Issue 47 / 2 December 2019

THE federal government has reacted to the Interim Report of the Royal Commission into Aged Care by approving funding for another 10 000 Level 3 and Level 4 Home Care Packages, with 5500 to be made available from 1 December 2019. A total of $537 million worth.

I’m sure that will bring comfort to the 120 000 seniors who are still waiting for an offer. One of them happens to be my old Dad, who was assessed at Level 4 in January of 2019 and has yet to hear boo. The intervening 11 months have cost him just over $154 000 in private care.

Mum’s in no better position. She was assessed at Level 2 in January and received a Level 1 offer a couple of months ago. Unfortunately, as a self-funded retiree, a Level 1 offer is next to useless financially, so she remains on the wait list for Level 2.

(For a full definition of the levels of Home Care Packages, read Dr Toby Commerford’s excellent explainer.)

My parents are “lucky” – if by lucky you mean that they worked hard in well paid jobs for 50-odd years and managed to tuck away some assets. Not to mention the tens of thousands of dollars they have paid in private health insurance over the years.

How senior Aussies on a pension manage to get through their sunset years with any sense of comfort, safety or dignity is beyond me.

As of 6 pm AEDT on Monday 25 November, there were 25 532 939 Australians. According to the Australian Bureau of Statistics (ABS), by 2066 that number may approach 49.5 million. In 2017, 15% of our population was aged over 65 years. Assuming that proportion hasn’t grown in the past 2 years, that is just over 3.8 million senior Australians today. If the 2066 population estimate holds true, by then we will have 7.4 million Australians over the age of 65 years, at least.

All of which makes 10 000 or so new Home Care Packages look a bit underwhelming, doesn’t it?

I’m not a doctor, and I’m not a statistician. And I’m certainly no politician. But there is one thing I know for sure – 100% of Australians will die. And I’m willing to bet that 100% of Australians will require the help of an aged care system either for themselves, or for their parents, grandparents, aunts or uncles, siblings or partners.

Of course, not all elderly people need the help of the aged care system for themselves. Some will be perfectly well and independent until the day they die. They are, in my inexpert opinion, the true lucky ones.

Let’s talk about just one aspect of ageing and aged care: dementia.

In 2009, 8280 Australians died from some form of dementia. At that time, dementia was third on the list of leading causes of death in this country. In 2018, 13 963 Australians died from some form of dementia, and it was the second leading cause of death behind only ischaemic heart diseases. That’s 8.81% of all registered deaths in that year, or 41.2 deaths per 100 000 people. Of the standardised death rates between 2009 and 2018, the only rate in the top five causes of death that has increased (ischaemic heart disease; dementia; cerebrovascular diseases; malignant neoplasms of the trachea, bronchus and lung; chronic lower respiratory diseases) was dementia. According to the ABS “on current trend, [dementia] will become the leading cause of death in coming years”.

There is no reason to believe those numbers are not going to climb. According to Dementia Australia:

In 2019, there is an estimated 447 115 Australians living with dementia. Without a medical breakthrough, the number of people with dementia is expected to increase to 589 807 by 2028 and 1 076 129 by 2058. Females account for 64.5% of all dementia related deaths. In 2018, dementia is estimated to cost Australia more than $15 billion. By 2025, the total cost of dementia is predicted to increase to more than $18.7 billion in today’s dollars, and by 2056, to more than $36.8 billion.

Again, it makes the federal government’s extra half billion look a little crook, doesn’t it?

Please don’t think I’m attacking the Morrison government in particular. The position we find ourselves in now, with an aged care system that is “in a shocking tale of neglect”, “diminishes Australia as a nation”, and “needs fundamental reform and redesign — not mere patching up”, has taken decades to fester. It crosses party lines, unquestionably. It just happens to be the Australian Labor Party’s turn to be in the fortunate position of being able to point the finger and say, “not good enough”.

It could be argued, of course, that I’m too emotionally involved to write sensibly about aged care in Australia. But, to be honest, why are we not all “too” emotionally involved?

There is not one of us – politician, journalist, doctor, nurse, tinker, tailor, soldier, spy – who is not going to come face-to-face with ageing. And there is not one of us who is not responsible for the position we’re in now, if only because we allowed it to happen on our watch – as voters, as citizens, as adult children and grandchildren.

As Jess Hill, an investigative journalist, said recently in the wake of the recent racehorse scandal:

“How many of us have buried a racehorse? Not many, you know? We don’t feel complicit in that. We can point a finger quite purely and say, ‘what a disgusting practice that is, and we don’t want to be any part of it’. But this disgusting practice of putting our old people in aged care homes and leaving them there to literally rot, in some cases, is something that a lot of us are complicit in.”

As I said, I’m not a doctor, but I know a lot of doctors – many of whom fight every day to give older Australians the best care possible. Those doctors get very little help or incentive from the government in that battle, to the point where it often costs them personally – both financially and emotionally – to stay in the aged care sector.

Band-aids won’t do the job. This system needs root-and-stem reform, not just money. Perhaps some of that $29 billion Australia spends annually subsidising the fossil fuel industry could be redirected towards honouring, respecting and caring for the people who got each and every one of us where we are today.

Cate Swannell has three decades’ experience as a journalist. Since 2013, she has been the MJA’s news and online editor. Since 2015, she has been the editor of InSight+.

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.


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The latest additions to aged care funding are not enough








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20 thoughts on “Aged care band-aid not even close to solution

  1. Ludomyr Mykyta says:

    As I have regularly pointed out, High Level Residential Care is continuing and palliative health care. Indeed, almost all the residents assessed as eligible for HLC meet the criteria for palliative care as defined by the WHO. They suffer from two syndromes, dementia and frailty, and often a third, delirium. They need 24-hour care. They are not making a choice between entering residential care and staying at home. Those who purport to represent the Ageing population should realise that unless the Government is forced to recognise that this is a failure of just healthcare delivery that can never be solved by the Accommodation Industry operating in the business model, should use their considerable clout to demand care that is the due of every Australian citizen is provided to this helpless captive segment of our population. The Royal Commission is refusing to hear this message, I have tried repeatedly. This gives the Government an excuse to do the same.

  2. Dimity Pond says:

    I think more attention needs to be paid to the lengthy period older Australians spend at home before they even go to aged care. Where is the evidence for what works in care over these years? We have multiple fragmented services that frequently don’t communicate with each other looking after folk during these years. They include general practice, which could be a lynchpin for bringing services together if the funding (and the GPs) were there. IN some countries services are co-located with the GP or regularly meet with them in paid time – in Australia the GP struggles to know if the ACAT team (and multiple other services) has done an assessment or not, let alone what was in it (some of this is due to patient consent for sharing the information, which is difficult in the case of dementia).
    There is evidence that good primary care could keep people out of residential facilities – and out of hospitals – for a lot longer. Most people would prefer to stay at home for as long as possible. WE need to work on this in terms of research, policy and properly funded practice.

  3. Stacey Masters says:

    I agree that many GPs work hard to provide the best possible care for people with dementia and frailty who are living in residential aged care. As Ludomyr points out, most HLC residents are palliative, yet discussions about the goals of care are not well documented and residents are transferred to hospital for interventions that are later determined to be futile. The RC Interim Report calls for a stronger, closer interface with the acute health care sector but it is unlikely that acute care provides the optimal environment for decisions to activate palliative care.

  4. Anonymous says:

    More staff required to care for patients in care, there should be a patient staff ratio 24 hrs per day.

  5. Helen Turner says:

    I live alone most of the time with my son coming home as often as he can. No set roster. He travels over 200 klms to work & only returns home for days off.. I am 83yr of age & live 30 klms from my shopping centre. Blue Care is the only home service availabe to me, however I did have their service for a short time but due to administration blunders I now, will not pay to have them near me. I am currenty awaiting an ACAT re assessment early in the New year. I currenlty pay a private cleaner & rely on my son for every other need. Yes many older Country Australians would dearly love to remain at home either alone or supported by family. Yes we paid our taxes & superanuation but with rising cost of living &
    Medical expenses we can no longer sustain our life style on the Gov Pension so are literally forced to seek nursing home placements. Life has become one big financial merry go round. I too did have pivate health insurane but that also is unsustainable in the light of todays costs.

  6. Rosbar@kern.com.au says:

    The acat assessment team is useless. My aged care a farce. My mum was assessed in 2015 as level 4 died dec 1 2018 at home with us with dementia having spent thousands on private care + what ever dva provided. + our family readjusting all our workloads to keep her with us. We dont regret a moment but i look around and see so many families who can not even do what we did and its a disgrace. My father was in the first commando unit in ww11 fighting for the country who did not look after his wife he did 2 tours in vietnam he served at maralinga and got a british empire medal. Didnt mum deserve better

  7. Anthony Walburgh says:

    Sadly we have an incompetent government that have lost it’s way and are incapable of addressing a critical area. They have their priorities in total disarray.

  8. kerry lohrey says:

    What about these “for profit” aged care providers making millions for their shareholders at the expense of the residents and government subsidies ?

  9. Anonymous says:

    Cate,

    Mum and dad are entitled to use CHSP funding with a service provider. Depending on dad’s needs, he definitely would not pay $154 000 a year with CHSP funding.

    As mum is a self funded retiree, she will have a co-payment if she is offered a package. From my experience, about $30 a day. In most circumstances she would be better off under CHSP.

    Offering more packages is not solving the problem, as they are not applicable in nursing homes where the majority of the problems are. I am against chemical and physical retraint, it should never be used, ever. In the governments response there was no mention of increasing staff, especially nursing staff, to decrease the need for restraints and many other issues within this sector.

    By all means throw money around, but the amount is not enough to buy bandaids to cover up the ongoing issues in the aged care sector. Wages in aged care need to be increased to attract qualified and better trained staff.

    RN
    Community Nursing

  10. Leianne Skinner says:

    Yes a bandaid solution and a very cheap one at that. Absolutely no relief for the over worked ,exhausted, stretched to breaking point staff. Did the struggles the staff are having on a daily basis even get mentioned- NO. The incidants of abuse and the cost of aged care is ofcourse a very big problem but please what about the staff. They are the framework of the whole system, arnt they worth at the very least a thought.

  11. Margaret Leigh says:

    I’m looking ahead to my ageing episodes of the unknowns
    After being a nurse and then nursing friends through their horrific episodes of deplorable medical care and outcomes by ignoring my and the patients pleading
    Secondly the refusal and deliberate ignorance of the relatives
    Thirdly the retirement companies

  12. Anonymous says:

    Aged care is a lie. I worked in it. Yes we need people to live at home. Have granny flats built with govt support. Better have little villages of say 10 small flats/units intermingled in the townships among all citizens not incubated or huddled in clostraohobic institutionalised dead end nursing homes. Then the units are still of value to the community and citizens. 1 unit can be for the Cordinator/Carers of their care.

  13. Sue smith says:

    I have advised I am entitled to an age care parcel probably earlier. Than the majority as my husband is a veteran .I don’t need iso why take itt

  14. Vincent Taylor says:

    You may be emotionally involved but you’re also spot on. All levels of aged care need a massive influx of funds.

  15. Anonymous says:

    I think the aged care sector needs a good overhaul every company that is in this sector should have the compassion and dedication to the people that they look after so the people that they employ need to be trained properly so the people they are caring for have the care that they deserve. So then the aged are shown the compassion and respect they deserve and should be a priority and maybe included in the decisions that are made about their care when possible. I love working within this sector knowing I think that makes a difference when you have people that want to give back to the generations that fought for the freedom that we have today. That needs to be a priority when these companies are looking people to do the jobs that it takes to look after the aged or they need to spend the money into training it shouldn’t be all about the money for some of these companies it is and that is all it is about.

  16. Anton Hutchinson says:

    Some interesting comments but the one that strikes me as arrogantly nieve is the one talking about making millions in profits. Let’s all get this clear, residential aged care is a business, just like a motel but for frail and unwell rather young and drunk. Despite the fact, well recognised by the Royal Commission and government, that residential aged care is grossly underfunded the vast majority of facilities are continuing to provide excellent care while they slowly go broke. The media loves to print about the millions in profits but there has to be profit and a return on your investment. Motels for example return around 18% plus but the nursing homes that did manage to make a profit returned less than 1%. When you hear from the haters about the millions remember that they have hundreds of millions invested.

    47% of facilities lost money last financial year, this is not a cut in profit but an actual cash loss. 47% equals about 1200 homes looking after 100,000 plus people and employing a similar amount.

    Home care is unsustainable, it was I’ll conceived and the enormity of the cost was simply not calculated. The recent 500million bought 10,000 places. Clearly costing 50k each. Another 120,000 places will cost 6 BILLION DOLLARS!!

    A person living in residential care under 65 suffering for example with MS will attract 70k per year from the government. When he/she move and are under full NDIS that cost goes to 700,000 per year.

    Residential care needs a 15% increase in funding and they need it now so why is the Morrison government throwing good money after bad with Home and NDIS but deliberately ignoring residential care? What is their agenda? Let me tell you this, residential care is getting a bum wrap and there isn’t any alternative.
    We should also not forget that the government set up this industry, why? Because like everything else they do they can’t do it well or to budget.

  17. Wanda Mills says:

    We desperately need people in power, politicians and including a PM, who are ethical and who have a social conscience for effective change.
    I watched my 102 year old mother suffer from neglect in a nursing home, and prior to that at age 100, struggle with dementia whilst living in her own home – with little Gov support.
    In retrospect I wish I’d had PowerOfAttorney to have sold her home and moved her to my home and paid every cent of her house sale on being decently cared for in those last 4 years of her life.

  18. Anonymous says:

    Australians are not aware there is NO legislation for the staff, resident ratio in aged care facility.
    That should be the first issue addressed. Too hard you make think, no it is absolutely simple. The 18.6 billion dollars allocated to facilities is based on ACFI assessment s done on residents and is paid where additional staff are required to address the personal extra care requirements of a resident.
    STAFF NUMBERS AT A FACILITY SHOULD REFLECT THE FUNDING LEVELS OF A FACILITY.
    Three monthly accreditation of ACFI funding at a facility should not rely solely on paperwork based assessments done at the facility. They need to be given access to the computer notes done by staff to coralate with the paperwork providing PROOF of entries on paper. This makes the faculty accountable for the accuracy of assessments done. The

  19. Anonymous says:

    I think that the CEO.Sof these big companies need to get their head out of their bums ,take a pay cut and get their managers to support the very hard care staff a big pat on the back for all their had work , in many times they work short staff or with under qualified staff, a lot of staff that i kbow are walking away . because of the pressure of the job for little pay and ues i have worked in aged care for many many years

  20. Anonymous says:

    I totally agree. Facility Managers earn 100k plus and what do they do sit in a office. Pay the carers that know the residents more and imcrease the ratio of carers to residents.
    Night shift you have 2 carers and 1 RN and majority of the time the RN is asleep in a corner somewhere and the 2 carers have to run the facility of 80 plus residents.

    Also this Aging in Place in some facilities is bullshit. You have residents suffering from dementia in the same wing as residents that have had a stroke. Those residents with dementia wonder around the whole day and into otber residents rooms which is very unfair.

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