Funding independence means redesigning the purpose of aged care

When outgoing Inspector-General of Aged Care Natalie Siegel-Brown addressed the National Press Club, she argued Australia’s aged care system doesn’t have a funding problem, it has a value problem.

Australia’s aged care system has been designed to respond once people are already in decline. Funding follows need, services increase as independence decreases, and the greatest investment is reserved for people with the highest levels of dependency. That imbalance is no longer sustainable. Australia cannot simply fund or build its way out of future demand; it must reduce preventable decline before it becomes inevitable.

The revelation that 65 per cent of people supported through the My Aged Care system are utilising 6 per cent of the total Aged Care budget via home support services elicited a chorus of slow blinks from the audience. 

“We keep asking if we can afford to fund prevention, but I think the better question may be whether we can afford to not fund preventable decline.”

“Every single dollar we spend reducing decline, is a dollar working harder for older people and the tax payer, alike,” she said.

Aged care is a system designed for problems

Australian Physiotherapy Association President and gerontological physiotherapist Dr Rik Dawson believes the evidence to support a different approach already exists. 

“We’re so used to providing funding for fixing problems. That’s how we’ve always done it in Australia,” he explains.

Dr Dawson believes the system should stop asking what older Australians can no longer do and start asking what is still possible. That shift might sound idealistic to some but measuring and building capacity is an approach that is already in use elsewhere around the world and can deliver tangible positive outcomes, both for older Australians, government coffers and the average taxpayer. 

From measuring need to measuring unrealised capacity

For decades, aged care assessments have determined what support someone needs today. Dawson believes they should also determine what support could be avoided down the track.

“I would suggest that every older person who’s about to enter the aged care system should receive a restorative care package to assess what their true level of functional capacity is.”

Dawson goes on to say that rather than immediately allocating ongoing services, restorative care would first seek to improve strength, mobility, confidence and independence before long-term support levels are determined.

The principle is already recognised through the government’s Restorative Care Pathway. It provides up to 20,000 places annually, or around 5,000 each quarter, for older Australians who would benefit from intensive, short-term allied health and other support aimed at restoring function and delaying further decline.

Dawson’s proposal is that Restorative Care Packages should become the default starting point for everyone entering the aged care system. With around 76,000 older Australians entering My Aged Care over a quarter, he argues the current allocation is unlikely to influence demand at the scale required. 

We know restorative care works, but is Australia investing in enough of it to meaningfully change the trajectory of future care demand?

Sector-wide, the objective is not to eliminate demand for aged care; we haven’t found the fountain of youth, after all. The aim is to help Australians remain independent for longer before requiring greater support. 

Providers can shape demand

For providers, this concept may appear counterintuitive. Why invest in helping people need fewer services? But for a sector grappling with long-term sustainability, there are few viable alternatives.

“If we have more restorative care packages, people would move on to Support at Home at a lower cost. You invest in building up capacity and then you give them a programme of support, but it’s less intense because they no longer need as much.”

A person who remains mobile, confident and socially connected for longer is likely to require less intensive support, delay hospital admissions and postpone entry into residential care. 

All the puzzle pieces are there; providers bring them together 

Much of the aged care reform conversation has focused on funding models, workforce shortages and program design. Dawson argues the evidence for prevention is already well established.

Regardless of how policy evolves, providers are best placed to expand restorative approaches, partner with allied health and demonstrate the long-term value of prevention.

The biggest shift needed here is philosophical. If aged care has traditionally asked what support people need because of what they’ve lost, the next generation of reform could first ask “what are you still capable of?”