So, what is the elephant in the room with aged care at the moment?
In a report released Friday 17 August 2018 that showed a recent increase in home care funding for elderly care recipients, there was a worrying trend in demand versus ability to provide that needed care.
That is, despite the growth in older people desiring home care services, the number of home care packages assigned (or available) is simply not keeping up with demand.
At 31 March 2018, according to figures only released on 17 August 2018, the queue waiting to receive a package had risen to 108,456 people. That is an increase of 3,854 on those waiting at 31 December 2017. Not only that , but just over half of all those in the queue have been assigned a package at a lower level than their needs require. Remember this is all based on the Australian Government’s own approved needs assessment, and allocation of packages.
Contemporaneously we have demographers projecting the number of residential aged care places required to be built/developed is now at about 75,000 by 2025. That is only eight years away.
The word governance may well have been used by Chaucer in 14th century England, but the phrase ‘corporate governance’ has only been commonly used since the 1980s.
Major corporate failures such as Enron, WorldCom, HIH, the dot.com crisis, the global financial crisis, and the Royal Commissions into institutional abuse of children and the banking sector, have increased governance expectations.
The community requires corporations to improve the way in which corporate governance is practiced.
That is, more is expected from companies behaving as good citizens.
Although not a legal term, ‘corporate governance’ does carry the sense of needing to be defined. It regularly arises in actions or Commissions as something lacking in practice.
Yet the concept of corporate governance has struggled to have a single definition. Early definitions were based around corporate governance being the ‘system by which companies are directed and controlled’ (Cadbury Report, 1992; King, 1994).
The Australian Stock Exchange recently broadened the scope of the concept of corporate governance to ‘the framework of rules, relationships, systems, and processes within and by which authority is exercised and controlled in corporations’.
Similarly, the G20/OECD principles discuss how the monitoring of performance against structure of organisational objectives can deliver better
I have never been a great advocate for regulated minimum staffing ratios, but prefer regulation of the things that are really important around provision of care services to the people, our care recipients. If you like, having enough of the right people at the right time, and not just to fulfil a compliance requirement around the number of pairs of hands.
In completing this Review my own views around staffing, quality of care, industrial considerations and the like have changed – for the better. It remains to be seen if those with the capacity to make an even more profound difference to improve care outcomes for frail, vulnerable, mainly elderly recipients of care – the Australian Government and Parliament – will actually choose to support those whom we serve.
It seems that in Australia rarely a month goes by where the public is not informed of another aged care failing. There is wide spread public perception of a lack of care and low quality of life for residents within the aged care system. The call for greater regulation of minimum staffing standards and additional funds to meet them is prominent but seems to fall on deaf ears of the Australian Government.
Without residential aged care provision, residents would likely be inpatients in State based hospitals at several times the daily cost of care of a residential aged care facility. However, the proportion of funds spent on care and service provision should be acquitted on what really matters – the care of people.
I have been tracking various residential aged care data and some interesting comparison figures for two decades now since the Aged Care Act came into being in 1997.Please allow me to say right upfront – collecting relevant and appropriate data from indices can be difficult and not always truly comparable.
The data represented below is purely to make us think, and perhaps identify for providers at least, why it seems to have become so much more difficult to maintain a high quality residential aged care service today to people with more pressing multiple morbidities than ever before.
Clearly, by comparison, our funding foundation has worsened over the past twenty or so years.
Some time back during one of our regular Braemar senior leadership meetings in 2017, we decided to take the lead in protecting our residents from influenza by offering complementary flu vaccines not just for our staff and residents, but also volunteers and the families of those in our care.
This week, free vaccinations were available at Braemar Cooinda and Braemar Village, while next week we will be providing the vaccines to those at Braemar House.
This move predated the recently announced Government plan to mandate all aged care providers to provide free flu vaccines to their staff. It was a decision we took as we felt it was an effective way to help reduce the risk of influenza entering the aged care environment.
The idea to expand the service to families and volunteers was developed by the Braemar team under the direction of Renee Reid, General Manager of Workforce. When chatting to Renee, she expressed the team’s desire to ‘meet and exceed best practice levels to reduce the risk of our health and care professionals contracting flu or passing it onto our residents,’ which to me demonstrates a commitment to resident health and wellbeing across the organisation.
I might just be getting old, but not a year goes by that I don’t think more deeply about Easter. Don’t get me wrong, I really love Christmas, and from the perspective of being a follower of Jesus, that is obviously a very special milestone of my faith. But Easter … Easter is the cornerstone event of my relationship with Jesus Christ.
In late January and early February 2018 I had the privilege of joining the Global Conference on Integrated Care (“GCIC”) in Singapore. I am delighted to say that for me this was the most beneficial conference that I have attended since my re-connection to the aged care sector in August 2016.
Every nation represented at the Conference shared information about their significantly growing healthcare budget and rapidly ageing population. All nations have health and aged care systems that were created for a previous generation. They are not designed for the massive ageing population growth that require more and more health, social and aged care services.
As often as I remind others of the difficulties aged care providers, their workforce and clients are confronted with, I remind myself that we belong to a bigger system of health and social care provision.
Many parts of that system attract what seems to us, by comparison, to be outrageous funding. Maintenance care only in a hospital costs approximately $1,200 per day. A day of care in an intensive care unit costs $6,000 plus per day. That is not to say of course that these services are not important and desperately needed.
I am about to board a plane for Singapore where this week I will be speaking at the GCIC 2018 conference on integrated care.
My topic will look at where the industry may go next in its clinical governance responsibilities. I thought this was interesting to look at twenty years on from the introduction of the Aged Care Act in 1997.
I will share my full paper next week and explore some further ideas following the conference. In the Essay, I have strived to briefly describe the history of residential aged care in Australia and show how economic drivers that largely determine the funding of care may also be diminishing the clinical appropriateness of care. This can place care recipients, providers, and program funders alike potentially at risk of failure of service in financially constrained times.
Wayne Belcher (OAM) will speak at the Global Conference on Integrated Care at the start of February, where he will present an analysis of Australia’s aged care sector, two decades after the Aged Care Act (1997) was implemented.
His presentation will cover areas including the history of aged care in Australia and how it has transitioned from basic care homes to a major industry, a review of the care models currently being employed as deregulation takes effect, and a review of clinical governance.
International experts from the USA, UK, Canada and Hong Kong will be among the conference speakers, which will take place at the Resorts World Convention Centre in Singapore from 1- 3 February 2018.