Integrated models of care that are embedded into local communities best meet the needs and preferences of seniors and carers, a report commissioned by the royal commission shows.

And innovative models of housing that integrate person-centred care could provide a “third sector” of aged care that warrants policy and research attention, according to the Royal Commission into Aged Care Quality and Safety’s seventh research paper.

The National Ageing Research Institute examined integrated models of care for older Australians in relation to health, social care, housing and accommodation to produce the report.

Dr Andrew Gilbert

Lead author Dr Andrew Gilbert said integrated care models that are community-focused work best because they are tailored to that local area.

Integrated care works with the available resources in a particular area, and looks at the current lines of communication and the gaps and it has to work with in that very local area, he said.

“And it has to work with the local population with what their needs are,” Dr Gilbert told Australian Ageing Agenda.

“When it’s not that, what ends up happening is decisions get made in a capital city by the top of the health department and it gets consumed with divisions between either the federal and the state departments, or there is the possibility that there is a kind of uniform policy that gets unveiled, which affects great care across all different areas,” he said.

On the need for integrated care models of care, Dr Gilbert said when people get older, they are more likely to have health concerns and need a range of supports.

But if services are fragmented rather then well-integrated older people can have issues accessing the services, he said.

“The various services that they access can be poorly integrated and not necessarily communicating with each other, and there can be complexities regarding their eligibility.

“It can [be] very difficult for people to manage and it also increases the likelihood that there will be medical errors, service duplication or poor communication between health professionals and aged care providers,” he said.

Innovative housing options

Dr Gilbert said there was opportunity for the government to invest more in housing options for older people that integrate services and communities of older people.  

“There is scope for government to recommit to supporting service integrated housing for older people, potentially by promoting or sponsoring co-housing developments and/or housing collocated with home care services,” the paper says.

The paper describes the service integrated housing model as sitting between community care and residential care. It can encompass retirement villages, independent living, assisted living, and extra care housing.

“What these models have in common is that the housing service, either directly or through external arrangements, supplies some form of support and care to residents in addition to providing housing,” it says.

It’s also a model that’s been largely ignored in favour of a competitive home care marketplace because it is assumed that home care clients have stable and sustainable housing and can make informed decisions, which is not always the case, the paper says.

The report says co-housing models, where older people can live in communities designed to meet age-specific needs, mutual care and support, can encourage social connectedness, reciprocal care, and engagement in community life.

The model can help older people remain financially and socially independent, and foster friendships and connections.

“We suggest there is scope for Government to promote and support the development of these facilities, through co-design with older people, and consider how integrated person-centred care services could be co- located on-site,” the paper says.

Co-housing remains more common in Europe than in Australia, the report says, and would probably need to be introduced in partnership with developers to succeed locally.

Provider PHN partnerships work

Care providers are well positioned to play a key role in integrating community health and aged care, the paper says.

For example, home and disability care provider IntegratedLiving is moving towards a model that would see it enter into regional partnerships with primary health networks.

Under the model, the provider would be able to use PHN resources to screen the community to identify and engage with potential client.

Good examples of integrated models

Dr Gilbert said good examples of integrated care in aged care are often found in regional areas or in ethno-specific services because they are generally multi-purpose services.

“They’re doing all these different functions within this one organisation, so they would say they have integrated their model,” he said.

He said the paper clearly supports further investment in pilots looking into which integrated models of care work best and a long-term commitment to improving integrated models of care, Dr Gilbert said.

“What you don’t want is a trial that goes on for two years and everyone’s expectations are raised and then it is abandoned,” he said.

Access the research paper Research paper 7 – Models of Integrated Care, Health and Housing here.

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1 Comment

  1. Isn’t it interesting how once the RC has a paper done the basic assumption is that the answers are not only available but readily implementable. Having worked on this concept for just under 10 years, including working with Government and DH&AC, there will need to be a complex realignment of regulation to enable a supportive regulatory environment. Aged care is regulated by the Commonwealth – Housing and Retirement Villages by the states. Community integration does not stop at a singular age cohort – it has implications for social and affordable housing. In all cases the housing model is regulated for a full life-cycle of singular use and application. This will never allow the full benefit of integration which resides in the flexibility of the housing form to be designed; built; and adapted for multiple applications. The full benefit would be gained through a complete change of mindset not focused just on older Australians. The old adage says that it takes a community to raise a child – and it takes a community to care for our elders. Under existing regulation, neither can be realised unless the customer has the funds to achieve it. There are sufficient funds within the system including the existing private housing, to enable this to be achieved. Why is there talk about using PHN’s? Surely it’s time to seek out solutions that are not predicated on taxpayer funding. The answers are there if we really want to see them; and at the same time we can remove the inherent capital risk in aged care.

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