No quick fix for aged care

No quick fix for aged care

Kate Burke

Just over a month ago, the Federal Government was congratulated for announcing its aged care reform package: Living Longer. Living Better.

However, questions are now being raised within the industry as to whether the $3.7 billion package is enough to make real change.

A redirection of funding within the department means the ten year package will only see an additional $576.9 million put into the aged care sector.

The reform, which aims to readdress the shortcomings of the overworked system, will boost home care packages and seek to address workforce pressures.

Prime Minister Julia Gillard first promised to reform aged care after last year’s productivity commission found the system was inadequate to cope with Australia’s ageing population.

At present, one in four people over 70 make use of aged care services; while one in ten use residential aged care facilities.

Ms Gillard believes it is important to boost these aged care services so Australians can receive quality care in the home.

“To make it easier for older Australians to stay in their home and receive the care they need, we will double home care packages from 59, 876 to almost 100 000,” she said.

Over the next five years, the Living Longer. Living Better reform will put $880 million into creating more home care packages.

Stella Topaz, a professional officer from the New South Wales Nursing Association, believes the move to increase access to home care is a positive step.

“It’s what the public is clearly asking for. People would rather stay in their home and so the home care program needs to be properly resourced,” she said.

“However if they are going to encourage home care, they need to go beyond medical and physical care and look at providing access to social activities and connections for the elderly.”

Harriet David is one of many senior citizens who would have preferred to remain in her home. At ninety years of age, she now lives in a low aged care facility with her sister and brother in law.

“I had a four bedroom house that I shared with them. We came here because we needed help and just couldn’t cope with all the house work that had to be done, “she said.

Ms David would have loved to have stayed in her home, however she felt that the Community Aged Care Package she was on was not providing her with enough support.

“If we had more help we wouldn’t have had to sell our home. We only received help about once a week. When we asked for more help, they said they couldn’t give us anymore, so we came here. I think it would be great if more help was available, so more people could stay at home for longer.”

Lynda McDonnell, Aged Care Assessment Team (ACAT) nurse, believes there is great public disappointment about the quality of home care packages on offer.

“In my area in the Inner West, home care is full. It is very difficult to get home care services,” she said. “Community aged care packages (CACP) are not much better. When they originally started you would get about six hours of service a week, now you would be lucky to get three and this is just not enough.”

Ms McDonnell believes the reform needs to streamline services and address the large gaps between the levels of help available.

“There is a big gap between the CACPs and an extended aged care in the home (EACH) package. In an EACH package you’re meant to get about 12 hours and in CACP you are rarely getting six, so there is a big difference between the two,” she said.

“It is a very complicated system because they have just patched things up and added on programs here and there. The people making the decisions don’t really understand what happens on the ground and are basically just throwing money all over the place.”

Ms McDonnell also believes the government’s push for home care packages is purely a financial decision.

“While it is still cheaper to keep someone in the community than in an aged care facility, at the moment we do not have the services to properly cater for those who stay at home,” she said.

While the reform will boost the number of home care packages available, there is no clear indication of what level of improvement will be made to them.

Nursing home director Janice Thorncraft is also concerned with the lack of support provided by home care packages.

“From what Julia Gillard is saying, it seems to be aimed at getting all the elderly back into the community again, putting them in community packages and keeping them out of nursing homes and that is fine, but what about the social aspect of the person. They’re not addressing that and sadly this is the area where the oldies drop their bundle,” she said.

“I would like to see a lot more entertainment and social services granted. If your brain is active and doing things, if you are socialising, playing bingo or doing exercise, you will have a much better quality of life.”

Social worker Aurelia Roper-Tyler works in psycho geriatrics and agrees that if the government want to push home care, they need to implement more programs to address the social isolation of the elderly.

“We have day centres in Sydney that are few and far between and god help the people who live in country areas. There is huge want. There are services that are fantastic, but we need four times more of them in Sydney and ten times more in country areas.”

Ms Roper-Tyler fears that reforms like this make promises which cannot be delivered. So while huge funding is a positive step, those within the sector are often cynical.

“We tend to feel that it is not organised and distributed properly and sometimes you end up just having top heavy administrative people, there isn’t much increase in vital low level services,” she said.

“Don’t get me wrong, we do need big increases in administrative and education services, but we also need the money to trickle right down to the patient.”

While home care packages cannot replace residential care, the government believes it will reduce the pressures on the residential system.

It is hoped by those within the industry that by addressing the workforce pressures in aged care, the Living Longer. Living Better package will improve the quality of home and residential care services.

The package will put $1.2 billion towards improving the capacity of the aged care sector to attract and retain staff, by introducing higher wages, improved career structures and development, education opportunities and better work practices.

Ms Thorncraft believes the government needs to act quickly if it wants to increase or even just maintain the number of aged care staff.

“You have to be really committed to come into aged care, it isn’t particularly hard work, but it is very emotionally draining. Young graduates tend to go for general nursing, because there is a lot more going for you there and it can give you post graduate training and a great diverse career path.”

“Aged care workers are getting older and older and if something doesn’t happen quick there is going to be no one to take their place when they retire,” she said.

According to Ms Topaz from the NSW Nursing Association the Because We Care campaign will continue to work towards quality staff.

“The productivity commission and this reform are a direct result of the campaigning of us and others. But we still have to address things like the quality and number of staff,” she said.
“We really think the money the government gives to the providers should somehow be attached to how much staffing they have to provide. Sometimes there is one RN and two AIN on duty at night for 100 people and that is just not safe.”

Ms David agreed that the staff at her aged care facility are stretched to their limits.

“There are only assistant nurses here and they are always running around, always so busy. They are meant to check that I take my medication and insulin for my diabetes, but they rarely check. If I were to make a mistake, no one would pick it up,” she said.

“As a retired registered nurse I am fairly with it, however there are some patients here, who really need to be getting more help and time.”

With the latest projections indicating that by 2050, ten per cent of the population will be accessing aged care assistance, the aged care work force needs to be promoted as a career of choice.

Ms David hopes that this reform will deliver more staff and more funding, because until it does both home and residential aged care services will not be equipped to provide adequate care.

“If there is not enough funding, if there are not enough staff, the programs will not work and elderly people will fall through the cracks,” she said.

“Yes, things are getting better for oldies like me, but this is only the beginning.”

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