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Aged care reform: experts respond

Prime Minister Julia Gillard and Minister for Aged Care Mark Butler today unveiled a $3.7 bn aged care package. AAP

The Commonwealth government today announced a $3.7 bn package of reforms to give older Australians “more choice, easier access and better care” in their later years.

The Living Longer Living Better plan includes:

  • An increased number of Home Care Packages, from 60,000 to 100,000;
  • A rise in aged care facility places, from 191,000 to 221,000;
  • More options to pay for these aged care places (lump sum, periodic payments or both);
  • The development of an Aged Care Workforce productivity strategy; and
  • Projected savings of $1.6 bn from changes to the Aged Care Funding Instrument.

The Conversation’s aged care and health policy experts have unpacked the report and share their thoughts below.

Colleen Doyle, Principal Research Fellow in Service Development and Evaluation at University of Melbourne

The reforms announced by the government today are welcome and in line with preferences expressed by older Australians – both in research and in government consultations – to be able to live in their own homes with adequate support for as long as possible.

The Extended Aged Care at Home Dementia packages that were introduced by the government in 2005 recognised that a substantial proportion, at least one third, of people receiving aged care support while living at home were also living with dementia. The program was evaluated independently and indicated that the services provided led to improved quality of life for recipients.

Participants in the evaluation at that time expressed preferences for more services for people at earlier stages of dementia. The reform announced today, which allows a dementia supplement to be paid to people receiving community care, will be a good step toward greater support for people at an earlier stage of dementia.

People who access support services as early as possible have better outcomes than people who, for any reason, delay accessing services. So encouraging people to start accepting small amounts of support will help to maintain function for as long as possible and lead to better outcomes for individuals. This increase in service support needs to be supplemented with increased awareness in the community about how best to care for people with dementia.

The Aged Care workforce is critical to maintaining adequate quality of care for older Australians. The tertiary education sector has the responsibility to ensure that knowledge translation happens in this workforce. At present, the aged care sector has little incentive to be involved even though it has the potential to raise the standard of quality of care as well as ensure government-funded research is relevant to practice.

Further efforts need to be made in reducing the stigma associated with working in aged care by improving community attitudes to the sector.

Stephen Leeder, Professor of Public Health and Director, Menzies Centre for Health Policy, University of Sydney

The proposals for reforming how we pay for the support and care of older people seek to remedy currently anomalous and inequitable financial arrangements that privilege the rich. By expanding services to support those who wish to stay at home, but who otherwise may have to be cared for in an institution, the reforms recognise the frequently-stated preference of older people for home care.

With more flexibility about the size, timing and method of payment for personal contributions to institutional care, a more humane and equitable approach has been proposed. And it’s set to be implemented quickly.

Dementia care has received welcome recognition and funding has increased for this special category of aged support.

It is appropriate, and welcome, for the federal government to be reforming its approach to paying for aged care. It would, of course, be even better if this were set within a context of public debate and policy formation around the topic of aged care.

Precisely what are we aiming to do with aged care?

How much care is it reasonable for an Australian to expect?

How does residential care for people – especially those with multiple problems such as heart disease, arthritis and emphysema – fit with the health system, which is good at acute treatment but not designed for the drawn-out, decades-long experience of ageing?

And what do we make of dementia? I visit a 93 year old relative with dementia who is happy but has no short-term memory and speaks in riddles. What do we, as a society, make of the existence of such a person? How do we value them? These are big questions indeed.

In the meantime, we have work to do. Our ageing population deserves a skilled workforce. We need to discuss how this workforce will be assembled. Geriatrics has traditionally had low levels of popularity as a medical career choice. And while other professions have done better, we need to make these careers more attractive. But without money, nothing will improve. So the increased funding, and changes to the distribution, are most welcome.

There’s not much fun about getting old. But it’s something everyone who cares about Australia’s values and the future of our society must confront – fun or not. Today’s announcements are a splendid endorsement of the efforts of dedicated bands of aged-care service providers, advocates and carers.

Steve Macfarlane, Director of Aged Psychiatry at Caulfield Hospital & Associate Professor of Psychiatry, Monash University

The government’s proposal to tackle workforce issues in aged care allocates $1.2 billion over five years, which, at first glance, promises to go some way toward addressing the current financial disincentives to enter a career in aged care. Most care within aged care facilities is currently provided by workers lacking advanced skills, so the lure of higher wages and improved career pathways is likely to help attract and retain a more skilled and motivated workforce to the sector.

Residents of aged care facilities can be difficult to care for, because of their combination of medical and cognitive impairments. This complexity should mandate a specific staff mix within facilities, with more higher-skilled registered nurses. Providers, otherwise, will inevitably opt for a (more highly paid) Personal Care Assistant because they’ll still much cheaper to employ than a (more highly paid) registered nurse.

Of possible concern from today’s announcements is the potential for increasingly onerous reporting requirements on staff in aged care facilities. Requirements for documentation of care currently consumes valuable time that would be better spent on providing that care.

It also remains unclear exactly what proportion of the funding will be new money, as opposed to existing funds redirected from the current Aged Care Workforce Fund.

Today’s announcement provides $268.4 million over five years to tackle dementia. These are impressive figures at first glance, yet they equate to less than $200 of extra funding a year for each of the 269,000 individuals currently suffering from this disease. It also overlooks the inflationary effects that would occur during this time, which dilutes the package even further.

The package seems to ignore the reality that dementia and the aged care sector are inextricably linked, with more than half of residents in high-level care suffering from dementia. Workers across the sector, not just health professionals, therefore require better support and education in dementia-specific care.

It’s significant and appropriate that general practitioners are to receive additional funding to support them to make a more timely diagnosis of dementia. But one thing that’s missing is a re-evaluation of the current restrictions that require specialist clinicians to diagnose Alzheimer’s disease before the patient can be prescribed cognitive-enhancing drugs. If GPs are to be supported in making a diagnosis, yet remain unable to initiate treatment, you have to question the point of such reform.

The package rightly observes that dementia remains under-diagnosed in hospitals, and provides $39.2 million to address this problem. But the day-to-day pressures hospitals face in treating a growing number of patients means they’re not best placed to manage new diagnoses, even if they’re better able to make them. Instead, a more appropriate use of funds might be to detect the patient’s cognitive impairment in the hospital and then refer them to their GP for a definitive diagnosis.

The provision of $23.6 million to support those with younger-onset dementia is welcomed, but seems poorly targeted. The ideal of enabling “younger people with dementia to actively participate through the development and dissemination of information for employers” seems to ignore the sad reality that younger-onset dementia tends to progress rapidly. Surely this money could be better spent, perhaps by the development of residential care settings that are geared towards the specific care needs of younger people.

The proposed reform of the Aged Care Funding Instrument to encompass items that reflect the care needs of those suffering high level behavioural disturbances is most welcome.

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