Aged care Q&A

In this issue we speak with Council of the Ageing (COTA) Chief Executive, Ian Yates, about the anticipated overhaul of Australia's aged care sector.

How confident are you that Federal Government’s report, Caring for Older Australians, will lead to meaningful and effective reform to the aged care sector?

We are reasonably confident, which is not to say that we won’t be working very hard to ensure that the government gives the report high priority. I think the government does take the report seriously. We are confident, firstly, that Minister [for Mental Health and Ageing] Butler has a strong commitment to reform, which he’s already demonstrated in mental health. He, without expressing a definite government view, was very welcoming of the directions of the draft report, fitting in with his principles of greater choice, greater consumer focus and better sustainability. We also have the Prime Minister’s commitment, which was made during the election campaign and has been repeated since, both by her and other ministers that aged care will be a second-term priority. We’re saying that means 2012, because there needs to be a fair lead time with this. That has been emphasised by [Minister for Health and Ageing] Nicola Roxon. We are getting much clearer signals that the Department of Health and Ageing also thinks that now is the right time.

There is a quite considerable cohesion between the key provider group peak bodies: the consumer organisations, the professionals and the unions. There is a quite remarkable coherence around the model, which is, by and large, pretty closely aligned with what the Productivity Commission (PC) recommended in the Draft Report. Our understanding of the Final Report is that it rather more fills out what was in the Draft Report, rather than proposing significant differences from the Draft Report. Our understanding from that is because we worked closely with the PC, during the hearings, and a lot of informal work was done on what it all could mean, and so on. They worked on the basis that people wouldn't be surprised when they read the Final Report.

What steps in terms of policy would you like to see made to address issues around housing and residential care?

I think what’s at the forefront are two significant shifts. The first shift is that we need a lot more support and care in the home, and that needs to be available immediately and at the appropriate level. What we have at the moment is a rationed number of, particularly community aged care packages (COCP), for which there are significant waiting lists, and they’re all under resourced. COCPs have not been properly kept in touch with increased costs for many years now. That means that they’re now really worth about two thirds of what were, and that has a really significant impact. There needs to be a lot more community care, and that care can be provided in any context. That’s what the PC is saying. There is needed properly-assessed care available in a flexible package that’s available when needed and in any setting. Secondly, we need to see a move to consumer entitlement and consumer focus. Because, at the moment, what we have is beds and places given to providers in regions. What the PC is saying, which is what we said in our submissions, is that it needs to be given the person against an assessment. So a person goes and gets an assessment, and then a person gets an entitlement, where they can then use that money to buy from an approved provider. So those are the two big structural changes, together with a real beefing up of the assessment process.

Then we’re saying if someone can put their care wherever you like, firstly the trend we’re already seeing is a move away from residential care, particularly low care, will continue. But we’ll see a significant increase in the seniors housing market. So we’ll see more flexible approaches. At the moment what we’re seeing is either aged care purchased buildings or retirement villages. We’ll see much greater diversity as the market will try to understand what it is that seniors in very late years want. And that might be quite differently designed high-care facilities which we see now in the extra-service category. But we will also see things like clusters of housing that people might even buy, rather than having to put in a loan against, which will remove that bond issue. But if the principle which the PC has enunciated is that in Australia, by and large, we regard the individual and family as responsible for the housing throughout one’s life, with the exception of the social housing as a safety net, then that continues in aged care, and you don’t have to deliver the care in specialised settings. So we’ll see more diversity, we’ll see people who want to pay lots of money to live in spiffy places, and we’ll see people who want to live in more modest but approved accommodation.

Australian aged care workers are typically amongst the lowest paid in the country. Considering Australia’s high demand for aged care workers where would you like to see the government moving in this area?

Workforce is critical whatever any kind of system that you've got. The PC Final Report, we believe, will say that attention needs to be given to giving fair and competitive wages in the sector. But, there’s not a simple mechanism for doing that, you need to work through the industrial system. And then the question will be: What is a fair and competitive wage, and how do you build that into the price? So what the PC is recommending are different user-payment mechanisms, but it’s still means tested, but still, on their recommendations, the bulk of what would be paid for, even by reasonably well-off people, will be paid by government. The Draft Report said people should contribute from between five and 25 per cent of costs; we think the final report will say between five and up to 35 per cent. But it still means governments are paying two thirds to three quarters of costs. So, if wages are increased, and I don’t hear anyone saying it shouldn't, government have got to be prepared to make that provision in the pricing structure. Certainly we should be increasing wages, but I want to say really clearly, increased wages should not apply just for nurses. The bulk of the workforce in aged care is personal carers, allied health, etc., and they need to be properly paid.

So by contrast, at the moment, instead of entitlement going to the consumer, based on their assessment, they still have to be assessed but the entitlement then goes to providers. Providers then either get that entitlement in the terms of either bed licences or packages, and they come through the ACAR (Aged Care Approvals Round) every year, which are assigned to particular providers and to particular regions. And what the PC is saying, and we recommended that they say, is that the entitlement should attach to the person, and then the person can get that from whichever provider that they prefer, that suits their needs best. The notion that somehow or another that care should be rationed by region is antiquated; it relates to the beds. At the moment you’d also have to say that the principle focus of the aged care discussion is around residential, whereas most people are cared for in the community, now. It is a strong consumer preference to be supported at home. It also means that community and home workers, there’s a potential for the professional worker to become a partner with the family, neighbours and friends, in a different way that is possible in a residential setting.

Do you think these sorts of measures are going to be financially sustainable over the long term given our ageing population?

I think there are probably two answers to that. The first is that the government shouldn't make a major shift in wages overnight. You’d need a phased series of steps to get there, and in which there’s a combination of contribution from public and private sources. The second point is that if we don’t pay decent wages in aged care then we won’t have a sustainable system anyway. And I don’t think that 21st century Australia is going to tolerate an aged-care system that starts falling apart. If we can’t staff then people will be at risk.

Are the current provisions for primary and ancillary medical services adequate?

We think there is an enormous opportunity for the health system to redesign itself around primary care directed at older people’s needs, but also health promotion and illness prevention. Health promotion, illness prevention and older people don’t seem to go together in the same breath with health-promotion purists. They have got this notion of ‘lifetime’, which means that they start with the kids and by the time they get old they’ll be better than these old people are. But you can make an enormous number of health interventions with people in their 50s, 60s, 70s and older, that give immediate gain, that delay morbidity.

Ten years ago when we were talking about running strength training programs for old people, you could see people look at us really strangely. ‘Yes, you need to get them to do a bit more exercise and so on, but strength training, in gyms? Pumping weights?’ Well, we have hundreds of thousands of people around the country now doing it, even though we've had very miserable amounts of government funding. But, the evidence is clear that people who build up their physical strength remain more active and involved, they get less depression; in fact it’s as good as a drug for treating depression. We really need to embrace that stuff in a much more vigorous way – aerobic health, physical health, mental health and dental health of older people – it would have a dramatic impact on their use of the acute system. If I was a health minister looking at my future demographics right now, I’d be saying, ‘oh my god, look at who’s going into our hospitals, there’s all these old people, what can we do?’ Well, we can strengthen them, get them active and involved. All of that costs far, far less than the costs every day. A huge amount can be done there, and we have to see that in a population sense, not in seeing each person individually.

Does the increased funding to mental health in this year’s Federal Budget take into account the apparent increasing demand for the elderly, as well issues such as dementia and Alzheimer’s?

We were very positive about that package, but it did not go far enough in terms of psycho-geriatric services. The Minister [Butler] admitted that, and said that he anticipated that would come at the same time as the decisions around the PC. Certainly those services are part of what we see as in scope for aged care reforms. Again, that’s about investing in mental health services for old people, and that can have a significant impact. Investing at younger ages would also have a significant impact, once they get older, but you can support now. Then, one particular subset of that is that we need to put more money into dementia, both into research, early detection and support.

Dementia is the unacknowledged major disease. Cancer, heart, stroke: we’re all now funding properly. Dementia’s right up there in terms of morbidity and mortality, but we don’t like to talk about it. The impact of it is huge. It’s estimated that in the not too distant future there will be about two million people in Australia with dementia. And every person with dementia affects about four other people.

How do you see e-health affecting aged care?

We’ve been very supportive of e-health, and have been very critical about the that fact that it’s taking so long to implement. We see e-health as particularly important, in terms of remote access, but also, obviously, the patient record is really important because older people tend to be users of such a range of medications. Knowing what medications are being taken and what they’re used for is really important as people move through the system, and colleagues can get confused about what’s happened. The other area that we’re feeling really positive about in terms of the future is assistive technologies; and that links with the focus in care in the home. There are a whole range of IT items that can assist people to get on with their lives. The industry is very interested in technology for workforce efficiency issues, and we don’t have any problems with that, but we’re interested in things that enable people to continue to live an independent life in the community. 

IAN YATES AM

Ian Yates is Chief Executive of COTA Australia, the national peak body for COTAs (Councils on the Ageing) in each State and Territory of Australia.

Ian was Chief Executive of COTA Seniors Voice (Council on the Ageing) in South Australia (SA) from June 1989.

COTAs are the peak aged consumer organisation in each state and territory, with over a thousand organisational members representing over 500,000 seniors, plus around 40,000 individual members of COTAs.

Ian serves as COTA representative on a wide variety of Federal Government and aged sector national bodies including the Ageing Consultative Committee to the Federal Minister for Ageing; the consumer advisory committees to the Australian Securities and Investments Commission and the Australian Competition and Consumer Commission and the Australian Energy Regulator; and the National Aged Care Alliance. In June 2011 Ian was appointed to the Board of the Aged Care Standards and Accreditation Agency Board.

Ian holds a number of other roles in the COTA network including as Chair of COTA Member Services; Director of COTA Insurance Services and CEO of the COTA National Projects Unit.

Among other roles in the community Ian is currently:

• Deputy Chancellor of Flinders University


• Member of the SA Government’s Health Performance Council


• Board member of the Aged Rights Advocacy Service

Ian holds a BA from Flinders University; is a Member of the Australian Institute of Company Directors; and was awarded Membership in the Order of Australia (AM) in 2005.