and a similar proportion felt they were well informed about the costs associated with moving into residential aged care, the survey found. Fewer than 10 per cent of respondents felt they were well informed about government-funded services to assist them in their own homes.
The PC said that “a natural consequence” of the reforms that gave seniors greater control and choice over their accommodation and aged care was “increased complexity for consumers.” Yet in giving evidence to the review, stakeholders argued that the consultations and provision of information around the reforms had focused more on aged care providers than consumers.
While the PC acknowledged that information provision and overall transparency for consumers was improving through the establishment of My Aged Care, it recommended that the type and efficacy of communications to seniors regarding their housing and care options “need to be considered by the Australian Government as reform implementation continues in the aged care sector.”
The PC’s criticisms follow those of Aged Care Financing Authority chair Lynda O’Grady who recently said that the communication to consumers around the changes to aged care, and the rationale behind them, had been poor.
“We missed out on great opportunity to herald the positive changes for the public at large, and to deliver communications that celebrated the improved value to the new consumers with clear content and delivered with the right tone,” Ms O’Grady said in mid-October.
Call to expand means testing
Elsewhere in its wide-ranging paper, the PC proposed further increases in consumer co-contributions for both home care and residential care.
The commission said there was “a strong case” for including more of the value of the family home in the means test for residential aged care, beyond the current $158,000 cap.
“Since residential care is typically the final place of accommodation in a person’s life, the family home is no longer an accommodation option, nor a vehicle for precautionary saving. The likely primary motivation for retaining the home in such situations is for bequests, and the current arrangements are effectively a subsidy for this preference,” it said.
Similarly, it noted that the means testing for home care services currently only covered income and a “more comprehensive means test that incorporates assets” would better align it with people’s capacity to pay.
“The arrangement where those with relatively high levels of assets are not under any obligation to use them to finance home care is inequitable,” the PC said.
Unfinished business from 2011
The PC noted that several recommendations from its 2011 inquiry into aged care had not been adopted, and it again argued the case for more structural reform to the system, such as freeing up the supply of aged care places.
The report said:
“There are also still tight and inflexible controls on the supply of residential aged care places… The current arrangements are intended to provide for equitable access to services and to manage the Commonwealth’s fiscal risk.
“However, they also restrict competition, protect legacy and ill-suited stock, reduce incentives for innovation, and restrict the capacity of the supply side to respond to structural and demographic changes in demand (for example, through transferring or trading places between providers).”
While some form of rationing of government support for aged care remained necessary, “the form and extent of it can clearly be improved.”
The PC suggested moving the main rationing mechanism from the supply to demand side, whereby “prospective aged care recipients undergo an extensive needs assessment to establish eligibility and level of service they will receive.”
The commission also noted its 2011 recommendation for consumer directed care to extend into residential aged care had not been progressed, and it again proposed greater government involvement in the home equity release market.
Accommodation policies fragmented
The PC noted the numerous reviews, including this year’s Senate inquiry into housing affordability, that provided evidence of the greater risks facing older people who were renting – such as poverty, homelessness and reduced mental health and wellbeing.
An increasing proportion of seniors were moving into retirement villages and manufactured home estates, but the security of tenure and financial arrangements in place varied across jurisdictions, it found.
Echoing numerous other research findings, including the most recent report from National Seniors, the PC said that the policies that affect older Australians’ housing decisions were “very fragmented, and there is no strategy that recognises the spectrum of choices, and their effects on aged care services.”
State and local planning systems created barriers to expansion and innovation in both mainstream and age-specific housing, it said.
“Operators of retirement villages and aged care services reported significant red tape in dealing with planning and development approvals, both for new facilities and for modification and redevelopment of existing outdated stock,” it said.
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As always, LASA is supportive of the reform process but it needs to be viewed through the prism of the true consumer and their family, not paid ‘professional’ consumers who purport to represent this cohort who we hear (and we know as providers) are lacking support, knowledge and understanding. Much funding, including to projects that LASA has been a tangential partner such as http://www.homecaretoday.org.au/, has been thrown to consumer groups who now appear to have little real cut through to inform the true age service consumer market. To be even handed we too still have work to do to reach many providers in a more timely and meaningful way – but we haven’t had scads of money, in fact none – from government to do this work.
It is important that all stakeholders with a consumer facing operation are supported in providing pathways for understanding the system that unfortunately has become more complex than less through this reform process. Nobody wants long living Australians to fall through the cracks and hopefully the oiling of squeaky wheels through directed funding will end and merit will be the basis in future for providing education, training and information programs to consumers and providers alike.
This confirms my view that the assumptions underpinning the positioning of older people as ‘consumers’ in the aged care reforms is problematic. For people to act as ‘consumers’ they need power, information and knowledge. Many older people and their allies enter the aged care system at a point of crisis with little information and the system often does not support them to make informed choices.
Policy reforms should be thinking about older people as ‘citizens’ and how to engage older people in the reform process. This could then focus on the rights of older people to build connections and relationships and the social connections that will support people to age well in their community.
The aged care reform process is important, but let’s not lose sight of the excellent analysis the PC has done about housing decisions. They have shown how complex the issue is, and how difficult it is for older people to get accurate information about housing options as well as care. Planning systems at State and local levels make it very difficult to provide suitable age specific housing alternatives for those who do wish to downsize. The report has detailed information about equity release products (‘reverse mortgages’) for those who want to supplement their income, or pay for home modifications or care. The plight of renters is not forgotten, and they need an expansion of government funding for social and affordable rentals. It is worth reading at least the overview section of the lengthy report to grasp the interconnectedness and complexity of housing decisions as we grow older.
I think this article is an excellent illustration of a core problem. The Productivity Commission describes the consequences of the way policy decisions are made and then provides us with a good example of why that happened.
Aged care policy is being made within the context of late 20th century thinking long after its flaws have been identified and its failures recognised. The reasons are not being confronted so the same mistakes are repeated.
Governments are elected on broad policies in which they believe – policies that are often ill suited to individual situations. They consult stakeholders they see as credible because they hold similar views. They have delegated decisions to Inquiries and Productivity Commissions drawn from the same limited pool of citizens.
These solutions are then marketed to the whole community as if they were selling a commodity – then implemented. Government and market have largely taken over the running of the country and in doing so communities and civil society has been “hollowed out” – losing knowledge, skills, interest and involvement. This leads citizens to lose confidence in their ability and to disengage. Instead of engaging and questioning they accept the opinions of those who are presented to them as experts or worse still don’t register as it flows past in the stream of sound bites.
Democracy depends on an informed, inquiring and active civic society engaged with the issues of the day. Government benefits from the experience, knowledge and skills of their citizens, a resource that we have squandered.
There is now clear evidence that services to communities succeed when the citizens in those communities are involved in designing, introducing and operating the service. Importantly they need a measure of control over the services so that they own them – instead, they have been excluded and this makes failure much more likely.
A necessary condition for a market to work for society is informed and knowledgeable customers in a position to use their power to shape and control the way the market works. Without an effective customer, markets fail society and people are harmed. This has happened in several vulnerable markets. Calling vulnerable people ‘consumers’ does not change the fundamental dynamic of markets and the way they work when the necessary conditions are absent.
While our country has boasted of its leadership role, it has been sitting on its hands in regard to the international Open Government Partnership program that has started addressing these problems. It stands out starkly in a different colour on a map of the world that shows the progress of countries in committing to and actually introducing open government. It is at least 4 years behind and it is only now that deadlines are looming that it is hurriedly initiating some limited debate and reluctantly going through the motions.
Aged care has been a victim of what an insightful writer described as “the debris of the 20th century littering the 21st”.
Aged Care Crisis (ACC) is attempting to re-engage our broad community in the aged care debate, involve them in looking at the problems, learning more and then engaging in debate about how we can progress the situation that we now face.
I have opened that discussion on the ACC web site by suggesting a way in which citizens can be directly involved in aged care so increasing their knowledge and enabling them to address all of these issues in [Solving Aged Care]. The broad sweep of the developing 21st century thinking that supports this proposal can be found in [Part 4; Developments in social thought]. We invite those who can think outside the square and be innovative to bring their knowledge and their ideas – then contribute.
Forcing older Australians to sell their home to fund care costs is not consistent with providing care in their own home? Isn’t isolation a factor in this model?
Funding for Home Care is at the expense of residential facilities – how can it be more cost effective to fund individual plans rather than a facility that has economies of scale?
The government is clearly determined to erode concessions available to not-for-profit providers as it seeks to grow the aged care “market” preferring to give beds to “for profit” providers at the expense of smaller organisations operating within the community.
There just doesn’t seem to be any consistent message from the government or the PC in how the issues of aged care should be addressed and there is no “one size fits all” solution for these issues either.
If you want to empower older Australians with knowledge and information, you need to simplify how it all works!
It is far too complicated with too much emphasis on an internet “hub” that seldom works, is too difficult to navigate on the odd occasion it does work, and is not a suitable source of information for those that do not have internet access. Is it deliberate to keep people uninformed?
Seeking accommodation in times of crisis is not conducive to wandering around the internet and collecting information at leisure. The “process” of accessing aged care needs real live people at its hub!
People do want to stay in their homes as long as they can so there is merit in good home care. We agree that making it simple, flexible and responsive is essential. We want to put real people in the community in control of much of aged care including informing and assisting those who need care. Loneliness is something they would be well placed to address.