The rationalisation of providers, streamlined software systems, media campaigns and a ‘user pays’ model could all be on the cards if the model proposed by the Commissioners in Consultation Paper 1 gets the green light.
Many of the submissions on the Paper focus on the existing system and how it could be improved, but there is little discussion on what will be the outcome if the new system is implemented.
So, what changes could the sector see?
- GPs and nurses filling the assessment gap
- Case managers to coordinate care
- A newer, younger workforce – valued for their work
- A volunteer ‘taskforce’ to provide community
- A focus on reablement through health and wellness initiatives
- Fewer hospital admissions and more focus on primary care for older people
- Higher fees for residential care settings for those who can afford to pay
- Standardised software systems and personalised health records
- Rapid consolidation of both home care and residential care
- New executives from outside the sector
- Specialised providers catering to niche markets
- A move towards a ‘user pays’ system – and education for consumers and families
- A more equitable relationship between the Government and providers
- New ageing housing models – including retirement villages
See below for the full details.
Here’s a reminder of what the models looks like below.
Accessing the system
As you can see, it starts with the entry point to the aged care system and two screening processes – a basic screening for simpler home supports and a comprehensive assessment for more complex care.
While submissions and witnesses at the public workshops questioned the need for dual assessments, the GP was pinpointed as the likely person to carry out basic assessments.
This makes sense. They have a prior relationship with the individual and the qualifications to provide a detailed assessment if incentives were provided.
Alternatively, GP practices could employ a senior nurse or nurse practitioner.
Finding services
People accessing the system would then be directed to a ‘care finder’ and referred to one or more of the three streams.
Much of the discussion in the workshops was around ‘system navigators’ or ‘case managers’ to coordinate care face-to-face with the My Aged Care contact centre and website playing a secondary role.
This would be like Denmark where case managers visit the over-80s to help with planning for independent living.
The entry-level support stream
The first ‘Entry-level support’ stream – to provide a larger number of people with basic home supports – will require the workforce to be rapidly increased – at a time when most workers are heading for retirement age.
That will mean incentives such as better pay, conditions and higher working hours will be needed to attract new and younger staff plus a community campaign to drive respect and value for their work.
This stream also puts the focus on community engagement – including a network of volunteers to visit the elderly and prevent them from becoming socially isolated.
Again, this model has already been proven in Denmark where care assistants are employed to support older people to contact volunteer groups and take part social activities.
The ‘Investment’ or reablement stream
The second ‘Investment’ or reablement stream will see health and wellness programs and assistive technologies targeting older people boom – and help to head off future health problems.
In Denmark – where reablement became mandatory for accessing home care in 2015 – only around 3% of older people receive over 20 hours of help.
Helping people to regain functioning will also cut the number of preventable hospital admissions and ease the number of ‘bed blockers’.
Case in point: a similar move in Denmark towards primary care over hospitals resulted in a drop in the number of hospitals from 98 to 20.
The ‘Care and Health’ stream
With a much larger number of people accessing nursing and allied health care at home than in residential care, there will be more scope for inreach services.
Care will also be separated from accommodation, with unsupported residents paying ‘rent’ to live in residential care.
This could potentially give providers the choice to charge a RAD or a DAP and build their cash reserves – critical for expansion.
Technology is key
Technology will be essential to achieving continuity across all three streams with personalised health records (like My Health Record) across the aged care and health care system.
See the Danish example where they mandated electronic mailboxes in 2014 to allow communication between patients, hospitals and GPs.
Standardised software systems will also cut down on duplication and make the collection of data easier.
Consolidation of operators – and executives
The new model also suggests the market could rapidly shrink as operators are required to provide a wider range of services over smaller geographical areas.
Providers will need to ‘raise the bar’ in the more competitive marketplace with new executives from other sectors coming in.
Innovation and research – being shared
There is also room for the Government to choose to designate some operators as ‘experts’ for different areas – for example, dementia, nutrition, and homelessness – and provide funding accordingly.
The resulting Intellectual Property could then be shared with other providers.
The public educated on the need to pay
The Government will also need to clearly define these new models of care so there is no issue with consumers and families about what their services entitle them to.
This includes educating the public on the need to pay more for aged care over five years so they will be prepared to pay more in 10 to 15 years and beyond.
Renegotiation of the relationship between the Government and providers
In addition, the Government will need to set KPI’s for these new targets like Denmark did – for example, reducing the number of older people in residential care by 50% in 10 years.
This will require a partnership approach with providers – rather than the traditional role of the Government controlling the whole sector as both buyer and regulator.
With providers in the driver’s seat, operators could demand a minimum return on assets to guarantee their viability into the future, regardless of their size or location.
New housing models
With greater focus on care at home, there will be increased demand for housing where these kinds of supports could be provided – whether that is in retirement villages, assisted living, serviced apartments, group homes, day centres and other new models of care.
In Denmark – where the building of new aged care homes was limited in 1988 – they have developed a range of different living options – and it has worked.
The number of aged care beds has dropped 30% between 1987 and 1995 – in contrast, the number of dwellings for the elderly grew from 3,300 in 1987, to 37,900 in 2001, and to 58,300 in 2006.
Less institutional residential care settings will also be key.
Will Australia take a cue from Denmark where guidelines and funding were made available to re-design existing aged care homes for people with dementia?
Anything seems possible.
Do you agree with the above points?
