COTA Affordable, Accessible, Appropriate Housing for Older Australians

HCCA Consumer Reps Ros Lawson, Sue Andrews and Marion Reilly attended the Council of the Ageing (COTA) Affordable, Accessible, Appropriate Housing Forum on Thursday 22 June 2017 at the National Press Club and have written a summary below of their thoughts and findings from the event.

An impressive range of expert speakers with both research and lived experience representing the community sector and government addressed the themes of the forum, many warning of a looming crisis as older Australians face mounting pressure from rising rental prices and carrying mortgages into retirement. They discussed new ways to address the changing housing needs of older Australians including affordability, housing security and housing options appropriate for older Australians, now and in the future.

With much criticism of one of Australia’s biggest retirement village operators as “bleeding residents until they die” in the news lately, the forum couldn’t have come at a more pertinent time. Surprisingly only a small percentage (5.7%) of seniors actually live in Australia’s 2,200 retirement villages , according to Ben Myers from the Property Council of Australia. He told the forum that the average age of entry to these villages was 75 with most staying about 7 years. The industry was now facing some serious problems. Most of the residential village housing stock is more than twenty years old and is often not what people want. These days village residents demand cinemas, gyms and coffee shops on site, pet friendly policies, communal gardens, and integration into the surrounding communities. One solution is to make retirement village mixed age communities. Myers quoted examples from Queensland where younger residents joined the villages where the average age was 80 and bought back the choirs and volunteering that had been in decline.

Providing residential villages in regional areas was often difficult because housing prices are currently not high enough for people to get sufficient equity to buy into the villages, and construction costs are often too high in rural areas.

Opening the forum, Ian Yates, CEO of COTA emphasised that the focus was on providing affordable, accessible and appropriate housing for seniors, and not residential aged care facilities. It costs the government as much as $34,000 a year to keep a person in residential aged care compared with $4,000 -7,000 to provide home support and care. Keeping people in their own homes and their own local community also promoted social connectedness with consequent good effects on their health and wellbeing.  

Overall, there is good news on the housing front for the majority of Australia’s 65 plus age group. But there is part of the population who are facing tough times.

Dr Judith Yates from the University of Sydney’s School of Economics said that 84% of the nation’s 65 plus are homeowners with 76% of that group owning their homes outright. The remaining 8% have mostly modest mortgages, and therefore most have very small housing costs. But private renters are in trouble, with about a quarter of them spending more than 50% of their income on rent causing much financial stress.

Renters also have much lower amounts of assets to call upon in times of economic hardship (the average is $1.2 million in super and property compared to under $200, 000 for renters). And this disparity will become even greater as the next generations face retirement.

The forum’s keynote speaker, John Daley CEO of the Grattan Institute (Australia’s leading non -partisan domestic research institute) says there are storm clouds on the horizon of housing accessibility for seniors.

A copy of John Daley’s presentation is on the Grattan Institute website: https://grattan.edu.au/wp-content/uploads/2017/06/COTA-seniors-housing-2017-June-16-9-original.pdf

Currently it’s not a social catastrophe as today’s seniors are net savers not spenders and will often pass away with more money in the bank than they retired with. But there are serious issues for those renters who are on pensions. They often have to skip meals, and are unable to pay utility and car registration costs so they can meet housing costs.

Rates of home ownership are falling for those in the 35-44, 44-54 age groups compared to those today who are 65 plus for whom the home ownership rate is the same as it was 35 years ago. In fifteen years’ time he predicts there will be significantly fewer people owning their own home, and there will be a real problem for renters as there has been little social housing built in the past 30 years. Currently the mix between private and social housing renters is about fifty fifty. Those people who have managed to get into social housing now will be staying on for many years so little will become available in the long term. According to Daley the only people able to access social housing now are the homeless and those suffering domestic violence.

And the answer to getting more housing is not for today’s seniors to downsize from their large suburban homes. When they downsize their choice is often limited to high end low density dwellings like townhouses and duplexes. Daley says this has arisen because those areas ripe for redevelopment- the medium density suburbs 10-15k from the city centre, are precisely those suburbs where there has been resistance to increasing the density of dwellings with apartments- the NIMBYs. As people prefer to downsize to a location that offers them shops, transport and community, most prefer to stay in the area they currently live in. Affordability is not on their list of desirability. So when large family home blocks are sold off, they are often replaced by high end town houses and duplexes. What is needed is to force developers to create affordable housing in larger developments and to ensure that the suburbs stay mixed as they are in Europe.

Daley warned of the shift from a system of stamp duty to land taxes which like rates would be paid over time. When land values go up because of favourable developments like trains and jobs then residents would pay more, and owners may have to seek economic buffers like reverse mortgages. 

He ended his talk by saying that what is needed is policy reforms like owner occupied housing being included in the asset test, and tax benefit and superannuation reforms. These are political debates that have currently stalled but he says when they next come to the fore they will run and run.

At the end of the discussion on affordability the former Senator Susan Ryan and now Age and Disability Discrimination Commissioner, raised the issue of the gender divide. She pointed out that there are more than 700, 000 women over 45 on low incomes who are single and do not own their own home. And John Daley agreed that the housing issue was most serious for women and that the overwhelming number of disadvantaged over 65s were women in single households and who are in the private rental market.

Other highlights of the Forum were the panel discussion about Affordable housing. Adrian Pisarski from National Shelter pointed out that there is no reliable current data about housing supply to inform policy decisions. More vulnerable people are more likely to be displaced and are then more at risk of homelessness which is on the rise including for older women. He mentioned Wintringham housing service in Melbourne as one of only a few who provide housing services for homeless people. Social housing is ‘broken’ and not meeting demand as the government is not investing enough. He thinks that the Community Housing sector has the capacity to increase supply but will always need investment from government.

Jeff Fielder from Housing for the Aged Action Group (HAAG) in Melbourne talked about their operation as an information and support service for older people. They provide early intervention for the growing number of older people at risk of homelessness. Again he noted that the private rental market does not work for older people because of short leases, high rentals and much lower rental housing in very poor condition. There need to be more options for people to access affordable housing equitably – public, community, independent living units, rental villages, aged care linked housing, Abbeyfield model, residential parks, shared living and a lot more advocacy. And he also noted that the aged care sector is well placed to assist with advocacy and appropriate placements by being better integrated with the housing and homelessness sector.

Lisa Langley from COTA NSW presented some outcomes of research with older NSW residents which tested attitudes and policy assumptions about housing which are made on behalf of older people.

The panel discussion about Accessible housing (regardless of age or ability) focused on issues of universal design, with contributions from Denita Wawn, CEO Master Builders Association, Sue Salthouse, Director of Rights and Inclusion Australia and David Brant from the Australian Network for Universal Housing Design. Contrary to the commercial market driven approach of the MBA, Sue Salthouse emphasised that self regulation doesn’t serve the market which shouldn’t only be driven by demand, an unreliable predictor of future longer term needs. Housing needs to be provided within the framework of human rights and our responsibilities under the relevant UN Conventions. She pointed out that all housing needs to have accessible and appropriate features. There is a complicated set of standards and regulations for builders, government and providers which makes accessible housing very challenging to regulate. 

David Brant picked up this issue saying that there needs to be more regulation and all new housing must meet a single basic accessible standard which ANUHB is lobbying for. This includes easy access from the outside (including lifts), internal ramps with no steps, wide doorways and halls, accessible toilet and bathroom and capacity for carer sleepover. This is slowly being implemented, especially in Victoria. This will ultimately be very cost effective by contributing to preventing older people being admitted (no falls, general safety) to aged care facilities.

The overlooked but very important issue was raised about older people living in rural and remote communities. They are unable to stay ‘home’ but can’t afford to move and are ineligible for assistance. This highlights the broader issue of lack of appropriate affordable services for remote communities.

For more information about the Forum go to the COTA Australia website where most of the presentations are available to download:

http://www.cota.org.au/australia/Achieving/national-policy-forum-powerpoint-presentations.aspx

Sue Andrews

Ros Lawson

Marion Reilly

Reframing Primary Health Care for Older Australians

HCCA funds places at key events for our members to attend and participate in policy discussions. The most recent event was the COTA annual policy forum. This is a report from three of our members who attended. 

COTA Australia held their annual national policy forum at the National Press Club on 21 July 2016.

It was an impressive line up of front line policy drivers in the field of primary health care for older Australians, a scenario that gets little traction in the media apart from the supposed impending “tsunami of silver haired” Australians coming to an already overstretched health care sector. Probably the key point to come from the conference was that the numbers didn’t represent an impending catastrophe, but that should be looked at differently, with the societal response to older people needing reframing and older Australians respected because of their contributions to society and their human rights.  

Ian Yates, the CEO of COTA Australia, noted that in a recent survey of their constituents, older people nominated heath as their top issue of concern, a change from the previous top issue of the economy. Health will now be a strategic priority for COTA.

Highlights of the forum were key note presentations from Dr John Beard, Director of the WHO Ageing and the Lifecourse Programme and Prof Diane Gibson, Dean of the Faculty of Health at University of Canberra.

Dr Beard highlighted issues from the recent WHO World Report on Ageing and Health (http://www.who.int/ageing/publications/world-report-2015/en/):

·         Healthy ageing requires an understanding of capacity and environment starting from high capacity where the needs are to help identify and prevent disease onset and adopt appropriate health behaviours; declining capacity where the focus shifts to slow decline often with multiple chronic conditions where prevention becomes important with things like resistance and balance training, and disabled public transport is provided; and finally significant loss of capacity with extensive needs and support;

·         The pressing need is for us to realign the health system to shift from an emphasis on acute care for the individual to care for multiple chronic conditions with better measuring and monitoring;

·         The costs of health care for the ageing need to be seen as an investment in the health system. Better health means long acquired skills and knowledge are maintained with the ensuing benefit to society;

·         Older people need a supportive community NOT always more funding. We need to harness volunteers to work with them within their homes and communities;

·         The term “successful ageing” comes from a US Calvinist perspective and implies there is also ‘failed’ ageing, a better approach would be to emphasis wellbeing “living long, living well”.

Professor Gibson’s research includes the health of older people with delirium and dementia in acute care settings. She began her talk on health care as a human right by detailing a harrowing story of how her mother took 5 days to die in hospital following a fall down a flight of stairs. She detailed other examples of how older people are often stereotyped by the health profession. She gave examples of how the health system treats older people differently and the ignorant assumptions behind them: failing to understand that withholding treatment leads to poorer quality of life, the hostile stereotypes about sexuality and appearance, and the lack of evidence based medicine, for example, with few chemotherapy trials done for the over 70s and rarely including women.

In the panel session on Primary Healthcare – Living Long Living Well, Dr Cathy Mead, President of COTA Victoria, emphasised the need to focus on the broader understanding of primary health care as encompassing the WHO's Declaration of Alma Ata (WHO 1978): “Socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems and in a way that gives priority to those in most need, maximises community and individual self-reliance and participation and involves collaboration with other sectors. It includes health promotion, illness prevention, care of the sick, advocacy and community development.”  She reiterated that it is crucial to step back from clinical care to a broader public health view and adopt a rights based approach that integrates social and health care. There is inadequate investment in prevention (1.5% of health expenditure) and she asserted that there is even ageism in how this is spent.

Dr Stephen Duckett from the Grattan Institute, gave two presentations, the first about better ways of supporting older people with chronic conditions to self- manage, with a focus on how multiple levels of systems and support can provide care for that individual. He insisted that the person needs to be at the centre of the care system, rather than the GP, and that critical enablers could be supplements to fee for service arrangements such as blended payments. The Grattan Institute publication, The Perils of Place, is also a valuable read about how hospitalisation rates for diabetes, tooth decay and other conditions that should be treatable or manageable out of hospital, show how Australia’s primary healthcare system is consistently failing some communities (https://grattan.edu.au/report/perils-of-place-identifying-hotspots-of-health-inequality/).

Stephen Duckett’s second presentation provocatively asked ‘Can the Health System Afford All These Old People?” And of course the answer was yes! An ageing population is not driving health expenditure and the ‘panic’ about ‘sustainability of the health system is a distraction – we must look at the benefits of health expenditure as well as the costs. The basis of his presentation can be found on The Conversation website: (http://theconversation.com/dont-just-blame-older-australians-for-increased-hospital-demand-62622).

Two other panel discussions covered:

·         Gaps in Access and Affordability in Primary Healthcare, with presentations on Mental Health (Dr Roderick McKay, NSW Institute of Psychiatry), Oral Health (Dr Jane Hartford, University of Adelaide) and Preventative Health (Rosemary Calder, Director of the Australian Health Policy Collaboration).

·         Models of Primary Health Care – What Do Older Australians Need?  The presentation from Dr Steve Hambleton on Outcomes of the Primary Health Care Review and Leanne Wells, Consumers’ Health Forum, on Consumer Focus and Control.

The facilitator Peter Mares summed up the forum with a list of the main points as he heard them:

·              primary healthcare must have the citizen at the centre of circles of care;

·              as we get older we have more teeth than previous generations but more gum disease;

·     better PHC is intrinsically linked better management of chronic conditions, patient engagement and agency and better coordination between systems;

·              more PHC, less hospitalisations;

·             why are we not getting there – increasingly complex systems;

·            Commonwealth/state division of responsibility – states must invest in PHC and preventative health care;

·           misinformation and myths (‘ageism’) about older people seen as a burden and a cost where less value is put on an older life, with no apparent economic importance;

·         BUT we are living longer and are healthier, as a society have plenty of time to adjust and contribute to greater civic leadership and community building.

Sue Andrews, Ros Lawson and Russell McGowan

Seniors Health Roundtable - 11 May 2016, Canberra

The ACT Government has an Active Ageing Framework that sets out the Government’s priorities for active ageing over the next three years. The framework articulates the Government's vision for all senior Canberrans to lead active, healthy and rewarding lives as valued members of our community. One of the guiding principles is the health care is affordable and accessible This means that health services are community based in addition to hospitals.

HCCA had been advocating for a focussed discussion with community members on ways to improve access to health services for older people. We were pleased when the Active Ageing Framework was released and they included an action to convene a round table on health of older people. We participated in the Steering Committee for this round table and our members turned out in force at the event on 11 May 2016.

The round table was opened by Chris Bourke MLA, Minister for Seniors and Veterans.

HCCA President, Dr Sue Andrews, spoke at the round table about the challenges in transitions in care. Her speaking notes are included here.

Theme: Transitions in Care – continuity of care across services

I would also like to acknowledge the traditional owners and custodians of the land on which we meet. I respect their continuing culture and the contribution they make to the life of this city and this region. I pay my respects to their elder past and present.

I am very pleased to be here today. The health of older people is one of the health policy priority areas for HCCA. We also have a very active group of members and consumer representatives who are involved in a consumer reference group who identify and advocate for the health of older people in the ACT and surrounding region.  Much of what I say in these introductory comments is informed by their work.

As health care consumers in many different settings, older people are particularly conscious of the frequency and quality of the transitions in care that they experience as they traverse the health system. As well as a general practitioner or family doctor, they are likely to have several other health care practitioners, often specialising in one organ system, disease or condition. They may receive this care in settings such as GP rooms and other private practitioners’ clinics, in a hospital (private or public), in a rehabilitation facility and in a long term facility such as in aged care.

Healthcare delivery is increasingly complex and multidisciplinary, and where the health care system is complex and often fragmented, good continuity of care across services is not always easy to achieve. When it is not working well people may not adequately understand their health problems and may not know which practitioner to talk to when they do have problems and questions. It is vital that older people are supported to access health literacy programs so they can be well informed and participate as much as possible in managing their own health care.

For consumers the challenges for achieving optimal transitions of care across health services relate to having many practitioners, many settings and many rules (eg about where different clinicians can practice, who has responsibility for different pieces of patient information).

Lack of access to health care can also contribute to disruption of continuity of care. Some older people may miss follow up appointments because they don’t have transport to their GP’s office, or need GP care after hours (sometimes resulting in a call to the ambulance to go to the Emergency Dept). They may not see their specialist because they can’t afford it. And they may not know what actions they need to follow if they have not received information that respects their cultural background or is in a language they cannot understand.

The Australian Safety and Quality Framework for Healthcare, under the principle of consumer centred care, identifies improvements in continuity of care as a key area for action. “Continuity of care for patients must apply within the healthcare team as well as between any team and other health professionals”. (p4)

One of the most important things for consumers is that each health practitioner they see is aware of their medical history, their social circumstances and their treatment plan. Lack of this information can cause considerable anxiety and frustration for patients (and the health practitioner) and can cause delays in appropriate treatment, duplication of investigations and even the provision of inappropriate care. (AQSH Framework p5)

Transitions in care for consumers always need to involve efficient and timely clinical handover. “Clinical handover is the transfer of professional responsibility and accountability for some or all aspects of care for the patient…to another person or professional group…Clinical handovers occur at shift change (in hospital), when patients are transferred between health services or wards, as well as during admission, referral or discharge.” (p5) Millions of clinical handovers occur annually in Australia and this is therefore a high risk area for patient safety with consequences that can be serious.

At all points in the process of transitions in care, communication between practitioners and with consumers and their families and carers is very important. Use of both paper based and electronic medical records are critical for handover and transfer documentation, as is working with patients to make sure they have sufficient information and understanding of their treatment to be able to effectively participate in maintaining the continuity of their own care.

Some of the issues that have been identified for discussion at this afternoon’s roundtable about transitions in care include:

·         High quality transitions in care through careful integration of services;

·         Avoiding gaps in care during critical transitions;

·         Effective communication with the consumer, their family, and other healthcare providers;

·         Complete transfer of information – a patient safety issue;

·         On- going access to health literacy for older people and their families and other care givers;

·         Access to essential services and a single point person to ensure effective coordination and continuity of care;

·         Health assessment processes that ensure consumers are supported to achieve the best health outcomes depending on their situation and condition;

·         Unnecessary or inappropriate transfer of residents of aged care facilities to hospital Emergency Departments; and

·         Availability of community nursing and community health services to enable people to return to their homes with appropriate support after discharge from hospital.

For most of us in this room today these are not new issues. So I look forward to our discussions this afternoon which will I hope focus on some innovative solutions for the healthcare system and improved outcomes for older health care consumers in our community.

Sue Andrews, 

President, Health Care Consumers Association ACT.

Health Issues Group Blog Post: COTA Transport forum by Nicholas Wales

Health Issues Group Blog Post: COTA Transport forum by Nicholas Wales

Jane Thomson from Council on the Ageing (COTA) came out to HCCA on the 13^th of November 2014 to present an insight to COTA’s study on how older people in the ACT travel and transport options.

In 2013 COTA ACT conducted research on how older people in the ACT travel. The aim was to find out how older people in the ACT travel and to identify and explore the issues to recognise potential solutions/improvements.

443 people responded to the survey resulting in the following:

•       78% of respondents had access to a car.

•       60% used buses (31% of those didn’t drive)

•       Nearly half said they had difficulty travelling.

•       Older age groups & people with mobility/health problems much more likely to have difficulty.

•       People weren’t aware of all the transport options

•       People felt transport was important for social connection and were afraid of becoming socially isolated

From the survey findings COTA put together A Guide to Getting Around in Canberra, for older Canberra residents which was printed in October. The guide gives an overview of transport options including buses, community transport, flexible transport, taxis, scooters, bikes and walking. It also includes advice about how to use or combine these options, relevant phone numbers and web sites and information about social clubs and recreational opportunities.

COTA also provides free individual and group transport training which is delivered by volunteers. The free individual transport training can be delivered to people in their homes, it has been available since June 2014. This service is help build the skills and confidence by going along on bus trips and provide info on services, social supports and connections. The free group training has been running since July 2014, it provides a presentations to groups of older people on transport options. It covers options, tips and ideas with info on services, supports and connections. For more information on training click here.

Jane then went on to looking at the main transport options in Canberra. She listed driving, buses, community transport, taxis, scooters, bikes and walking as the 7 primary options for travel in Canberra.

Driving:

Driving is a great while you can do it but can be a challenge when you lose the licence. NRMA provides a Safer Driving School which can help seniors assess their skills and retain their licence. Park & Ride can help minimise driving and also avoid parking charges.

Buses:

Buses are a cheap mode of transport (free if you’re over 70), however they are hard to use if you have poor balance and/or mobility. There are also major issues with frequency and reach, especially on weekends, so where possible use the frequent bus network. NXTBUS is better than written or online timetables as it tells you how far the bus is away from your stop or if you have missed it. Accessible buses make it easier to get on and off the bus, however accessible buses only run on some routes.

Community Transport

Community transport is available through the 5 regional Community Services Organisations for eligible residents in their designated areas. The service offers door to door but are not always flexible and/or available, as this service prioritises medical over social travel. The Belconnen Community Services offers whole of Canberra service. There is also a Flexible Bus Service which is available for members of the community with limited access to public transport. Their contact number is 6205 3555

Taxis

The taxi service will take you door to door, however this service is expensive and there can be driver behaviour issues. Fares can be reduced, such as sharing or the taxi subsidy scheme. The ACT Taxi Subsidy Scheme provides financial assistance to ACT residents with a disability or significant mobility restriction that prevents them using public or community transport.

Other options

Scooters and bikes

Scooters are great for short trips. There is lots of advice around – Independent Living Centre, AusScooter, Guardian Mobility and Scooter Safe handbook. Scooters can go on accessible bus, if meet size/type conditions, but you cannot drive them on a main road.

Electric bikes are a great substitute for easy travel, as the electric motor will assist you when needed. Bike hire available through SEE-CHANGE. Electric bikes can use on footpaths, cycle paths and roads

Walking

Walking is great for your health, however poor paths and ramps can be an issue. Fix My Street is an ACT Government initiative, where the public can put in a repair request for a specific location. You can contact them online or phone 13 22 81.

Jane stated that COTA will continue providing transport training and information through volunteer peer-educators. COTA would also like to update the transport Guide, this is depending on feedback and funding.

COTA will continue to lobby for better transport options in Canberra with the help of community involvement.

If you would like any further information on the services and information COTA supplies please contact them on 02 6282 3777 or email contact@cotaact.org.au

You can also visit their website at: http://cotaact.org.au/

HIP Project Officer 

Nicholas Wales

"Aged Care: The People’s Forum" – at the National Press Club, 13 August 2013

Carol Bennet, CEO of CHF, at the Aged Care Forum.

Panel:

• Ian Yates – CEO, Council on the Ageing (COTA)
• Glenn Reiss – CEO, Alzheimer’s Australia
• Carol Bennett – CEO, Consumers Health Forum of Australia (CHF)

Ian Yates opened the forum by stating that over 40% of voters in the coming election will be over 50 years old. COTA wants to see a new deal for older Australians, which is outlined in their election platform. 

COTA is campaigning for:

• an end to ageism and age discrimination in all aspects of Australian society
• access to quality health services for all older Australians
• the participation of older Australians in the workforce as long as they want or need to
• access to quality aged care services when and where they are needed
• a reasonable standard of living for older Australians 

Yates went on to make the point that unemployment of Australians between the ages of 55 and 65 has the potential to have a detrimental impact on the health and wealth of this demographic. Whilst he welcomes the Government’s “Living longer, living better” initiative, aimed at reforming the aged care sector, Yates believes that it does not go far enough. The package will provide 80,000 new consumer-directed home care packages, in a similar format to the proposed Disability Care Australia packages. “Consumer-directed” means that the consumer controls the package and can leave different services if the care does not meet their needs.  The initiative will enable simpler access to residential aged care facilities (RACFs) and easier to understand financial arrangements to allow for comparisons between facilities. The new health reform package introduced by the Gillard Government will also see the provision of more beds in RACFs.

In summing up, Yates expressed his disappointment in the two federal leaders’ lack of attention to aged care during the recent debate.  He noted that there appeared to be little difference between policies of both parties. Yates emphasised that aged care funding needs to be provided on a needs-assessment basis rather than the current quota system, which is ineffective. He applauded the consumer-directed care elements of the “Living longer, living better” package, noting consumers want to make a contribution, be independent, and exercise personal choice. Yates also believes that the “My Aged Care” online gateway, which is part of the package aimed at simplifying information and access to aged care, needs a local face. He went on to state that the Productivity Commission report that informed the new reforms was comprehensive, but that significant portions of the report’s recommendations had not been included in the final package.  Yates asserted that there was strong support amongst the membership of COTA against the inclusion of the family home in the assessment of assets for an aged care place. Finally, he spoke on the need to have an open conversation about what constitutes a good death and respecting the choice of older Australians through the advanced care planning process. 

Glenn Reiss followed on from Ian Yates, commenting on the many exciting and daunting challenges facing the incoming Government with regard to dementia care. According to Reiss, the exciting part is the potential for driving social policy change, from the current model of a “one size fits all” approach to service provision, to a new model that promotes access to appropriate care and consumer empowerment. There are 320,000 people currently living with dementia in Australia, and by 2050, 900,000 Australians are predicted to be living with dementia. Dementia care costs the health system $5 billion annually and is the biggest risk factor in aged care. Reiss asserts the need for an increase funding for dementia research. To this end, Alzheimer’s Australia has launched its Fight Dementia campaign. While the Government has commenced implementation of an aged care reform package, Reiss believes that there will be a 5-10 year period before the impact of these reforms is fully felt.  

In summing up, Reiss called for:

• Access to care based on individual needs 
• An expansion of community care, particularly for those with higher needs, so that there is a real alternative to care in RACFs
• Dementia-specific respite care
• System advocates to help in guiding consumers through the complex system and ensuring informed choices
• Assured good quality in RACFs – at the moment its variable and not up to the standard that Australians would expect
• Zero tolerance of poor quality care in RACFs – quick remediation and investigation of adverse incidents
• Increased investment in dementia research
• Robust connection and communication between Disability Care Australia (DCA) and the aged care sector to ensure that people do not fall through the cracks at the DCA cut-off point of 65 years 
• Commitment from all political parties to these reforms

Carol Bennett started her address by noting how little about aged care had been mentioned during the election campaign thus far.  Carol warned that politicians will ignore the aged care debate at their peril.  She made the point that health is more than just treating illness – it is about occupational health, safety on roads, nutrition, transport, engagement in community life, family life, and all the other factors that make up a person’s life. Our system should promote health not just treat illness.  Bennett believes that our system is currently too hospital-centric, meaning that interventions are delivered the most expensive in environment, eating up limited health dollars.  A sizable proportion of hospital-based interventions should be dealt with in the primary health care context, within the community in a more appropriate setting and at a much lower cost. 

Bennett further commented that:

• Australia’s out of pocket health expenses are one of the highest amongst OECD countries, with costs for consumers higher than in the US and UK. 
• Poor dental health is an indicator of social disadvantage in our country, and that the burden of our current ineffective system impacts disproportionately on older Australians.
• Medication expenses are an issue for older Australians, due to the inflated costs for medications being passed on to consumers from the Government.
• Consumers don’t want to be passive recipients of services and that consumer-directed control of services and treatment is imperative.
• The current health system seeks to prevent mortality at all costs even against the best interests of patients.  Dying with dignity is not accessible for many older Australians. We need to have a conversation about futile care.
• Dementia care is particularly alarming at the moment with a system that focuses on acute episodes of care, rather than on quality of life.  Treatment is based on waiting for a crisis rather than on prevention or mitigation strategies.
• There is a critical need to move away from the current funding system that encourages episodic care rather than the holistic kind of care desired by consumers. Older Australians need to be at the centre of their care.

After the statements from each panellist, Yates, Reiss and Bennett participated in a Question and Answer session.  Below is a summary of that discussion. 

• All panellists agreed that improved aged care is not just about an increase in funding, but about a reimagining of the way in which care is delivered.  They all believe that community care needs to be emphasised so that the focus is not on institutional care. 
• Consumer stories are powerful for community organisations, as it puts a human face to an issue where figures and statistics cannot.  The Alzheimer’s Australia dementia campaign is based on consumer stories. 
• There is a growing trend toward older Australians wanting to have a voice and to contribute to the effectiveness of the health system.
• Advanced care planning needs to be coordinated nationally, across all states and territories to ensure a consistent approach. 
• There is a general acceptance that the new reforms introduce a “user pays” system where those who can afford to will pay more for their care.
• There is a little known “third class” in aged care which is comprised of older immigrants who have been sponsored by their families to come to Australia but don’t have access to any health services because of their visa determination.
• Economists and consumers agree that the current system is failing lots of people as there are not enough community care packages or RACF places where consumers want to go. There is a general belief that the new reform package will go some way toward improving some of these issues.
• There is a significant net capital and recurrent funding increase to RACFs as a result of the new reforms and there is a monitoring system to ensure this results in better care.
• There is a need to bring disability care, mental health, and aged care systems together to ensure people don’t fall through the gap and that services are delivered efficiently and effectively.

Kerry Snell

Health Infrastructure Program
Consumer Coordinator