Report: Options for Redesigning and Reforming Australia's Aged Care

This report delves into the challenges facing Australia's aged care system due to an aging population and increasing diversity among older people. It highlights the desire of older Australians to maintain independence, control over their lives, and connection to their communities. The report identifies deviations in service quality, delays, constraints, and shortages within the current system. It emphasizes the need for fundamental reform to address rising demand, disability rates, community concerns about care quality, and the need for a skilled workforce. The analysis covers the strengths and weaknesses of the existing system, including increasing quality and safety standards alongside concerns about waiting periods, limited choices, discontinuous care, constrained pricing, and workforce shortages. Future challenges, such as a projected increase in the number of older people accessing aged care services, rising diversity, and the need for specialized care for dementia and other conditions, are also discussed. The report proposes policy objectives focused on promoting well-being, independence, and consumer-directed care, while ensuring affordability and efficient resource utilization. It also emphasizes the importance of considering the well-being of caregivers and taxpayers, guiding future policy changes to promote wellness, accessibility, respect, and ease of navigation within the aged care system.

Problem: Over the next 40 years, population ageing and growing diversity among older people -
in terms of their care needs, preferences and affluence - are expected to pose a number of
challenges to Australia's aged care system. These include a significant increase in demand - those
aged over 85 tend to be the main users of aged care services, and their numbers are expected to
increase at least four-fold by 2047
Background: it has been seen that generally the older Australian wants to remain independent.
For this purpose, they want to have control over the way they live. They want to remain linked
and significant for their relatives and community. Moreover, they also want to have some level
of choice regarding their care. Therefore, in view of the changes that have been introduced in the
HDS system during the last decades have resulted in widening the scope and improving the class
of care and support that is being provided to the older people in Australia, significant deviations
are present in the quality of services (McDonald and Russell, 2012). Consequently, fundamental
reform is necessary for overcoming the delays, constraints, discontinued these and shortages that
are present in the current system and also for responding to the challenges that may be created in
the future. Some of the challenges that are present in this regard can be described as follows:
 A rise in the number of older people in Australia.
 Rising number of incidents related with disability and disease caused by old age,
particularly dementia.
 Concerns of the community regarding the variability in the quality of care.

 Rising expectations regarding the flexibility and the nature of care that is being provided.
 The need for considerable number of more nurses and personal care workers having
improved skills.
Therefore, it is clear that the care being provided to the aged can be improved significantly. The
policies of the government as well as the relevant programs and rules and services being
provided by the community groups and industries should be reshaped, keeping in view the well-
being of the elderly and they should be provided in the manner which compliments the self-
esteem and supports freedom of the older people. At the same time, it is very important that the
services should be inexpensive for the elderly and also for the society. Under these
circumstances, the present report is being made for the Minister with a view to develop detailed
options related with redesigning and reforming the aged care system in Australia and also for
recommending the path of transition to a new system (Fine, 2000).
The present system in Australia: most of the people in Australia reaching old age can expect to
require the services related with aged care. Within restrictions, the intensity, kinds of services
and their period, are delivered in accordance with the assistant needs of each older person.
Mainly care and support is provided by partners, family, friends and neighbors of these persons.
Therefore, out of the elderly in Australia who are getting assistance in the community Oedipus
and are receiving this care from informal carers. At the same time, the services subsidized by the
government also being provided to more than 1 million older people in Australia every year.
After these persons, more than half are getting low intensity support provided by Home and
Community Care (HACC) program.

The strengths and weaknesses of the system: the strong point and flaws that are present in case of
the present system are known well. Therefore, in terms of the sense of the present system, the
quality and range of care and support that is being provided to the older people is increasing.
Similarly the safety and quality standards are also improving continuously. Generally the
workforce is having the appropriate skills and is dedicated to caring. Nonetheless a result of the
adjustable quality of training, it is possible that certain workers do not have the sufficient skills.
On the other hand, there are a lot of weaknesses also present. The necessity for basic and
extensive reforms has been identified by the Hogan Review, 2004, the National Health and
Hospital Reform Commission Report, the Henry Review and the reports of the Productivity
Commission made in this regard (Yu and Qian, 2018). Therefore the concerns that have been
expressed by the experts in this regard can be discussed as follows.
The delay in care assessment and limits that are present on the number of dead licenses and care
packages, the elderly may have to deal with excessive waiting period and may have a limited
choice of carers. Alternatively, the care providers also have reduced incentive for, improving
quality, becoming more efficient and to innovate and respond to the requirements of consumers
(Chan and Chan, 2018).
The discontinuous care across the packages of services based on community is also an issue. The
changes that take place in the care needs of an older person may result in a change in their care
package, personal carer and care provider.

Constrained pricing: these concerns embrace the small charges for high care accommodation, the
reducing hours of service in the care package funding level and the need for 'temporary'
conditional adjustment payment.
Difficulties have also been seen in arranging finance, particularly for building like residential
facilities.
There is a variable quality of care present across the system. Due to this reason, the older people
and their carers find it difficult to navigate through.
There is also uncertainty regarding the availability of care. It results in limited confidence among
the persons needing care that they can leave the care package during the periods of independence
and greater wellness and in case their circumstances change they can re-engage readily.
At issue is the shortage of workforce. Partly as a result of low wages, higher administrative loads
that is the result of regulation and the limitations placed on the scope of practice and strenuous
work environment, these problems arise.
There is also overlapping, complex and costly regulations. The government has an entrenched
culture of unwarranted aversion to risk and also the want of freedom in case of certain regulatory
activities.

There is inadequate independently of the complaint handling process from the Department of
Health and Aging, and the development of policy and administration of regulation has been
combined as it is the best practice.
Future challenges: as the proportions of the challenges that are faced by the aged care system in
Australia are known well, still they are worth of brief review.
It is anticipated that by 2050, more than 3.5 ml older people in Australia will be accessing the
aged care services every year and nearly 80% of the services is going to be delivered in the
community.
In the same way, by 2050 the number of people in Australia at least 85 and more is estimated to
rise to 1.8 million and become 5.1% of the total population of Australia.
Diversity is also rising among the older people in Australia regarding their preferences and
expectations, comprising a larger desire for free living and accessing care that is culturally
relevant. This is particularly true in case of several culturally and linguistically diverse or
sexually diverse and indigenous communities (Henderson et al., 2016).
Read further advancements being made in the administration of some diseases, more and more
persons will be going to need intricate care for dementia, diabetes and other commodities that are
related with longevity and also the palliative/ end-of-life care.

Option 1: A large number of elderly in Australia having low income, have substantial wealth,
which provides them the capability of dealing with their lifetime accommodation costs and also
for making a small contribution to the cost of their care, subject to the presence of a rational
protection net.
It is estimated that there will be a drop in the accessibility of casual carers, which will reduce the
capability of some elderly persons to obtain home-based care.
The aged care workers will face the necessity of significant expansion caused by the tightening
of age induced in the overall labor market. There will be a predictable drop in family support and
casual caregivers. At the same time there will be a significant call for care workers from other
segments of health organization. As a result there will be need for adopting the new models of
care.
Under the circumstances there will be a need for harnessing new and cost-effective, information
and assistive technologies that provide the opportunity for the productivity gains and also high
quality of care.
Therefore it can be stated that as the system has been configured at present it is not in a position
to deal with these challenges. Under these circumstances, basic reforms are necessary and tenure
arrangements should be created on the clear statement of the policy objectives of the government
regarding the caring of older people in Australia.
Policy objectives:
Robust rationale is present for the participation of the government in aged care including the
equity of access to suitable care, protecting vulnerable consumers and also correcting market

failures like the gaps that are present in the information provided. In principle, the government of
Australia has the responsibility for the planning, funding and regulation of easy chair and also to
support informal carers. It has been said by the government in this regard that it tries to make
sure that all the older people in Australia have timely access to appropriate care, and the support
services are available required at their age, through a safe and secure aged care system. In this
regard, the common theme regarding the vision of future system of care is that the focus needs to
be on well-being; independence should be promoted by the services provided; and the people
should have the ability of making their own life choices, even if it results in the people accepting
a higher level of risk. Therefore the older persons should be treated with respect and dignity. The
result is that the carers of old people are also required to be supported adequately.
Option 2: The main purpose of public policy should be to advance the well-being of the society
as one. Therefore regarding ACK policy, the emphasis concerning the older persons should be on
their bodily and emotional requirements, connectivity with other people, the ability to have an
effect over the environment and their safety. At a wider level, the well-being of the members of
family, friends and neighbors providing care to the older persons and the persons providing
formal care should also be considered (McInnes and Ibrahim, 2013). The effect of these policies
on the present and future taxpayers, who fund daycare subsidy, should also be considered.
Therefore in order to guide the future policy changes, it is required that the objective of the easy
care system should be to:

Promote wellness and independence of older people and their continuous contribution to the
society.
But he sure that all the older people, requiring care and support have the access to person
centered services that have the ability of changing according to the change in their needs.
The system should be consumer directed, which allows the older people to have a control and
choice regarding their lives and also to die well.
The older persons receiving care and support should be treated with respect and dignity.
The system should be easy to navigate. Therefore the older people should know what care and
support is available to them and how they can access the services.
The system should assist informal carers in performing their role.
The system should be affordable for the persons who need care and also for the overall society.
It should provide incentive for making sure that the resources dedicated to caring for the older
people in Australia are used efficiently and broadly equitable contributions are made between
different generations.

It is worth mentioning in this context that even if a distinction is present between different
components of each care costs, unpacking change the care is significant for the purpose of
designing the funding principles for the future and also for making sure that consists in subsidies
and user contributions are present across the care settings (Rogers, Barrett and Swanson, 2011).
Consumer directed care: it has been expressed by the older people in Australia that they are not
willing to remain the passive recipients of services which depend on funded providers. Instead
what to remain independent and have the ability of selecting where they live, which provide their
they're going to use and also the way in which the services are being provided to them and if they
want to purchase additional services or higher standard of accommodation. In this regard,
significant empirical evidence is present, which suggests that the choices made by the consumer's
result in improving well-being which includes greater life expectancy, higher life satisfaction,
independence and also the better continuity of care (Lau, Willetts, Hood and Cross, 2014). Apart
from the competition at its present between the providers in a system where the consumers have
the choice results in a more dynamic system, which has increased incentives for greater
efficiency, quality and innovation. At the same time, greater flexibility in the system will also
allow the providers to increase the scope of services provided by them, which frees them from
the present highly regulated and averse to risk the regime. Therefore it is required that the
regulations it should revert back to more appropriate role of making sure the safety and quality
and also protecting the one level and to deal with the market failures.
Option 3: It has been pointed out by several experts that there is significant complexity present
in the current system and it is difficult to navigate. In order to exercise their choice, the older
people need accurate, relevant and information that can be understood easily buy them.

Therefore it can be proposed in this regard that such information should be delivered by a new
national platform. Such platform should be able to indicate, simplify and increase the current
disparate information networks. Therefore a single agency should have the responsibility for the
information platform. The older people in Australia should be able to directly access the
information or through general practitioners, health clinics or other entry points. If a large
number of information centers are enabled, it will have significant advantages and all the
services will be based on one coherent and integrated information source. Such gateway is also
going to consolidate several different assessment processes that are undertaken by HACC
providers and present and also the Aged Care Assessment Teams. In order to receive an
entitlement for proving an entitlement to approve the aged and skill system to the older people,
first of all, they should be assessed by the gateway or by a local team of professionals. In the
same way, the evaluation of the capacity of informal caregivers and any support required by
them should also be a part of the functions but the carers should be allowed to separately
approach the Carer Support Centers in the area wide range of persistence which includes
emergency respite (Tham and Hardy, 2012).
A particular set of criteria is going to be used by the assessors. That is going to apply in case of
all levels of care and support, both in residential and community settings. The Gateway is also
going to arrange for the Centrelink for undertaking a distinct assessment of the financial
capability of the older person to make contributions wherever required. At the same time, other
low intensity carers and community support services outside the Formal Aged Care System is
going to be continuously access to directly or being offered as a part of gateway assessed
entitlement (Stargatt et al., 2016).

Recommendation and Solution: It also needs to be mentioned that the care needs of the older
people in Australia are different in case of each person and they also change passage of time
because aging is a unique experience. Therefore the care needs of the people depend on their
functional capabilities, culture and language, physical and mental health and their living
environment. Consequently, the older people in Australia should have access to a wide range of
care and support services that can deal with their particular needs and to the extent possible, help
in restoring their wellness and independence. On the other hand in case of the prison system, the
care needs are not being fulfilled on account of the inflexibility of the system. Therefore even if
the HACC program has some ability of delivering a wide range of services for dealing with the
particular needs of the clients, community care packages to not have such flexibility in its
services. Limitations are present regarding their supply and funding and at the same time,
significant cats are present between the packages. Under the circumstances a model of care and
support needs to be proposed that can provide a flexible range of services for dealing with
individual requirements of the older people by using a mixed approach to access. This uses an
entitlement based approach along with providing direct access to certain services (Tang, 2009).
The older people who are facing an increase in freight he may need personal care services like
help in eating, toileting, showering and dressing, oral hygiene and regular monitoring of their
health. The number or the intensity of care services that may be required by the older people can
increase but these can be temporary instead of being permanent or even a decrease after some
time. The older people may also increasingly need specialized care, like the care needed for
wound management and other health and nursing care. This includes dementia, incontinence,
challenging behavior palliative and end-of-life care as well as rehabilitation and restorative care,
which includes transitional and sub-acute care.

References
Chan, D. and Chan, L. (2018). Aged care services in Australia and commentary on lessons
learnt. Aging Medicine, 1(1), pp.50-54.
Fine, M. (2000). Coordinating Health, Extended Care, and Community Support Services.
Journal of Aging & Social Policy, 11(1), pp.67-90.
Henderson, J., Willis, E., Xiao, L., Toffoli, L. and Verrall, C. (2016). Nurses' perceptions of the
impact of the aged care reform on services for residents in multi-purpose services and residential
aged care facilities in rural Australia. Australasian Journal on Ageing, 35(4), pp.E18-E23.
Lau, R., Willetts, G., Hood, K. and Cross, W. (2014). Development of self-efficacy of newly
graduated registered nurses in an aged care program. Australasian Journal on Ageing, 34(4),
pp.224-228.
McDonald, T. and Russell, F. (2012). Impact of technology-based care and management systems
on aged care outcomes in Australia. Nursing & Health Sciences, 14(1), pp.87-94.
McInnes, J. and Ibrahim, J. (2013). Preparation of residential aged care services for extreme hot
weather in Victoria, Australia. Australian Health Review, 37(4), p.442.
Rogers, A., Barrett, S. and Swanson, M. (2011). Aged care in Australia. Meadowbank, N.S.W.:
TAFE NSW, Training and Education Support, Industry Skills Unit.