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MAV Opinion Editorial - Our aged care system is failing older Australians
Australia has an ageing population. By 2055 it is estimated the number of Australians aged over 65 years will double.
Yet our aged care system is not meeting the needs of our ageing population, let alone capable of meeting future service demands.
We need to do better. Our parents, grandparents and elderly neighbours alike all deserve high-quality care to remain living independently and connected to their community for as long as possible.
How we care for people as they age is the subject of a Royal Commission. Commonwealth spending on aged care is about $18 billion a year and expected to double.
The most sensible, cost-effective option is to provide adequate levels of community care that support people as they age. Yet evidence provided to the commission highlights the need to improve our community care system. It serves the largest segment of older Australians and prevents premature admission to costly residential care.
National reforms over the past three years have changed how community care is provided. Consumer-directed Home Care Packages give individual funding to older people, who must find providers to meet their assessed care needs. In Victoria, this service is received by about 24,000 older people. But market-based services are falling short and risk failing our frail older population. Commonwealth allocation of individual care packages are not meeting client needs. Some receive good service, while others receive none.
Widespread reports also suggest funding for frontline services can get eaten up by large administration and case management fees. And the system is confusing.
Having to find your own carers and navigate an online system is too hard for many, leaving some vulnerable clients without the vital care they need. Older people are also experiencing long wait times to begin receiving care after they are assessed. This is leading to unnecessary hospital and residential care admissions.
In contrast, the Commonwealth Home Support Program (CHSP) provides in-home care at a lower cost than almost identical services offered under level 1 and 2 Home Care Packages. The difference is that CHSP is block funded to councils and other providers, who tailor individual services and help people to navigate through the system.
About 200,000 Victorians — the majority aged over 85 years — receive community care through the CHSP. This is more than eight times the clients receiving individual Home Care Packages. But CHSP funding is not guaranteed beyond June 2020.
Seventy two Victorian councils deliver in-home services including cleaning, home maintenance, delivered meals, personal care and respite. Carers are known to recipients, with long-standing relationships and trust built over many years.
Victorian councils are voluntarily contributing between $150 million and $200 million extra each year to stretch Commonwealth funding further. They provide extra community transport, health, well-being and social support programs that work together to keep older people socially connected, healthy and living at home for as long as possible.
Victoria's integrated model works well. Councils have a successful history of planning and delivering quality community care for more than 70 years. Clients also value their council is easily accessible on the phone or in person — to provide advice, assessment, advocacy or referral.
Yet this is all now at risk. Service stability is not guaranteed. Many councils are reviewing whether to continue funding and directly providing community care services beyond 2020. The quality of care, service coverage and access are all at risk under a consumer-driven model.
Our frail ageing community members need us to protect the strengths of Victoria's long-standing community care system.
Local government seeks an agreement from the Commonwealth, and ongoing block funding to service delivery agencies such as councils and rural health services to retain and expand the CHSP. It is not feasible or cost-effective to deliver regular, small amounts of care to large numbers of people using individual packages.
The Commonwealth must also commit new funding for population-based service planning and co-ordination. This is vital to ensure access for all older people, particularly in rural areas where councils and health services are often the only organisations with capacity, expertise and local connections to manage community care.
And public sector stewardship of community care is imperative if the benefits of a mixed market system are to be realised. Councils are inclusive and provide a sense of community. Councils join the dots between funded and non-funded services, and ensure local services meet individual needs.
This cannot be achieved from Canberra. Nor can the market deliver these outcomes.