$3 billion dollars welcome but the point remains missed – policy keeps forgetting australians want to age at home

Minister Butler’s announcement that $3 billion dollars would be committed to deliver more beds has been largely welcomed. His National Press Club Address tackled multiple elements of the ‘cracks’ in aged care and how the incumbent government is seeking to solve them. From capital injections to help providers build more beds, to supporting those beds for those with less means, industry leaders are acknowledging the help this will bring.

But there is a deeper vein of frustration that has been building in the sector, for provider leadership and staff who are having daily conversations with seniors and loved ones, the question needs to be asked, why is government policy repeatedly ignoring what seniors have been voicing for decades? When every report returns the affirmation that seniors want to age at home, why do policies and strategy continue to not only lag behind but miss the point entirely? While bringing showering back into covered services alongside clinical care is a long-overdue step, advocates and industry leaders ask: why hasn’t government focussed on investing in preventative medicine and support to keep seniors exactly where they want to be, at home, and healthier?

Pre-emptive

While the sector has routinely asked for stability and assistance to tackle significant challenges to bed builds, the deeper vein of issue persists – why has government focus not entrenched pre-emptive measures to mitigate the demand for beds?

From non-profit, to for-profit, to faith-based and all in-between, from purely RAC providers and then those just in home care, to those in the market to meet both, there has been a ubiquitous and frankly put, perplexed confusion as to why the government has not invested in keeping Australian seniors at home longer, and healthier.

Every report under the sun has come back with the same figures, Australians predominantly want to age at home. Provider leadership has been clear, yes the $3 billion dollars is welcome to help catch up to the drastic need of seniors entering residential aged care right now, but a glaring omission was found in Minister Butler’s Wednesday press address. The conversation must turn to what is behind consecutive administrations forgetting the larger, more financially expedient strategy, to support seniors to, as much as possible, not need it at all, certainly not needing RAC early.

Within the government’s own figures, Australians have been saying year in and year out that they want to age in place at home. That figure has stayed around 90% for decades. Advocates remain perplexed and in many cases angry at how policy has not met this blatant sentiment.

While the win of having showering placed alongside clinical care in Support at Home, with co-payments scrapped, advocates and industry leaders are frustrated that a campaign needed to be waged at all.

Home is cheaper

Multiple reports across health disciplines, psychological studies and industry white-papers have yielded the same results, seniors at home, in the environment where they are familiar and feel safe have tended to support them to remain healthier and need less complex care from hospital and RAC settings.

A RAC CEO spoke with Hello Leaders and said, “it’s bizarre how the government hasn’t seen keeping seniors at home as a significantly beneficial policy lever. Not only is keeping seniors at home and out of hospital cheaper for the tax-payer, it also helps us in RAC try to catch up with bed demand and build rates, and save places for those that really need the higher level of care in RAC.”

“For many of the people we accept into our home, they have higher needs, and we also have to work alongside them in their sadness at having to enter RAC care. It would be so much better if the government willingly saw and supported keeping seniors at home and out of expensive hospitals and entering residential care early”, he says.

Another CEO, Russell Bricknell of Juniper in WA tackles the ships in the night attitude of government and sector leadership.

At its core he reminds government, the Royal Commission supported pre-emptive measures to keep seniors at home for longer, and healthier too.

“The Royal Commission suggested that home care services should not be rationed, we [Juniper] support that view.”

Burden of persuasion

The battle won of showers now covered for seniors is a start but advocates and sector leadership point to the unnecessary greater dispute being waged, the consistent delay in packages being released, the consistent approval of packages at interim amount of 60%, further reducing services to keep seniors supported at home, and the “bizarre” IAT tool churning out unfathomable results of ineligibility of funding for desperately needed services.

Butler and the government last year noted sector approval to suppress in-home, pre-emptive support packages, “the deferral of the commencement [Act and Support at Home Program] followed advice from the aged care sector, as well as advocacy and representative bodies.”

And yet numerous CEOs in aged care have directly contradicted this over the last few months, Bricknell notes, “Juniper, Uniting Care Australia and many other providers all campaigned for there to be no delay to the release of home care packages from the moment that Act was passed in parliament.  Our view was that a delay in package release was unjustified and would result in hardship for older Australians.”

Advocates and provider leadership have been voicing this strategy for years. Supporting seniors as they approach 80, the age used to determine higher aged care needs, will yield cross-sector, cross-demographic improvements, namely, the easing of pressure on RAC and hospitals. Seeing pre-emptive home care as a return on investment is a no-brainer, sector leaders attest, with financial, capacity and resource impacts yielding powerful beneficial impacts, to both seniors and tax-payers.

But that environment is still one that has not been gripped by the government. Advocates and industry leaders detail a sustained onus of persuasion that still seems to be falling on their shoulders.

Strategy efficacy

The Inspector-General for Aged Care has tackled this strategy conversation head on. Following Minister Butler’s National Press Club Address she has responded by welcoming the scrapping of co-payments for showering, “there is no doubt the removal of co-payments for these services will make a meaningful difference.” But her analysis goes further.                                     

“But there is also a financial dividend from this decision. Far from being a budget burden, incentivising timely uptake of Support at Home means more people get the right help earlier, at lower intensity—slowing decline and reducing the need for the most expensive, tertiary care at the back end of the system.”

Siegel-Brown bears strategic and convicted witness to what providers and advocates have held as substantive and beneficial for decades, support seniors earlier, to be healthier longer, to stay at home, where they want to be, and there will be financial savings and pressure easing in healthcare, hospitals and RAC.

She poses the question industry leaders hope reaches government ears, “so the question is: how do we use the existing $40 billion aged care budget to support ageing in place, delay residential entry, and make the whole system work harder for longer, for more people?”

 “It’s not about spending more, but using existing funding to support the services that help older people stay well, independent and at home for longer. This reduces the need for more intensive and costly care later.”

For sector leadership, for tax-payers, and importantly for seniors looking to a strong, resilient and importantly, sustainable aged care, Siegel-Brown echoes wide sentiment, “[Wednesday’s] decision brings us one step closer to the vision of the new Aged Care Act 2024. But we can do more without breaking the budget.”