We need to enable independence for seniors
Older people should be able to dip in and out of home care programs and services as needed, writes Professor Tracy Comans.
As we age, the desire to remain functional and independent in our own homes becomes increasingly important. Everyone would like the opportunity to continue living in familiar surroundings in the way that they want.
The government provides financial support to help older people meet these goals. The Home Care Package Program and community home support programs provide funding for services that can allow people to keep living at home.
By some measures they have been quite successful. There are now fewer older people living in residential care as a proportion than in previous decades. In 2010, for every 1,000 people over 70 there were 86.8 places in residential care. By 2021, this figure had dropped to 74.2. More people are living at home longer than ever before.
However, while there has been clear advancement, I have been involved in several research studies that show home care may not be operating as efficiently and effectively as it could be, hindering the speed at which progress is made.
Home care services can be split into two categories: services for – such as cleaning and collecting the shopping – and services with, like physio and occupational therapy so the person can continue to do their own activities of daily living and shopping with someone supporting them.
When it comes to packaged care, services for are more likely to be offered by providers and taken up by older people. Of the four levels of Home Care Packages people can qualify for, this is particularly so with package levels 1 and 2.
Once gardening and cleaning are paid for, there are little to no funds left over. This means people are missing out on allied health and nursing services that may help them improve their functional ability and reduce the need to move to higher level packages or prematurely enter residential care.
A recent study, which I participated in, led by Professor Yun-Hee Jeon at University of Sydney compared the outcomes for 20,980 Veteran’s Affairs community nursing recipients with matched Home Care Package Program recipients.
The Veteran’s program is nurse led and allows people to dip in and out, having bursts of therapy or help when needed, and ceasing services when they are well. In comparison, the HCP program tends to be more rigid. Services are provided on a set, regular basis, and rarely changed.
As a result, people using HCPs continue getting support when they may not currently need it or alternatively can’t scale services up easily when needed. It is not practical to cease the package or reduce the level once set up due to the cost and time it takes to reinstate a package.
It’s incumbent on all of us as a society to ensure that our tax dollars are being spent in a way that maximises the benefit to the most people and reduces waste
We found that people receiving the VCN program had a lower risk of admission to residential care and an overall lower risk of mortality over a five-year period. The cost savings, largely driven by the difference in residential care costs, amounted to around $1 billion.
It’s incumbent on all of us as a society to ensure that our tax dollars are being spent in a way that maximises the benefit to the most people and reduces waste. Often there is a tension between people demanding more of government in expanding services and the cost that this presents to the budget bottom line.
Providing more flexible options for home care with an emphasis on reablement and services with is likely to have substantial benefits. Older people should be able to dip in and out of the programs as needed. Reforming the way we deliver care at home could have the dual benefit of improving the quality of life of people receiving care and reducing costs to the government. This is something we can all get on board with.
Professor Tracy Comans is director of the National Ageing Research Institute
We hope you enjoyed this article – please add your comments below
Visit our features portal for more in-depth stories
My comments come from a brief background of working with war widows who, with a Gold Card, had access to DVA Home Services. I remember investigating the types of services a particular group of widows accessed, and was not surprised that a very small proportion of people chose a HCP. The service options under DVA aged care services including VHC, community nursing and residential respite seems to outweigh HCP especially on L1 or L2. Access to a HCP possibly means losing access to DVA funded community services. So from a service perspective, war widows are better serviced on DVA aged care than on a HCP. And from a cost perspective, war widows are possibly better off as DVA funded services aren’t means tested, to the best of my knowledge, and offer a low fee for standard services.
DVA aged care services is definitely flexible but HCP can be flexible if older people and their carers are educated about its flexibility. Clients can change the frequency and type of services but flexibility may be a challenge from a workforce and business perspective. Maybe there needs to be a cultural shift in understanding HCP. Maybe the upcoming Support at Home will offer flexibility.
Sure, we need to support people to continue living in their preferred home but independent? Typically people, as they age, lose aspects of their capacity to do the things they once did. The term, independent is a fallacy as no one is truly independent. We are interdependent beings so one’s capacity to live at home as we get older is linked to variable supports including reablement services. One less talked about service to support ‘independence’ is counselling which is critical in supporting people’s wellbeing and their capacity to accept services. Counselling is not a long term service, and like some allied health options, is a good short term support service.