The Productivity Commission has released the Caring for Older Australian report. Experts respond.
Rhonda Nay, Professor of Interdisciplinary Aged Care at La Trobe University gives a general response to the Report:
The Productivity Commission has at least mentioned end of life but they appear to have given most of their emphasis to funding, which is not surprising.
It is disappointing though because it would’ve been good to see more visionary work around workforce and care issues.
The biggest issue facing us is dementia and that hardly gets a mention. The whole issue of dementia has been badly neglected which is really strange given that it’s the major challenge facing not only the aged-care sector but the health-care sector.
There really needs to be a major rethink about new ways of working, new skills mixes and new ways of educating people because to simply say that we need more nurses in universities for example, is counter-productive.
All you do is bring the entrance score down and put out more of the same, which is not what we need.
We keep talking about people wanting to stay at home and of course they do, staying at home sounds lovely.
It’s one of those feel-good statements but the reality (and the Report also recognises this) is that we’re coming into a period where there are going to be real challenges for the workforce because of the baby-boomers retiring so we’re going to have to (we’re already seeing this) try to keep people in the workforce longer, which means you don’t have the carers at home.
We also know that as needs increase, particularly with dementia, there comes a time where formal care becomes appropriate and I don’t think that’s addressed. You can’t just keep saying that people want to stay at home.
Removing the distinction between high and low level of care was removed in the Report and that’s a good thing.
The majority of people who need residential care will be people who have high care needs. There are all sorts of exciting possibilities around what sort of facilities we create, which I don’t think the Report has addressed.
If you’ve got dementia, it’s a terminal illness so there needs to be a much greater emphasis on dementia and end-of-life care, which are the big issues facing international health-care systems and the Report hasn’t come to grips with that.
And of course, we need more research that includes the voices of people living with dementia that their families.
Marian Baird, Professor of Employment Relations at University of Sydney addresses some of the issues in the report impacting workforce participation:
The chapters on informal care and the formal caring workforce form a small component of the report. Given the pressing demographic and labour force issues which they highlight, more exploration of informal care would have been welcome.
Exploratory research indicates that the need to provide care for an older person, usually parents, is a pressing issue for many mature age workers, particularly women.
The policy dilemma here is the need to increase workforce participation and the number of informal carers. But the people who are most able to meet both these demands are largely drawn from the same pool of workers, that is, mature-aged women. Those worker-carers face real dilemmas.
The often demanding care they provide is different from those caring for children, as caring for an older person can be much more unpredictable and may also be undertaken “remotely” by carers living at a distance.
At the same time, they have to manage the competing demands of inflexible workplaces.
So it’s good to see the report’s proposal to extend the Fair Work Act right to request flexible working (currently available only to parents of children under school age and under 18 if the child has a disability) to carers of older people.
But the proposal would only make it available to a limited group of carers of older people, unlike the rights that such carers already have in Victoria as well is in the United Kingdom and New Zealand.
And of course, any new right along these lines has to play out in organisations. We need a lot more government guidance, support and encouragement for employers to implement appropriate policies for worker-carers – along the lines some employers are currently developing.
Finally, I think there’s another issue, noted by the Productivity Commission needing greater examination.
There are people who are not in the workforce who want to work but realise the barriers to them participating fully are too great so they don’t even offer themselves for work.
Michael Taylor, Research Fellow, Australian Institute for Primary Care & Ageing at La Trobe University considers how the Report addresses the shortage of general practitioners caring for people in residential care:
The Productivity Commission’s Report recommends increasing the Medicare rebates to general practitioners who visit aged-care facilities and people’s homes.
The rebates are to be independently reviewed by the new body, the Australian Aged Care Commission (AACC), which will take into account the cost of providing these services.
The Commission identified these payments as a substantial problem, and in deciding what the rebate should be the Commission believes that opportunity cost (what else GPs could be earning compared to what they are paid to visit residential aged care facilities) should be taken into account.
When a GP visits an aged-care facility they also incur costs for travelling to the facilty and back.
This compounds the opportunity cost problem, and results in GPs being substantially worse off when compared with staying in their consulting rooms.
The overall opportunity cost could be as low as $20 or as much as $100 per visit, depending on the number of patients that they see and the out-of-pocket fees they charge.
At the moment, the opportunity cost is something that GPs have to bear individually, and has the effect of driving down service delivery to residents.
In deciding the rebate level in the future, the AACC would be well advised to look at the variation in travel time across Australia; for example, the difference between GPs in regional areas and those in urban areas.
The Report also alludes to a new approach to GP service delivery to residents: having doctors located in aged care facilities.
The Productivity Commission argues that there are likely to be economies of scale from a doctor (or several doctors) specialising in the provision of care in one or more facilities.
The creation of such economies of scale is quite compelling, and this approach may also support GPs in becoming more experienced in the clinical care of residents.
Given the often-complex clinical characteristics of residents, such as the high rates of dementia observed, this model may be quite advantageous.