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We can have the aged care we need

19th July 2019

16,000 elderly people died waiting for home care in 2017-18. We can and must do better, writes Benetas policy adviser Dr Olivia Ball.

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The Aged Care Royal Commission was in Mildura this week focussing on the experience of informal and unpaid carers of elderly people in our community – most often partners and daughters.

It heard from family members frustrated and at times devastated by caring for ageing loved ones without adequate support. And people assessed by professionals as needing home care dying as they wait for assistance.

Barbara McPhee AM from NSW told the public hearing that she got a call from the Commonwealth Home Support Program saying her mother had finally reached the top of the waiting list --- 14 months after her mother had died.

It’s clear from this week’s evidence and the data that Australia’s system of home care is failing them.

The federal government chooses not to provide enough home-care ‘packages’ for the number of people who need them. It could and should choose otherwise. Older Australians and their carers need urgent action to make home care services available and affordable when they’re needed.

The media tends to focus almost entirely on residential aged care, when in fact the great majority of aged care is support provided to people who are living in their own home. And that is a good thing.

Most of us want to ‘age in place’ at home and avoid going into residential care for as long as possible or at all. That outcome is the ‘very strong preference’ of most older Australians, according to the Royal Commission, and from a public policy perspective, supporting people to age in place is far less expensive than 24-hour residential care.

Home care services support people to remain living safely at home and, importantly, they also help older people maintain their social connections, with home visits, support to get out and attend group activities, and assistance with online communication.

Withholding home care support by arbitrarily capping the number of packages available risks the health and safety of vulnerable elderly people.

They are more likely to fall waiting for a grab-rail to be installed or while struggling to do their own cleaning; they are at risk of harm from not taking medications correctly, less able to eat well if they have trouble shopping and are more likely to be lonely and isolated without social support.

And home care helps keep people out of residential care. Delays in providing home care increase the likelihood someone will have to give up their home and independence and move into costly residential care.

The latest government data show there are over 93,000 people receiving home care and a further 75,000 people needing and waiting for it. The shortfall is huge.

The government is cagey about waiting times, but people assessed as needing care wait months for any in-home support to commence, before waiting an average of “12+ months” more for the level of care they need. The Royal Commission has heard that people assessed at the lowest level wait an average of 22 months.

In the 2017-18 financial year, more than 16,000 people in the queue died waiting.

There are real limits to the number of home care packages we can have in Australia and they are not budgetary. The real constraints on the amount of home care we can have –- and the amount of healthcare, residential care, dementia care, mental healthcare and palliative care we can have –- are the number of doctors, geriatricians, nurses, personal care workers, gardeners, cleaners, cooks, podiatrists, psychologists and other allied health professionals we have in Australia and can train for our future.

We must expect more of our government. We do not have to accept substandard care. Our goal as a society should be to provide the care we need when we need it. Not 14 months after our loved one has passed away.

We ought to redefine fiscal responsibility as spending to meet community need. There is no excuse for $158 billion of tax cuts when our elderly are dying in need of adequate care.

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Dr Olivia Ball is a policy adviser at leading Victorian aged care provider Benetas and a specialist in human rights.