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

Age Friendly Shopping Centres

According to the World Health Organisation, ‘making cities more age-friendly is a necessary and logical response to promote wellbeing and contributions of older urban residents and keep cities thriving’. Where cities are age friendly they tend to be friendlier for all age groups as their direct needs are frequently shared with other groups, particularly people with young children and those with disabilities.

Canberra has been accepted as an age-friendly city. Living up to the WHO ideals should result in a friendlier and more relaxing environment. In shopping centres this is good for business and therefore profits.

These needs include:-
• Having appropriate seating at regular intervals. Appropriate seating includes the correct height, and with arms, to enable older shoppers to sit down and get up easily.
• Shopping centre seating needs to be user friendly, with seats facing each other to enable interaction between users.
• Individual stores which involve customer queues, such as banks, should be encouraged to provide seats on their premises.
• Many grandparents today act as baby sitters. Adequate seating near play areas is necessary to attract these customers to centres.
• Car parks should be easily accessible to shopping centres, not separated by busy roads, as at the newly built Casey centre. This is a government responsibility but centre managers should have input into such planning. Where access to centres is limited or hazardous, customers are discouraged.
• Underground car parks should be appropriately lit, to accommodate older people who often have less efficient eyesight.
• In toilets, hooks behind doors, designed to hold handbags etc. should be at a suitable height for older people who tend to be shorter.
• Shop keepers, particularly in supermarkets, should be encouraged to store goods purchased by older customers on shelves which are at a height accessible to this group.
• In centres which have facilities for entertainment, the interests of the elderly could be taken into consideration.
• Safety within centres should be paramount for all shoppers, including the elderly. Where safety is compromised, such as with ‘Wet floor’ signs, older people, for whom falling is a permanent hazard, are automatically discouraged from patronising the centre. The signs have no legal consequence and should be replaced by a non-slip flooring surface.
• Moving staircases connecting floors should be appropriate for use by older shoppers. Those recently installed in the Gungahlin shopping centre extension are quite hazardous for older people, particularly for those with trolleys.

Older people form an increasing percent of the population and their needs in shopping centres should be considered, particularly as these are often paralleled by other groups. Attracting customers and providing an environment in which they are relaxed and comfortable is good for shopping centres and is therefore good for business and profits.

Audrey Guy
HCCA Member

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.

Conference Report SYMPOSIUM ON POPULATION AGEING AND AUSTRALIA’S FUTURE Shine Dome, Canberra, Tuesday 11 November 2014 by Kay Henderson

SYMPOSIUM ON POPULATION AGEING AND AUSTRALIA’S FUTURE Shine Dome, Canberra, Tuesday 11 November 2014

Background

The Symposium was sponsored by the Academy of Social Sciences in Australia (ASSA) in collaboration with the ARC Centre of Excellence in Population Aging Research (CEPAR).  The Symposium was held in conjunction with an Annual Meeting of FSSA that included a book launch and a lecture on income contingent loans by Prof Bruce Chapman, both held after the Symposium closed and each of which I also attended.

Much of the Symposium ranged well beyond health care, with general policy issues also covering social welfare, social and population change and economic issues.  However, health care consistently came up within the context of general discussion.  The Keynote Speech was given by the Age Discrimination Commissioner, Susan Ryan, who spoke on “The Longevity Revolution – Crisis or Opportunity?”   The other speakers at the Symposium were grouped into four “panels”:

1. Societal Ageing:  What it means and why it matters;
2. Population Ageing:  Global, Regional and Australian perspectives;
3. Improving Health and Wellbeing; and
4. Responses by Government and Families/Individuals.

Within the context of general discussion of the implications of an ageing population, two presentations had particular relevance to issues of health and the funding of health care.  One dealt with the enhancement of “cognitive capabilities” over an individual’s lifespan and the other with the interlinked issues of ageing, entitlement and the funding of health care.

Cognitive Capacities

Prof Kaaren Anstey has the dual titles of Director, Center for Research on Ageing, Health and Wellbeing, and Director, Dementia Collaborative Research Centre – Early Diagnosis and Prevention, ANU.  Her presentation covered what is known (in a preliminary sense) about what happens to people’s cognitive capacities as they age.  The term “cognitive capacities” refers to memory, thinking, reasoning, problem solving, planning and processing speed.

Once, it was thought by psychologists that “intelligence” was innate and relatively fixed throughout life.  Now, researchers view cognitive abilities in a much more fluid and dynamic way.  Environmental and genetic factors come into play, and the trajectory of cognitive abilities through life is not predetermined.

Prof Anstey focused on two elements in cognitive development over a lifespan.  The first, “cognitive reserve”, is the peak cognitive ability that an individual achieves and is a reflection of optimal brain development and education.  The second element is the rate of cognitive decline through adulthood and into old age.

There is growing evidence that the brain is far more plastic than previously realised.  Research on brain development combined with increasing longevity suggests that our perspective on education needs to change.  Participation in education at various points during adulthood may have influences on the brain we have not yet imagined.

There is still much to be learned about the cognitive capacity of the brain, particularly into old age.  Researchers are now examining whether there is a link between cognitive capacity and dementia.

Prof Anstey stressed that bringing all our knowledge together and creating the best possible public policy for cognitive health is likely to promote a genuine increase in the numbers of adults who age well and to reduce the incidence of late-life dementia.

Ageing, Entitlement and Funding

Jane Hall is Professor of Health Economics, Centre for Health Economic Research and Evaluation, UTS Business School.  Her presentation, co-authored with Kees van Gool, examines the phenomenon noted by the OECD that in developed countries health care expenditure increases at a faster rate than national income.  For Australia, health care expenditure is expected in the Commonwealth Government’s “Intergenerational Report” to grow more rapidly than Commonwealth Government spending on aged care and pensions.

Prof Hall noted that the Australian Institute of Health and Welfare regards an increase in the prevalence of chronic disease as Australia’s biggest health problem.  However, Prof Hall also notes that while ageing populations have resulted in a greater incidence of chronic diseases, treatment has changed in such a way for most diseases that patients expect to manage their conditions so as not to have to withdraw from normal life.  There is a substantial variation in health within all age groups.  Interestingly, almost half of the 85+ age group rate their own health as good to excellent.

While ill-health is variable within populations and particular age groups, public funding is designed around three main funding streams – for hospitals, pharmaceuticals and medical services – that are separate and inflexible.  Prof Hall postulates that greater flexibility in service delivery could result in savings in the health care system.  For example, in an internet-connected world many patients may get some health services without physically seeing an expensive doctor.  The last year of life is the most expensive time for health care provision. Half of Australians die in hospitals, which are expensive, while surveys show that most would prefer to die at home.

Prof Hall concluded that ageing per se is not a threat to the sustainability of the Australian health care system.  In particular, it is not a threat to the continued viability of tax-financed universal health care insurance.  Prof Hall maintains that universal coverage and high levels of public insurance must be part of the solution to the policy challenge of healthy ageing.  Because of the wide variation in health status and expenditure, policy reforms that are aimed at the average are likely to miss their target and have sub-optimal health and financial consequences.

Comment

While both presentations were by necessity delivered in very general terms, each highlights issues of relevance to the continued evolution of health status and health care delivery in Australia.  Research into “cognitive capacity” is still at an early stage, and as more is known there may be significant benefits for ageing portions of the population generally.   A move away from health care funding and service provision that is based on “average” needs towards one that targets those within the population who have the most intensive needs would decrease the likelihood that ageing will in itself result in greater public health care expenditure.

For both issues, “Watch this space!”

Prepared by Kay Henderson