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Ask the elderly what they need, not the care industry

Older people are finally being consulted about the type of care they need. EPA/Diego Azubel

Australia’s population is ageing, presenting an economic challenge to look after the most vulnerable members of our society.

The Productivity Commission released a report last month recommending a complete aged care overhaul, suggesting a system with more choice and flexibility for older Australians.

One of the largest care providers is Australia Unity, and its Chief Executive for Retirement Living Services, Derek MacMillan, has argued for the recommendations which would help his industry.

So who really has a say in aged care policy?

The Conversation spoke to Hal Kendig, Professor of Ageing and Health at the University of Sydney.

Do you think that private companies that provide aged care have too much influence on public debate or the development of aged care policy?

Of course, providers have a lot of influence on policy development. But if you look at the history of aged care, there’s been a broad move away from what has been almost entirely provider dominant, even provider determined, use of public funding.

You can see this from the beginning of aged housing in the 1950s, through to the nursing home industries in the 80s and 90s and so forth.

There has been a historical change and the Productivity Commission report recommendations do move us towards more consumer-focused care.

But it’s pretty important to remember these are just recommendations, the government has yet to accept them, and the government is now consulting and getting different views, but it is conceivable they won’t get implemented in the turbulence of policy-making.

If private providers have had, or continue to have influence, how do they exert that?

The provider organisations, of course, have influence in all sorts of ways. But the aged care providers and retirement village providers are not huge powerful interests, that’s really important to understand.

They are part of the providers who make a living for what they and most people believe are good causes and they do it in a way that’s more traditional. And I think that’s all understandable, there’s nothing nefarious about that.

I think the difficulty with it is that the older people themselves are not making these calls, either in terms of the policy, or in terms of how the public money is being spent on care arrangements.

It is very encouraging that the minister on Ageing, Mark Butler is now going around and consulting about these recommendations.

The minister now doesn’t actually want to hear from academics or providers or industry bodies, he wants to hear from older people themselves and their carers.

I think that’s positive, and I would be concerned if people were to take these [Productivity Commission] recommendations as a provider-led response because in fact, if you look at history, while providers have their say, this is a major step forward from a consumer point of view in all sorts of ways.

The main thing about the Productivity Commission recommendations is that they will improve consumer choice because people can mix and match care and accommodation. They can get high levels of care under these proposals without having to go into a nursing home.

The other great thing is that the flexibility means that those older people who can actually pay for the accommodation side of care, can actually pay more by drawing on the wealth they have in their home. And that I believe is very important for equity.

What was your reaction to the article by Derek McMillan? Was there a bias there?

We need a wide variety of views in informed public debate on aged care and this comment is one of many which many people would agree with.

There’s no doubt that the providers have a major say on what happens in terms of aged care but we’re sort of turning that around with the current policies, as long as it’s an option rather than a coercion.

So the way this is put, it’s another option. I don’t see [the article] as that severe. And in fact, the strongest provider pressures are from the volountary organisations not the private-for-profits.

I did not see the article as overly industry driven. Although, of course, were his suggestions to be implemented there would be more money available to support industry providers for accommodation and care.

The key point here is that these financial mechanisms need to be ways to increase choice for older people and the recommendations from the Productivity Commission about use of wealth in the home, in my view, are basically just that. It frees up people to be able to draw on the wealth in the homes for aged care, for less intensive aged care and also importantly more intensive care, like nursing homes.

Social equity is a major issue in health and aged care, do you feel there is an inherent problem with having a fair system and having profitable private providers?

That’s not the way I think about it, what I would say whatever the sector of the provider – whether they be a private developer or a private aged care firm or a voluntary organisation – they should meet the same standards.

A while ago, there used to be the argument that a religious organisation did not require government intervention or oversight, because they did it for God and their motives were more pure than those of governments.

And so for a long time, voluntary organisations resisted regulation. Historically they would say we know better than the politicians and we know more than the governments. And maybe that is true in some respects but in the end, it’s public money.

Whoever is providing the care you want them to have the same high-quality standards. And there is a public interest in [looking after] frail and dependent and vulnerable older people.

So I don’t think we can just trust the motives, whatever the group. So that’s why I find it hard to say we should look more carefully at the private groups.

I think we should look with the same scrutiny and apply the same standards with all groups – voluntary and private.

The Productivity Commission is arguing that this should be more transparent – you see what it costs, you see who gets access to what, and there are rules.

It’s been very hard for older people so far to figure out what they got for their money, if they put it into aged care.

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