A 'perfect storm' in aged care

It may have flaws, but National Seniors’ Research Director Professor John McCallum writes that consumer-directed care deserves more effort to ensure its success.

The Federal Government must feel like it’s faced the perfect storm, or a ‘North Queensland cyclone’, in the past month in its politically sensitive, aged care portfolio.   Retirement villages, or retirement living accommodation (a State Government responsibility), has been outed for gouging residents and their families and the difficulty of regulating safety and quality in nursing homes has raised its hydra-head yet again. Now the new National Seniors report on the Federal Government’s consumer-directed home care program says it’s at risk of failing.   Until February this year, Australian home care services were in packages awarded to service providers. Now older consumers are assessed for funding, which they can use to ‘purchase’ services from providers of their choice. The system is also designed to allow older people to age in their own homes and communities, rather than moving to nursing homes. This major reform is like shifting from a ‘command’ to a ‘market’ economy and many people find it hard to know what to buy or how to buy it.   The National Seniors survey of 4,267 members found 98 per cent of members 50+ believed choice of home care services was extremely or very important regardless of their age, with those living on the aged pension most likely to say it was extremely important. However, despite almost universal support for it, a fifth of respondents had no confidence of being able to choose a provider to suit their needs and another third were unsure. The responses were a real curate’s egg.   National Seniors member interviews and local member forums revealed some problems with the new system, including lack of choice, high administration fees and insufficient care packages. Confidence was particularly low among residents of regional communities, where the number of providers was low or non-existent.   As one woman told National Seniors: “My experience with my mother made me realise that the providers are so stretched that even ... getting on a list for home care was difficult. In the end my mother went into a facility before we could arrange home care support.”   Another member demonstrated how consumers felt unable to negotiate their own services: “I know one person who is considering cutting out a one-hourly visit each day to reduce costs. He doesn’t know what he is paying for and is too sick to question, or just doesn’t understand the system, but assumes the service provider is doing the right thing.”   The dilemma is, despite the problems, support for the concept of consumer-directed home care was high, with consumers wanting choice and flexibility in aged care. And, despite reports of “endless horror stories” about the My Aged Care website – the main source of information –more than half said they were satisfied with it.   The experience in Australia mirrors what’s happened elsewhere in the world during the start-up phase of consumer-directed systems. Over 10 years ago, in Japan, their long-term care insurance system had significant failure in regional areas. It takes people time to get used to having choice.   With overwhelming support for consumer choice, we need to reform consumer-directed care to avoid market failure. It’s also high time to recognise that the government can’t do it all and give it credit where it’s due for what is a bold initiative.   Service providers report that improvements usually occur within six months of their messages so the system is responsive to comment and criticism. So service providers, experts and consumers should get their messages through to government to give them the chance to make the changes necessary for reform.   It’s important we work together to ensure CDC succeeds – already one million Australians are receiving aged care services, the majority at home, and by 2050 it’s projected to be more than five million.   Let’s not throw the bouncing baby out with the bath water.   National Seniors’ new research report Consumer Directed Care in Australia: Early stage analysis and future directions is available here.   This article by John McCallum originally appeared in the June/July/August 2017 edition of 50 something magazine.

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