29/09/2011
Access to aged care services should be a right for older citizens the same as school is for 5-year old citizens, the 2011 Aged Care Review, convened by the Committee for Economic Development of Australia (CEDA) in Adelaide, has been told.
Federal Minister for Mental Health and Ageing, Mark Butler
Managing Director of Bupa Care Services, Paul Gregerson
Regional Director, Australian Bureau of Statistics, Mike McGrath
CEO of the peak aged care body, COTA, Ian Yates
Anglicare CEO Dr Lynn Arnold
CEO of Masonic Homes, Doug Strain
Consulting Gerontologist Dr Anna Howe
Federal Minister for Mental Health and Ageing, Mark Butler, said older Australians had earned the right to get the support they need when they need it rather than have services rationed.
Mr Butler told the forum the Productivity Commission's broad ranging Report into Ageing, released in August, signified a new approach to ageing. The approach recognised "the wonderful opportunities attached to an ageing population" - particularly as this population was generally healthier than previous generations of older people.
Policy makers faced a unique situation in Australia over the next 15-20 years in which two different generations of older Australians would be alive at the same time. These segments of the older population would have very different needs.
"There is a need not to lump everyone over 65 in the same basket. At around 60 to 65 years, perhaps people need to be preparing for retirement, getting their income in order, getting healthier or connected in the community. Around 75-80, people start to need some support in the home. We need to calibrate our understanding of aged care," Mr Butler said.
Consumer-directed care, of the type developed in South Australia, would be the key.
Mr Butler said Australians were more concerned about ageing than many other countries with an older demographic profile - possibly due to publicity surrounding Treasury's Intergenerational Report, which raised fiscal and workforce concerns about ageing issues.
"In our forums with older Australians what we are hearing is that they are concerned about the quality of care available to them, access to services and their desire to stay independently at home for as long as they can. They are also talking about end of life care and the circumstances of their death," Mr Butler said. They especially did not want to be trapped in hospital, supported by machines, he said.
Whereas the Intergenerational Report had focused on projections of workforce challenges and high dependency ratios, the Government was keen to introduce a positive policy framework.
"We have got to have a positive framework around ageing issues rather than thinking of it as, at best, an inconvenience and, at worst, a downright problem," Mr Butler said.
"We commissioned a comprehensive report not just to deal with some of the pressures bearing down on us now but to look ahead at some of the challenges and opportunities."
Key policy issues raised by the Productivity Commission Report included: securing supply of services to assist older people, providing easy access to information about services through a "service gateway" and financing service delivery.
Mr Butler said the Government was open to all suggestions about the Productivity Report's recommendations - but while stakeholders were pressuring for the 2012-13 Federal Budget to be an aged care budget, no timetable had been set for a government response to the report. The Productivity Commission noted that it would take at least five years to implement recommendations and Mr Butler anticipated work would begin in this term of government.
The key policy issues identified in the report would be around:
- Securing an adequate supply to meet the needs of older Australians - particularly in home-based care and community services.
- Growing the workforce in aged care services in tight labour force conditions.
- Providing a service gateway to help consumers make decisions about their care options.
- Financing service delivery in a variety of new ways, including periodic payments, while ensuring that these changes did not affect the viability of the aged care sector.
"We are a smart country, we are a comparatively wealthy country; it is not beyond our wit to deal with these issues," Mr Butler said.
Demand for nursing home beds declining
Managing Director of Bupa Care Services, Paul Gregerson, said nursing home occupancy was declining as people were increasingly seeking home-based or community care. This represented increasing choice in aged care services.
"In terms of residential beds per head of population, there is probably an oversupply. Where we should start focussing, is on effective community services. We must understand what people want," Mr Gregerson said.
Any reform must be about retaining the health of the ageing, he said. And with this, there must be a new emphasis on low care places and community support.
Mr Gregerson said that the $1.9 billion funding for the Federal Government's Home and Community Care (HACC) program would be better allocated to community services.
"At the moment under the HACC program, there is a burring of the subsidies. Many receive reimbursement for the costs of daily living such as garden maintenance. There's double dipping and no formal assessment," he said.
"We advocate a simpler model (than the HACC program) where the individual pays for daily living and there is a portable care funding tool to provide for other care-related services," Mr Gregerson said. This would allow for greater choice in services for older people.
The regulatory framework in aged care services needed to be revised to allow for greater innovation and competition, while protecting against market failure, he said.
Ageing to have an image makeover
Just because many older Australians need help, doesn't mean they are helpless, says the Regional Director of the Australian Bureau of Statistics, Mike McGrath.
While most older people aged over 75 needed help looking after their property, 40 per cent of those over 90 said they didn't need any help.
"We are lulled into a view of older people being almost helpless but the reality is that they are not," Mr McGrath said.
While South Australia's population was shifting from a triangle-shaped distribution, with very few older people in the 1970s, to a coffin-shaped distribution, with a greater proportion of older people by 2055, it was important to grasp the complexity of the change.
"If we keep an eye on the change and understand the complexity, we will be able to capture the opportunities," Mr McGrath said.
"If I were looking for an opportunity in an ageing market, I would be looking at property maintenance or the tools older people might use to look after their property."
Most of the needs of older people at home were currently being met by family, Mr McGrath said.
In 2009, 196,000 primary carers were aged 65 or over - most of these were female. And there were 194,000 primary carers aged between 15 and 65 caring for someone over 65.
Demographically, ageing had some advantages, particularly for men. Whereas males struggle for female attention until their mid-30s, they faced "nirvana" over 65 as they are significantly outnumbered by women, he said.
Older consumers to have a bigger say in policy, says peak body
Policy makers are beginning to see older Australians as continuing contributors to society, says the CEO of the peak aged care body, COTA, Ian Yates.
Mr Yates said the Productivity Commission's Report on Ageing reflected a larger shift in the way society viewed ageing, seeing older people as contributors and consumers with choices rather than people to be looked after.
"What the Productivity Commission did say was that aged care should stop being rationed. Aged care services should be an entitlement, just as when you turn five, you are entitled to a primary school place," Mr Yates said.
However, these services increasingly would be focused on supporting people to remain independent rather than move into homes, reflecting consumer preferences.
"Support for daily life with one or two minor interventions has an important impact on people's capacity to remain independent," Mr Yates said.
"No one should be forced into a nursing home because there is no home-based care funding."
However, simplifying access to services was critical, he said. Some kind of "seniors gateway" was essential to enable people to co-design a package of services and co-contributions to fund these services. This entitlement should be consumer-focused rather than paid to the provider.
And it was important that wherever people were in the country, if they had the same resources and need, they would pay the same.
"We assume that people will pay for their accommodation as in any other phase of life," Mr Yates said. But these costs needed to be transparent and people needed choice in how to pay.
Whereas stakeholders were divided in 1997 about proposals to reform the aged care system, there was an unprecedented level of agreement about the policy direction in 2011.
"The key thing to say is that we need the reform to start in 2012 as the reforms will take five years or more to implement - a lot of things can be done immediately," Mr Yates said.
Society needs to invest in older people, says Anglicare CEO
Anglicare CEO Dr Lynn Arnold told the CEDA Review of Ageing that a discussion about the opportunities and challenges of ageing essentially meant "investing in older people".
Dr Arnold said aged care service delivery needed to be integrated into the policy mainstream, rather than "relegated to the domain of social ministries", recognising that older people still wanted to participate and contribute to society.
Policy should reflect the view that older people are citizens with full rights rather than considering that the only right they have left is the right to be cared for.
"We don't send children to school to care for them, but to develop them," Dr Arnold said. The service delivery focus needed to change from needs-based services to demand-based services, and a change from believing we are doing people a favour by providing services.
"We need to change the nature of the general discourse around ageing from a defensive discourse to an affirmative, positive position," Dr Arnold said.
"At the moment, we talk about the number of beds in an aged care facility, rather than the number of people who call it home.... We talk about senior moments... but older people have more to remember. It takes time to retrieve a piece of information from an expansive data base," Dr Arnold said.
Dealing with the policy challenges of an ageing society called for innovation - particularly in addressing issues associated with the higher dependency rates projected for 2050.
"We can see technology becoming really important in providing services," Dr Arnold said.
"Provided we are prepared to be excited by ageing, there is a lot to be excited by - opportunities to deal with issues, that on the face of it, are very daunting but in reality are not."
Aged care sector, not defence, is the ticket to growth in SA
CEO of Masonic Homes, Doug Strain told the forum that South Australia had an opportunity to capitalise on its position as a leader in aged care and retirement services.
"We should be looking to grow our national footprint in this sector and internationally," he said.
While the share of the defence sector in GDP was set to fall, the share of aged-care related sectors was set to increase significantly. The sector was the third largest property-holder in the country, behind Government and hotels.
"If I was trying to get a competitive advantage, I know where I would try to put my effort - into infrastructure investment in the aged care sector," Mr Strain said.
Masonic Homes, like many other aged care service providers, was investing hundreds of millions of dollars into constructing new facilities. New accommodation was likely to be developed at Roseworthy as part of South Australia's 30 year plan, he said.
Yet, while South Australians had a perception of themselves as Australia's oldest mainland state, its demographic profile was not vastly different from elsewhere in the nation. And while Australians were anxious about an ageing population, Australia's age distribution was not significantly different to the age profile of most developed countries. For example, while the median age in Australia is 37.5, it is 44.6 in Japan, 43.7 in Germany, 39.6 in Singapore, 36.8 in the United States. Countries such as India and Brazil had lower median ages at 25.9 and 29 respectively.
"But if we were really concerned about an ageing population we would move to Uganda where the median age is 15," Mr Strain said.
South Australian seniors were a wealthier class than previous generations of older Australians and had a key advantage in holding capital.
"In the 1950s there was a clear predominance of young kids. People over 85 just weren't there. Older people lived in granny flats out the back of someone's house….in 2000, you are starting to see old people," Mr Strain said.
"They are living longer and healthier lives...they will continue to contribute and will be active consumers," he said. "They are no longer a welfare class."
This change had led to a decline in the occupancy of nursing home places.
Yet, Mr Strain said the Government needed to act quickly on the Productivity Commission's recommendations.
"We at Masonic Homes, think it is a good report but we have a fear about cherry picking recommendations. The Government needs to implement it as a whole....if we delay people will suffer - the greatest thing they lack is time. We need to get on with it," he said.
Government Urged to Act Quickly on Aged Care Reform
The Government must seize the moment to implement aged care reforms, says Consulting Gerontologist Dr Anna Howe. While there had been many reviews of aged care over the past 10 years, there had not been enough action.
Dr Howe urged the Government to begin implementing reforms such as providing community care packages and phasing-in supported residential accommodation supplements, using undersubscribed funding for nursing home beds.
Introducing stop loss provisions to ensure no one paid more than $60,000 a year for their accommodation would provide relief for the families of those who stay in nursing home care for longer periods.
"We need to change the system to be more responsive," Dr Howe said.
"In 2016, when CEDA has its next Aged Care Review, I hope we can tick off some of these recommendations or we will not be looking at a bright future."
Policy could also tackle issues associated with the workforce shortage, providing measures to support women to return to the workforce after having children, increased access to superannuation and decent employment conditions in aged care.
"It could make a huge difference if we taxed superannuation... There is a new class of taxpayer subsidised retirees," Dr Howe said.
However, she raised concerns about the assumptions on which the Productivity Report had based its funding recommendations.
"The Productivity Commission is confident we will all be richer but I don't share their confidence," Dr Howe said.
The growing wealth of women over 65 was falling and two thirds of these women had no superannuation. Only 15 per cent of women in the 65-70 year age group had more than $40,000 of superannuation. Of those over 70, even fewer had super.
While men grew their income in the 10 years before retiring, many women experienced lower incomes as they worked part time to care for people.
And the picture of home ownership among older Australians was also distorted, calling into question preferred mechanisms for financing aged care accommodation, Dr Howe said.
While the Productivity Commission advocated a bond system in which older people would receive a Government-backed line of credit secured against their home to help fund their aged care accommodation, this would be beyond the reach of many.
"Many older people have borrowed against their homes to help their kids, they've had business failures, late life divorce, lost their partner or their job," she said.
Many older Australians were renters or living in boarding houses. "And many own small houses in rural Australia - good luck selling that to fund your retirement."
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3 November, Sydney - The Hon Jillian Skinner MP, Minister for Health
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