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The World At Large
Caring for Older Australians
In 2010 The Australian government initiated a public inquiry into ‘.. further structural reform of the aged care system in the light of emerging demographic challenges..’. The government appointed the Productivity Commission (PC), an autonomous body with its own act of parliament, to carry out the inquiry through research and public consultation, and develop options for redesigning the aged care system with a view to increasing choice and independence for older Australians needing care. This scenario is somewhat similar to the UK Royal Commission on Long Term Care. However, there has been a plethora of reports on aged care in Australia over the last couple of decades, and the PC was required to incorporate this history with current and future demands in developing an action plan for aged care that fits with the 21 st century.

In the final report released in August 2011, the PC documented some of the vulnerabilities of the existing aged care system, including its relationship to the rest of the health system. Some of the challenges of an older and increasingly diverse Australian population were identified as: a significant increase in demand with the ageing of Australia's population; significant shifts in the type of care demanded, with an increased preference for independent living arrangements and choice in aged care services; greater levels of affluence among older people, recognising that income and asset levels vary widely; changing patterns of disease among the aged, including the increasing incidence of chronic disease such as dementia, severe arthritis and serious visual and hearing impairments, and the costs associated with care; reduced access to carers and family support due to changes in social and economic circumstances; the diverse geographic spread of the Australian population; and an increasing need for psycho geriatric care and for skilled palliative care; and finally the need to secure a significant expansion in the aged care workforce at a time of ‘age induced' tightening of the labour market and wage differentials with other comparable sectors.

The PC received over 500 submissions to its inquiry and conducted a large number of public consultations, which indicates a lot of interest in this key policy area. The classic Australian aged care service triangle below (Howe 2010) was used to illustrate the existing aged care system, currently providing services to over one million older Australians, 70% of whom are female and with more than half aged 85 years or more. By 2050, this service provision is expected to grow to 3.5 million users. While this system has been increasing in range and quality of care services, the PC focused on the weaknesses in this system, as outlined above, which have resulted in delays in assessments, some discontinuity of care, financial inequities across different levels of the system, which the PC concluded leads to some uncertainty about care availability.

Consequently, the PC report, after 17 chapters of solid research and consultation findings, makes around 80 recommendations addressing its key terms of reference of redesigning the aged care system to meet future challenges. The recommendations, based on consumer-directed guiding principles, cover key issues, including paying for aged care, access, service quality, catering for diversity, accommodation, carers, workforce regulation, and policy and research. The report then outlines a possible implementation plan for transition to the new system. While the report has generally been well received by consumer groups and providers, it has raised some controversial issues with funding or paying for aged care as the most discussed. The PC wants to broaden the funding base to pay for aged care, and although it stopped short of recommending Long Term Care insurance, it does recommend that older Australians continue to contribute to their costs of care but with a maximum lifetime limit, and a safety net for those of limited means. Future residents it argues should be given the option of selling the family home, or using an innovative Australian Aged Care Home Credit Scheme for those who do not want to sell. A simplified ‘gateway’, in the form of a one-stop shop’ in each region is recommended to enable easier access to vital information for families needing care services.

The Federal government is still considering its response to the report, and the 2012 budget is seen as a possible time to enact some of the recommendations. However, what the government does decide will of course be set in the overall context of the Australian and global political economy. Regardless, this report will be useful reading for those interested in aged care.

References:
Productivity Commission (2011), Caring for Older Australians Report No.53, Final Inquiry Report, Canberra, Australia.
Howe, A. (1996; revised 2010), ‘Changing the balance of care: Australian and New Zealand’, in OECD 1996, Caring for Frail Elderly People: Policies in Evolution, Social Policy Studies no. 19, Paris, p. 231.

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