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Aged care: it's getting personal

Opinion

The way Australia is funding aged care has changed and it’s caught many people unaware, writes Andrew Beer.

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The Australian population is ageing. Just in case you are one of the very tiny percentage of the population who hasn’t heard, we expect that by 2050 the proportion of Australians over 65 will be double what it is today.

Successive versions of the Intergenerational Report produced by the Australian Treasury, and a series of high-profile pronouncements by state and federal politicians, have drummed into us some basic facts about Australians living longer and young people constituting a smaller percentage of the total population. Along the way they have managed to generate a little fear about what it is all going to mean.

But in many respects, the ageing of our population is something to celebrate. It reflects advances in our housing, nutrition and other basic living conditions; it is a product of advances in medical technologies; it reflects the strength of our primary health care system; and it is a positive outcome of public health measures that have progressively addressed premature deaths, from road traumas right through to preventable diseases.

However, the growing numbers of older people are just one part of the picture.

Over past decades, we have seen big changes in the way we provide support to older people and how that support is funded.

Between the 1950s and 1980s, the model for aged care support saw Federal Government capital grants awarded to a range of community organisations for the expansion of purpose-built accommodation.

More recently, the Federal Government has changed the way it provides funding for to older people who are able to continue living within the community because they receive a home care package, that is, they remain able to live within their own homes.

Following a Productivity Commission Report in 2012, the Australian Government announced reforms to the aged care sector and specifically the rollout of a Consumer Directed Care (CDC) model for aged home care packages. Full implementation of CDC took effect from July last year.

The CDC model represents a fundamental shift in the way assistance for older people is funded.

Where once government funded service provider agencies – charities, local governments, community groups etc – to deliver help to older people in their homes, CDC embraces a philosophy of “personalised” care for older Australians, where care budgets are individualised and older people have greater oversight of, and responsibility for, the budget.

Consumer Directed Care looks to give greater choice to older people. Within their allocated budgets, they have the capacity to decide which services they use, who provides them, at what time, and in which location.

The goal is that CDC will deliver greater flexibility in services, with a better match between what people want and what they get.

Some have argued it will also result in greater transparency for users and the public alike, enhanced self-esteem for clients as they take control of a key part of their life and better prospects for independence.

Many within in the aged care sector have argued for this new model for a long time, believing it will deliver a better service to older people and allow them to adjust the services they use as their needs change.

However it seems the broader community – older Australians themselves, their carers, family members and friends – may have been caught unawares by the changes and are now confronted by a new set of decisions associated with ageing.

The new system doesn’t come with an open cheque book and older people will need to find ways to meet their needs within the reasonably tight budget allocation.

Some may find that they can no longer receive the level of support they once enjoyed and may need to make some difficult decisions about prioritising one form of assistance over another.

Consumer Directed Care also raises the prospect of fees and costs for a proportion of recipients, which may act as a disincentive to participate. For some, paying privately for the assistance they need may look like a better option.

Regional residents and service providers have also voiced concerns about the new approach. They’re concerned that government-defined programs that provide for a uniform level of assistance across the nation may overlook the higher cost of providing services in rural and regional Australia.

The reality is, we just don’t yet know how CDC will play out in Australia.

Some nations have embraced this type of model; others appear to have experimented with this policy direction and then turned back.

What is clear, is that we need to know more about this important policy shift and the impact it has on older Australians.

If you are over 65 years or an Aboriginal or Torres Strait Islander aged over 50, receive a Home Care Package and are interested in participating in a research project that examines these questions we would like to hear from you.

You can contact the research team free of charge at 1800 372 597. Your interest, thoughts and assistance in answering these questions will be anonymous and greatly appreciated.

This project is a collaboration between Andrew Beer, Debbie Faulkner, Justin Beilby, Jonathan Karnon, Charmaine Thredgold and Victoria Cornell.

Andrew Beer is Dean of Research and Innovation at the University of South Australia Business School.

 

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