Attachment 1 - FINAL Research Report Support Accommodation ... · Research Report - Page 6 Profile...

The support and accommodation needs of older residents and the anticipated impacts of aged care reform

RESEARCH REPORT

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ContentsExecutiveSummary................................................................................................................................................................4

Introduction...........................................................................................................................................................................5

Profile-OlderPeopleinWaverley.........................................................................................................................................6

Disability............................................................................................................................................................................7

Dementia...........................................................................................................................................................................7

Carers.................................................................................................................................................................................8

OlderRenters.....................................................................................................................................................................8

ResidentialAgedCareinAustralia.........................................................................................................................................8

NationalAgedCareReforms..................................................................................................................................................9

HomeandCommunityCareHACC-Whatischanging?........................................................................................................10

HomeCarePackages-Whatischanging?...........................................................................................................................10

NewHomeCarePackagesProgramme...........................................................................................................................10

ConsumerDirectedCare(CDC)........................................................................................................................................11

ConsumerContributionsforaHomeCarePackage.........................................................................................................11

ABasicDailyFee..............................................................................................................................................................11

AnIncomeTestedCareFee.............................................................................................................................................11

NewSupplements–DementiaandCognitionandVeteranswithacceptedmentalhealthconditions..........................12

ASingularHomeSupportProgram..................................................................................................................................12

ResidentialAgedCare-whatischanging?..........................................................................................................................12

RemovaloftheHighCareandLowCareDistinction.......................................................................................................12

MeansTestinginResidentialCare...................................................................................................................................12

AccommodationPaymentsforResidentialAccommodation..........................................................................................12

Means-testedCareFee....................................................................................................................................................13

FeesAccordingtoAbilitytoPay.......................................................................................................................................13

TreatmentoftheFamilyHomeinMeansTesting...........................................................................................................13

AnnualandLifetimeCaps................................................................................................................................................13

PublicationofAccommodationPrices.............................................................................................................................14

IncentivetobuildmoreandupgradeResidentialCareFacilities.....................................................................................14

ServiceProvisioninWaverley..............................................................................................................................................14

HomesupportinWaverley..............................................................................................................................................14

ReviewofCouncil’sHACCservices..................................................................................................................................15

HomeCarePackages........................................................................................................................................................15

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AgedCarePlacesinWaverley..........................................................................................................................................16

ResidentialAgedCareinWaverley..................................................................................................................................16

VacancyRates..................................................................................................................................................................17

AgedCareSupplyinWaverley.........................................................................................................................................17

Analysis................................................................................................................................................................................18

AgeingPopulation............................................................................................................................................................18

Disability..........................................................................................................................................................................18

Carers...............................................................................................................................................................................19

SupportingAgeinginPlace..............................................................................................................................................19

Affordablehousing..........................................................................................................................................................19

Independentlivingoptions..............................................................................................................................................20

Ageinginplace-awayforward.......................................................................................................................................21

Conclusion............................................................................................................................................................................21

Recommendations...........................................................................................................................................................22

References...........................................................................................................................................................................23

Appendix1...........................................................................................................................................................................24

Governmentresponsibilitiesinagedcareservices......................................................................................................24

Developmentandoperationofagedcarefacilities.....................................................................................................24

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ExecutiveSummaryWaverley'spopulationisageing,peoplearelivinglongerandwantingtoremainlivingintheirhomesandlocalcommunitiesforaslongastheycan.Whilstmanypeopleremainwellandhealthyastheyage,atsomestagemanywillexperienceadisabilityorillnessandrequireaccesstoagedcaresupportservices.Withintheolderpopulationtherearealsovulnerablegroupsthatmayrequireextrasupportandconsiderationoftheirneedsincluding:

• Peoplefromculturallydiversebackgrounds;• AboriginalandTorresStraitIslanderpeople;• Peoplerequiringassistancewithcoreactivitiesofdailylivingandpeopleprovidingunpaidassistancetoafamily

member;• Peopleintheworkforceearningbelowtheminimumwage;• Peopleexperiencingrentalstress;and• Peoplelivingalone.

Peoplewantgreaterchoiceandflexibilityfromagedcareservicestomeettheirindividualneeds,culturalneedsandpreferences.Whilstinrecentyears,therehasbeenanincreaseddemandforandavailabilityofin-homecareservices,theretentionofresidentialcareremainsimportanttosupportolderresidentswhoneedbothcareandaccommodationtoremainlivinginornearWaverley.

InAustralia,theaverageageofentryintoresidentialagedcareis80yearsandover,andtheaveragelengthofstayisbetween1-5years.Thismeansthatturnoverisrelativelyhigh.TheregionthatcoversWaverleycurrentlyhas85.9operationalagedcareplacesper1000peopleover70yearsofageand27.7allocatedhomecarepackageswhichgivesanoverallallocationratioof113.6placesper1000peopleovertheageof70.ThisisinlinewiththenationalstandardsetbytheAustralianGovernmentof113places(DSSStocktakeofAustralianGovernmentSubsidisedAgedCarePlacesandRatiosasat30June2014).AccordingtotheMyAgedCarewebsitetheregionhasapproximately30organisationsprovidingawiderangeofin-homecareservicestoresidentsinthearea.DuringthelastAgedCareApprovalACARfundinground(2014),thegovernmentallocatedafurther252packagestoin-homeagedcareservicestotheregionthatcoversWaverley.Aspeoplearechoosingtoremainintheirhomesformuchlongerthanwaspreviouslythecase,supplyofin-homecare

TheAustralianGovernmenthasbegunmajorreformoftheagedcareservicesystem.Themainchangesofthereforminclude:

• emphasisonconsumerchoiceandpreferences,includingenablement,consumerdirectedcare,careplanningandgoalsettingonanindividuallevel;

• phasingoutblockprogramfundingofcommunitycareservicesonalocallevel,andtenderingtosupportservicesataregionallevel;

• movingtowardsauserpayssystemwhichentailassetandincomemeanstestedcarefeeswithcapsforbothin-homecareandresidentialcare;and

• movingtowardsindividualisedfundingarrangementsforinhomeagedcare.

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packagesiswherethegreatestdemandwilloccur.Supplyofagedcareplacesintheareaislikelytobesufficientforthemediumterm.Itisimportanttonotethatnotallthedetailofthereformsareyetfullyknownorunderstood.FurtherupdateswillbeprovidedtoinformthecommunityandCouncilasnewdevelopmentsoccur.Recommendationsaredetailedintheconclusionofthereportandincludestrategiestoassistolderpeopletoremainconnectedtotheircommunityandsupportnetworksandstrategiestoimprovethedesignandaccessibilityofaccommodationandthebuiltenvironment.

IntroductionThisreportprovidesanupdateontheprovisionofagedcareandaccommodationforWaverley'solderpeopleinthecontextofthecurrentnationalagedcarereforms.Thereportincludes;

• AprofileofolderpeopleintheWaverleyLGA• Anupdateonthenationalagedcarereforms• AnoverviewofserviceprovisionforolderpeopleinWaverleyinrelationtoin-homecareandresidentialaged

care• Anoverviewofindependenthousing/livingoptionsforolderpeopleinWaverley• Apreliminaryanalysisidentifyingareasofneedasweplanforourageingpopulation

TheAustralianDepartmentofSocialServicesisresponsiblefortheregulationandallocationoffundingforagedcareprogramsandservicesacrossAustralia.Theagedcaresystemisdividedintoregions.Resourcesaregenerallyplannedandallocatedacrosstheseregions,andinformationiscollectedandreportedonaregionalbasis.WaverleyformspartoftheSouthEastSydneyRegionwhichcomprisesBotanyBay,Hurstville,Kogarah,Randwick,Rockdale,Sutherland,CityofSydney,andWoollahra.Wherepossible,informationsourcedforthisreporthasbeenbrokendowntotheLocalGovernmentlevel,howeverthishasnotbeenpossibleinallinstances.AlthoughlocalgovernmenthaslimitedinfluenceovertheallocationofAustralianGovernmentfundingtoagecareservices,theyarewellplacedtoconsultwithlocalcommunities,monitorcommunityneedandifnecessaryadvocatetootherlevelsofgovernmenttoaddressgapsinserviceprovision.Localgovernmentalsoplaysamajorroleinprovidingcommunityinformation,co-ordinatingandsupportinglocalcommunityservicesandaddressingbarrierstoaccesswithinthebuiltenvironmentthatcanpreventolderpeoplefromparticipatingincommunitylife.Thesupplyofservicestomeetlocaldemandwillneedtobemonitoredintothefutureasthereformsarefinalised,servicestransitiontothenewsystemsandpeopleseekaccesstoservices.

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Profile-OlderPeopleinWaverleyIn2011,theproportionofWaverleyresidentsaged65yearsandoverwas12%,whichwassimilartoGreaterSydneyat12.7%.Theproportionagedover85yearswas2.2%comparedwith1.9%inGreaterSydney.OverallpopulationgrowthforWaverleybetween2011and2025ispredictedtobe12.6%,whichisslightlylowerthantheEasternSydneyRegion(12.9%)andacrossNSW(13.6%).Correspondingwithpredictionsofanageingpopulation,growthofthepopulationover65isforecasttobemuchhigherat30%forWaverleyand37%fortheEasternSydneyRegion.ThehighestgrowthinWaverley'spopulationisexpectedtobeamongstthoseagedbetween75and79yearsatjustover60%.The2011Censusalsoshowedthat;

• 64.2%ofresidentsovertheageof65werebornoverseas,makingWaverley’solderpopulationmoreculturallydiversethantheoverallpopulation,andGreaterSydneyat50.7%.

• 3.7%ofWaverley'sIndigenouspopulationwereagedover65years,whereasjust0.04%oftheIndigenouspopulationofGreaterSydneywereagedover65.

• Workforceparticipationamongthe65+agegrouphassignificantlyincreased,from11.3%in2001and11.9%in2006,to16.56%in2011.Morethantwofifths(41.8%)ofWaverley’solderpopulationhadcompletedyear12,amuchlargerpercentagethanforGreaterSydneyat28.3%.

• 53.33%ofolderpeopleinWaverleyearned<$600perweekcomparedto68.86%inGreaterSydney.16.24%ofolderpeopleinWaverleyearned>$1,000perweekcomparedto9.49%inGreaterSydney.

• OlderrentersareavulnerablegroupinWaverley,affectedbyincreasingrentalcostsinthearea.12.2%ofallrentersinWaverleywereagedover50yearsold.

• 8.1%ofresidentsover65occupiedlonepersonhouseholds,whichissimilartoGreaterSydney(8%).

• Overathird(36.2%)ofWaverley’spopulationover65yearsprovidedunpaidassistanceorsupportofsomekind.13.4%ofthisgroupreportedvolunteering,12.3%providedchildcare,and10.5%providedassistancetoapersonwithadisability.

• Only16.5%ofWaverley'spopulationover65yearsreportedaneedforassistancewithself-care,communicationormobility,comparedto19.2%inGreaterSydney.However,theneedforassistanceincreasedsignificantlywithage,withonly3.9%of60-65yearoldsreportinganeedforassistance,comparedto42.8%ofpeopleagedover85years.

ThesestatisticsshowthatWaverleyhasarangeofvulnerablegroupswithinitsolderpopulation.Waverleyhasalargeculturallydiverseolderpopulation.Challengesfacingresidentsfromculturallydiversebackgroundsinclude:communicationbarriers,differentculturalpracticesanddifficultyinaccessingappropriateservices.ForAboriginalandTorresStraitIslanderpeopletherecanbemuchhigherlevelsofdisabilityatamuchearlierageandlowerlifeexpectancy.Halfofourolderpopulationintheworkforceareearninglessthanthemedianwage.Wehaveapocketofolderrenterswhoarebeingaffectedbyrisingrentalcostsinthearea.Asignificantpercentageofourolderpeoplearelivingalone,potentiallyleadingtoriskofsocialisolationifthereisanabsenceoffamilytosupportthemastheyage.Almosthalfofourolderpopulationover85yearsrequireassistancewithself-care,communicationormobility,andoverathirdofourolderpeopleareprovidingsomeformofunpaidassistance.

53.33%ofouroldercitizensearnlessthan

$600perweek

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DISABILITY

Atsomestageduringtheirlifetime,mostpeoplewillexperiencemobilityloss,sensoryorcognitivedisability.Theprevalenceofdisabilityisstronglylinkedtoageing.AroundhalfofAustralia'solderpopulation(1.7millionor7.5%ofAustralians)haveadisability.Assuch,olderpeoplewithdisabilitynowformalargerpartoftheAustralianpopulationthanpreviouslymeasured,havingrepresentedonly7.1%and7.0%ofthepopulationintheprevioustwosurveysin2009and2003. The2012SurveyofDisability,AgeingandCarersSDACfoundthatforpeopleagedover65years:

• Around42%neededassistancewithatleastoneactivitybecauseofdisabilityorage.• 87%reportedhavingalong-termhealthcondition.Thelong-termhealthconditionsmostfrequentlyreportedas

causingolderpeoplethemostproblemswerearthritis(16%),hypertension(11%)andbackproblems(9.4%).• Onethirdofolderpeoplereportedneedingassistancewithpersonalactivities(29%),mostcommonlyhealthcare

(25%)andmobilitytasks(18%).Propertymaintenance(23%)andhouseholdchores(18%)wereotheractivitiesthatolderpeopleneededassistancewith.

Accordingtothe2011Census,16.5%ofWaverley’spopulationover65yearsreportedaneedforassistancewithself-care,communicationormobility,comparedto19.2%inGreaterSydney.Theneedforassistanceincreasedsignificantlywithage,withonly3.9%of60-65yearoldsreportinganeedforassistance,comparedto42.8%ofpeopleagedover85years.TheSouthEasternSydneyLocalHealthService,intheirFallsInjuryPreventionPlan2013-2018,reportedthatatleast1in4peopleaged65yearsandoverfallatleastonceperyear,andmanyhavemultiplefalls.Whilstmanyfallsdonotresultinaninjury,fallsarewidelyacknowledgedtobealeadingcauseofprematureadmissiontoresidentialagedcarefortheolderagegroup.Justover10%offallsinacommunitysettingoccuronfootpaths,highlightingtheimportanceofensuringaccessibilityinthedesign,constructionandmaintenanceofCouncil'spublicinfrastructure.DatafromtheEasternSydneyMedicareLocalpopulationhealthprofilestatesthattherateoffallsrelatedhospitalisationinWaverleyandacrosstheeasternsuburbsforthoseaged65yearsandoverishigherthantheNSWaverage.TherateinWaverleyis34.18per1000populationcomparedtotheNSWaverageof31.29per1000.

DEMENTIA

WiththecontinuedgrowthandageingofAustralia’spopulation,thenumberofpeoplewithdementiaisanticipatedtoincreasesignificantly.DementiaisoneofthefastestgrowingsourcesofmajordiseaseinAustraliaanditisnowthethirdleadingcauseofdeath,afterheartdiseaseandstroke.AccordingtoAlzheimer'sAustralia,dementiaisthesinglegreatestcauseofdisabilityinolderAustralians(aged65yearsorolder)andthethirdleadingcauseofdisabilityoverall.By2036,thenumberofpeoplewithdementiainNSWisexpectedtoincreasefourfoldfrom84,000in2009to341,000in2050andcorrespondswiththediagnosisofalmost26,000newcasesannuallyinNSW(onepersonevery6minutes)increasingto116,000newcasesin2050.Itshouldalsobenotedthatover70%ofpeoplewithdementiaremainlivinginthecommunity.Theestimateddementiaprevalenceto2018fortheSouthEasternSydneyregionispredictedtobe14,193peoplecomprisingof:Sutherland:3729,Hurstville:1347,Kogarah:999,Rockdale:1725BotanyBay:638CityofSydney:1717,Waverley:982,andWoollahra:1136.

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CARERS

Overathird(36.2%)ofWaverley’spopulationover65yearsreportedprovidingunpaidassistanceorsupportofsomekindand10.5%reportedprovidingassistancetoapersonwithdisability

OLDERRENTERS

In2011therewere2,837peopleover50livinginrentalaccommodation.Rentersinthisagerangewere12.2%ofallrentersinWaverley,and17.7%ofthewholepopulationintheiragerange.Malesandfemaleswereaboutequallyrepresentedinallagegroupsexceptforpeopleaged85yearsandoverwherefemalesweretwothirdsofrenters.Thevastmajority,76.5%,wererentingfromaprivatelandlorddirectly,orthrougharealestateagent.TheproportionrentingfromapublicagencyincludingDepartmentofHousing,achurchorcharity,orcommunityhousingproviderwasstartlinglysmall,at17.8%.Maleswere50%ofallrenters,but53%ofrentersinprivaterental,and38%ofrentersinpublicrental.Morethanhalfofrenters54.1%,over50years,livedinfamilyhouseholds,comparedwith63%ofrentersinallagegroups.Aboutonethird,36.1%,ofolderrenterslivedalone,comparedwith29%ofrentersinallagegroups.Asmallproportionofolderrenterslivedingrouphouseholds,7.7%,comparedwith21%forallrenters.

Morethanhalfofolderrenterswereworking,52%,3.7%wereunemployedandlookingforworkand41.6%werenotintheworkforce.Themajorityofolderrenters,68.1%,earnedlessthanthemedianincomeforWaverleywhichin2011was$973perweekor$50,596perannum.Morethanaquarterofolderrenters,28.0%,earnedmorethanthemedian,somesubstantiallymore.Themajorityofthesewere50-59andlikelytobestillworking.

ResidentialAgedCareinAustraliaAlthoughthefollowinginformationisnotavailableforWaverley,itprovidesanideaoftheaverageagepeopleinAustraliaareenteringresidentialagedcarefacilitiesandtheaveragelengthofstay.InGovernment-fundedagedcarefacilitiesinAustralia,between2010and2011:

• Mostpeoplelivinginresidentialagedcarefacilitieswerewomen,themajoritywereaged80andoverandmanywerewidowed.

• Aboutthree-quarters(77%)wereaged80andoverand57%wereaged85andover.Thedifferenceinlifeexpectancybetweenmenandwomenisevidentwith70%ofpermanentresidentsbeingfemaleandmorewomenwidowed(64%)thantheirmalecounterparts(26%).

• Theaveragelengthofstayisincreasing.Forpermanentresidentswholeftresidentialagedcarebetween1July2010to30June2011,overone-third(38%)wereinresidentialcareforlessthan1year(27%forlessthan6months).Two-fifths(44%)hadalengthofstaybetween1and5years.Womentendedtostaylongerthanmenatanaverageof168.1weekscomparedwith109.5weeks,andmostresidentsleftduetodeath(91%).

41.6%ofourover50yearsresidentsarenot

intheworkforce

Theaveragelengthofstayisincreasing

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Theaveragecompletedlengthofstayforpermanentresidentsin2010-11was145.7weeks,anincreaseof11%since1998-99,whenitwas131.3weeks.

• TheageprofileforAboriginalandTorresStraitIslanderpeoplewasdifferent.At30June2011,therewere1,127residents(0.7%)inpermanentresidentialagedcareidentifyingasAboriginalandTorresStraitIslander.Theseresidentshadayoungerageprofile,with24%underage65comparedwith4%forallpermanentresidentsinthisagegroup,reflectingatendencytowardspoorerhealthandeligibilityforresidentialagedcareatage50.

(Agedcarepackagesinthecommunity2010-11:astatisticaloverviewAustraliaInstituteofHealthandWelfare).

NationalAgedCareReformsInAugust2011,theAustralianGovernmentreleasedthefindingsofaProductivityCommissioninquiryintoagedcareinareportcalledCaringforolderAustralians.TheinquirywasgiventhetaskofdevelopingdetailedoptionsforredesigningAustralia’sagedcaresystemtoensurethatitcanmeettheemergingchallengesofsupportingolderAustralians.Thereportfoundthat,whiletheagedcaresystemhadimprovedoverthepastdecade,therewerestillkeyproblems,includingdifficultiesencounteredbyclientsinnavigatingtherangeofservicesavailable,limitedconsumerchoice,variablequality,gapsincoverage,inconsistentpricingandworkforceshortages.

By2022,theAustralianGovernment'svisionisthatAustralia’sagedcaresystemwill:

• Besustainableandaffordable,longintothefuture.• Providediverseandrewardingcareeroptions.• Encourageagedcarebusinessestoinvestandgrow.• Offergreaterchoice,withcontrolinthehandsofconsumers.• Supportpeopletostayathome,andpartoftheircommunities,foraslongaspossible.Inachievingthisvision,theproposedchangesinclude;• Emphasisonconsumerchoiceandpreferences.Introducingconsumerdirectedcare,careplanningandgoal

settingonanindividuallevel.• Phasingoutblockprogramfundingofcommunitycareservicesonalocallevel,andtenderingtosupportservices

ataregionallevel.• Movingtowardsauserpayssystem,entailingassetandincomemeanstestingwithcapsforbothin-homecare

andresidentialcare.• Movetowardsindividualisedfundingarrangementsforcommunitycare-individualswillbeallocatedabudget

basedontheirassessedneedswhichismanagedbytheindividualorbytheirchosenprovider.Thereformsarestillbeingimplementedandnotallthedetailsareyetknown.Thereishoweverastrongpossibilitythatblockfundingforhomesupportserviceswillbephasedoutandindividualisedfundingintroducedwhenasingularhome

TheagedcarereformsannouncedbytheAustralianGovernmenton20April2012,aimtobuildamorenationallyconsistentandsustainablesystemandwaslargelyinformedbytheProductivityCommission’sreport.Thereformsgiveprioritytoprovidingmoresupportandcareinthehome,improvingaccesstoresidentialcare,givinggreatersupporttopeoplewithdementia,andstrengtheningtheagedcareworkforce(DoHA2012).

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supportprogramisformedin2018.Manysmallerserviceswillneedtolookatamalgamatingorriskbeingpushedoutbylargerorganisations.Councilwillalsoneedtocontinuetosupportlocalin-homesupportservicestosuccessfullytransitiontothenewconsumerbasedcaremodels.

HomeandCommunityCareHACC-Whatischanging?FromNovember2015,theAustralianGovernmentwillintroducetheCommonwealthHomeSupportProgram(CHSP)thatcombinestheexistingCommonwealthHACCProgram,theNationalRespiteforCarersProgramandDayTherapyCentresProgram.TheaimofthenewCommonwealthHomeSupportProgramistoprovideentrylevelin-homeandcommunitysupportservicesforpeopleovertheageof65yearsand50yearsforAboriginalandTorresStraitIslandersandtheircarerssothattheycancontinuelivingintheirownhomesandcommunity.Thisprogramwillcontinuetoprovidebasicsupportservicessuchaspersonalcare,domestichelp,transport,meals,socialsupportandrespiteservices.KeyfeaturesoftheproposedCommonwealthHomeSupportProgram(CHSP)

• AstandardisednationalassessmentthroughMyAgedCaretoassistthedevelopmentofgoalorientated,person-centredsupportplansforpeoplereceivingservices

• Wellnessandenablementapproachtoservicedeliverythatrequiresserviceproviderstoidentifyeachperson'sgoalsandstrengths,andtoworkwiththemtooptimisetheirfunctionalcapabilityandindependence

• Deliveringtimelimitedserviceswhenappropriate• SupportingthetransitionofpeoplewithmorecomplexorhighersupportneedstoanappropriatelevelHome

CarePackage• Afeesframeworkwhichoutlinesprinciplesproviderscanadoptinsettingandimplementingtheirfees,leadingto

greaterconsistencyandfairness• Reviewoftheplanningandfundingallocationmechanisms,includingensuringgreatercontestabilityforfunding

HomeCarePackages-Whatischanging?TheAustralianGovernmentisexpandinghomecarepackagessignificantlytoassistpeoplewhohavehigherormorecomplexneedstoremainlivingathomeandtointroducemorechoiceandflexibilitybyensuringthatcarepackagesaredeliveredthroughconsumerdirectedcare(CDC).TheGovernmentwillincreasethetotalnumberofHomeCarePackagesfromaround60,000to100,000by2016-17.Morethan40,000additionalpackagesareexpectedtobeavailableoverthefollowingfiveyearperiod,from2017-18to2021-22.

NEWHOMECAREPACKAGESPROGRAMME

Since2013,anewHomeCarePackagesProgramreplacedtheformercommunitypackagedcareprogrammes-CommunityAgedCarePackages(CACPs),ExtendedAgedCareatHome(EACH)packages,andExtendedAgedCareandHomeDementia(EACHD)packages.

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AHomeCarePackageisacoordinatedpackageofservicestailoredtomeettheindividual'sspecificcareneeds.Thepackageiscoordinatedbyahomecareprovider,withfundingprovidedbytheAustralianGovernment.TherearefourlevelsofHomeCarePackages:

• HomeCareLevel1–tosupportpeoplewithbasiccareneeds.• HomeCareLevel2–tosupportpeoplewithlowlevelcareneeds.• HomeCareLevel3–tosupportpeoplewithintermediatecareneeds.• HomeCareLevel4–tosupportpeoplewithhighcareneeds.

ArangeofservicescanbeprovidedunderaHomeCarePackage,includingcareservices,supportservices,clinicalservicesandotherservicestosupportapersonlivingathome.

CONSUMERDIRECTEDCARE(CDC)

FromJuly2015,serviceprovidersmustofferallHomeCarePackagestoconsumersonaconsumerdirectedcare(CDC)basis—CDCprovidescarerecipientsandtheircarerswithgreatercontroloverthetypesofcaretheyaccessandthedeliveryofthoseservices.Individualisedfundingwillbeintroducedfrom2017.Thismeansthefundingforapackagewillbedirectlyallocatedtoclients,ratherthantoservices.Clientscanthendecideiftheywanttoengageaservicetomanagetheirfundsforthem.Whileconsumerswillhavegreaterchoiceandflexibilitytodirecttheirpackagetotheirpreferredapprovedprovider,planningratioswillcontinue,cappingtheoverallsupplyofpackagesavailable.

CONSUMERCONTRIBUTIONSFORAHOMECAREPACKAGE

PeoplewhostartreceivingaHomeCarePackagefrom1July2014canbeaskedtopayabasicdailyfeeandanincometestedcarefee.Theincometestedcarefeeisdependentuponaperson’sassessableincome.

ABASICDAILYFEE

Thisisafeewhichallpeoplereceivingcareareaskedtopay.Themaximumfeethatcanbechargedis17.5percentofthesinglebasicagepension,whichiscurrently$136.78perfortnight.

ANINCOMETESTEDCAREFEE

Thisisanextracontributiontowardsthecostofcarethatsomepeoplemayneedtopay.Theincometestedcarefeeispayabledependingontheamountofincomesomeonehas.Itiscalculatedattherateof50percentofincomeabovecertainincomethresholdswithannualcapslimitingthemaximumthatcanbecharged.TheDepartmentofHumanServiceswillassesswhethersomeoneneedstopaythisfeeandhowmuch.Fullpensionerswillnotneedtopayanincometestedcarefee.Youcanonlybeaskedtopayanincome-testedcarefeeifyouhaveayearlyincomeabovethefollowingapproximatethresholds:

• individualperson–$25,316• memberofacouplebutnowseparatedduetoillness(individualincome)–$24,848• memberofacouplelivingtogether(combinedincome)–$39,306.

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NEWSUPPLEMENTS–DEMENTIAANDCOGNITIONANDVETERANSWITHACCEPTEDMENTALHEALTH

CONDITIONS

Additionalgovernmentfundingisalsoavailabletohelppeoplewithamentalhealthcondition.AdementiaandcognitionsupplementandaVeterans’supplementispaidtoahomecareproviderforpeoplewhoareeligible.ThesesupplementsapplyacrossallfourpackagelevelsofHomeCarePackagesandarepaidat10%ofthegovernmentsubsidyfortherelevantlevelofHomeCarePackage.

ASINGULARHOMESUPPORTPROGRAM

FromJuly2018,theHomeCarePackagesProgramandtheCommonwealthHomeSupportProgramwillbeconsolidatedintoasinglehomecaresystem.Detailsofthenewprogramhavenotyetbeenreleased.TheGovernmenthaspromisedconsultationwithstakeholdersonpotentialprogramandfundingoptions,aswellasoptionsforimplementationandtransition.Currently,theCHSPisblockfunded,whilehomecarepackagesarefundedthroughindividualbudgets.

ResidentialAgedCare-whatischanging?TheagedcarereformsrecognisethatwhileolderAustraliansprefertoreceivecareathomeforaslongaspossible,therewillalsobeanincreasingdemandforresidentialcare.

REMOVALOFTHEHIGHCAREANDLOWCAREDISTINCTION

From1July2014,thedistinctionbetweenlowcareandhighcarehasbeenremovedinpermanentresidentialagedcare.Thiswillresultinflexible,simpleandmoretransparentarrangementsinpermanentresidentialagedcare,reducingredtapeforconsumersandproviderswithoutcompromisingthelevelsofcareprovidedtoresidents.

MEANSTESTINGINRESIDENTIALCARE

Incomeandassettestshavebeencombinedsince2014toensureaconsistentfeespolicy.Thechangesareintendedtoimprovethefairnessandsustainabilityoftheagedcarefinancingarrangements,withstrongsafeguardstoensureaccesstocareforthosewhocannotaffordtocontributetothecostoftheircareandaccommodation.

ACCOMMODATIONPAYMENTSFORRESIDENTIALACCOMMODATION

From1July2014,allresidentswhocanaffordtodosohavethechoiceofpayingfortheiraccommodationthroughadailyaccommodationpayment(DAP)orarefundableaccommodationdeposit(RAD),oracombinationofboth.Agedcareprovidersarenotabletochoosebetweenagedcarerecipientsonthebasisofhowtheyelecttopayfortheiraccommodation.Residentshave28daysfromwhentheyentercaretodecidehowtopayfortheiraccommodation.

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MEANS-TESTEDCAREFEE

Dependingonaresident'sincomeandassetstheymaybeaskedtopayameans-testedcarefee.Thisisanadditionalcontributiontowardsthecostofcarethatsomepeoplemayberequiredtopay.Itcontributestoday-to-daycarecostssuchasnursingandpersonalcare.

FEESACCORDINGTOABILITYTOPAY

Aresidentialagedcarefacilitymayaskresidentstopayoneormoreofthefollowingfees:• Abasicdailyfee:thiscoverslivingcostssuchasmeals,powerandlaundry.Forsomepeoplethisistheonlyfee

theyarerequiredtopay.• Anaccommodationpayment:thisisforaccommodationintheresidentialcarefacility.Somepeoplewillhave

theiraccommodationcostsmetinfullorinpartbytheAustralianGovernment,whileotherswillneedtopaytheaccommodationpriceagreedwiththeresidentialagedcareprovider.TheDepartmentofHumanServiceswilladvisewhichappliesbasedonanassessmentofeachresident'sincomeandassets.

• Feesforextraoradditionaloptionalservices:additionalfeesmayapplyifahigherstandardofaccommodationischosenoradditionalservicesrequested.Thesevaryfromfacilitytofacility.

Theamountaresidentwillberequiredtopaywilldependontheirincomeandassets;however,therearelimitsinplace.Furthermore,accommodationprovidersareexpectedtomeettargetsforconcessionalplacesassetbytheAustralianGovernmenttoensurethatresidentswhocannotaffordtopayhaveequitableaccesstocare.

TREATMENTOFTHEFAMILYHOMEINMEANSTESTING

Itisimportanttonotethatthetreatmentofthefamilyhomehaschanged.Forcouples,halfoftheircombinedincomeandassetsareconsideredintheincomeandassetsassessment,regardlessofwhichpartnerearnstheincomeorownstheasset. Partofthevalueofthehomemaybecountedinanassetsassessment,buttherearesomeexceptionstothis.Itwon’tbecountedasanassetif:

• apartnerordependentchildislivingthere,or• acarereligibleforanAustralianGovernmentincomesupport

paymenthasbeenlivingthereforatleasttwoyears,or• acloserelativewhoiseligibleforanAustralianGovernmentincome

supportpaymenthasbeenlivingthereforatleastfiveyears.Thefullvalueofyourhomewillnotbeincludedintheassessmentofyourassets.Insteadacappedamountof$157,051.20(asat20March2015)willbeincludedorthenetmarketvalueofyourhouse,iflower.Wherethehomeisincludedasanasset,andthepersonisamemberofacouple,50percentofthenetmarketvalueofthehomewillbeattributedtoeachmemberofthecouple,andeachmember’sproportionwillbesubjecttothefullvalueofthecapthatappliesatthattime.Itwillbetheloweramountofeitherthecaporthenetvalueofeachmember’spartofthehomethatwillbeincludedasanasset.

ANNUALANDLIFETIMECAPS

Thereareannualandlifetimecapsthatapplytothemeans-testedcarefeeforagedcare.Oncethesecapsarereached,aresidentcannotbeaskedbytheirserviceprovidertopayanymoreofameans-testedcarefee.Anyincome-tested

Incomeandassetsassessmentcriteriaare

changing

ResearchReport-Page14

carefeepaidinaHomeCarePackagewillalsocounttowardsaresident'sannualandlifetimecapsinresidentialagedcare.TheAustralianGovernmentwillpaythemeans-testedcarefeeforaresidentaftertheyhavereachedthesecaps.

• Annualcap-Themaximummeans-testedcarefeearesidentcanbeaskedtopayeachyearis$25,000.• Lifetimecap-Themaximummeans-testedcarefeearesidentmaybeaskedtopayis$60,000intheirlifetime.

PUBLICATIONOFACCOMMODATIONPRICES

Since2014,allagedcarehomeshavebeenrequiredtopublishtheirmaximumaccommodationpricesanddescriptiveinformationontheMyAgedCarewebsite,theirownwebsiteandinotherrelevantmaterialstheyprovidetoprospectiveresidentsandtheirfamilies.Thisinformationisforresidentswhohaveenteredanagedcarehomeonorafter1July2014,andmeansthatprospectiveresidentsandtheirfamiliesarenowabletocompareaccommodationpricesanddescriptiveinformationfordifferentagedcarefacilities.

INCENTIVETOBUILDMOREANDUPGRADERESIDENTIALCAREFACILITIES

TheGovernmentisreformingagedcarefinancingarrangementstogiveagedcareprovidersthecertaintytheyneedsothatmoreagedcarefacilitiescanbebuilt,andexistingfacilitiescanbesignificantlyrefurbished.From1July2014,facilitiesthatarenewlybuiltorsignificantlyrefurbishedonorafter20April2012qualifyforahigherlevelofGovernmentaccommodationsupplementpaidforresidentswithlowmeans.Themaximumleveloftheaccommodationsupplementintheseresidentialagedcarefacilitieswillincreaseto$52.49(1July2014rate).

ServiceProvisioninWaverleyHOMESUPPORTINWAVERLEY

Therearecurrentlyover30organisationsdeliveringentrylevelhomesupportservices.TheservicesfundedtocoverWaverleymayalsoprovideservicestopeopleacrosstheEasternSydneyregion.Furthermore,someservicesarefundedtoprovidespecialistservicesforspecifictargetgroupssuchas:

• Peoplewithdementia• Carers• Veterans• Peoplefromaculturalorlinguisticallydiversebackgrounds• AboriginalandTorresStraitIslanders

ThehomesupportserviceslocatedinorontheborderofWaverleyare:WaverleyCommunityandSeniorsCentre,TheJunctionNeighbourhoodCentre-ECHO,RandwickWaverleyCommunityTransport,SydneyCOAandJewishCare.ThemajorityoforganisationsintheregionfundedthroughtheHACCprogramhavetakenstepsoverthelastyeartopreparefortheintroductionofthenewCommonwealthHomeSupportProgramfrom1November2015andhavebuiltcapacitytoexpandtheirservicestomeetfuturedemandifneeded.UnderthenewCHSParrangements,themajorityofserviceswillhavetheirfundinglevelsextendeduntil30June2018.

ResearchReport-Page15

REVIEWOFCOUNCIL’SHACCSERVICES

Inresponsetothereforms,CouncilreviewedwhatthechangeswouldmeanforitsHACCfundedservices.Aftercarefulconsideration,CouncildecideditwouldnotcontinuetheWaverleyMealsonWheelsserviceafter30June2015.Council’sdecisiontookintoconsiderationanumberoffactors.Firstly,WaverleyCouncilwasoperatingarelativelysmall-scaleMealsonWheelsservice,meaningthatthecostofrunningtheservicesignificantlyexceededthegrantmadeavailablebytheAustralianGovernment.Secondly,anumberoflargenot-for-profitorganisationsalsooperateaMealsonWheelsserviceinWaverley,andtheseorganisationsintendtoexpandandfurtherimprovetheirserviceintheyearstocome.CompetitionwiththeseserviceproviderswasnotinthebestinterestsofourMealsonWheelsclients.Thirdly,thelargerMealsonWheelsservicesoperatinginWaverleyprovidetheoptionofothertypesoflowcostserviceswhichwerenotbeingprovidedbyCouncil.Theseincludeinhomesupportandcareservices,socialactivitiesandmealsinacommunitysetting.Allclientsweresuccessfullytransitionedtootherlocalsubsidisedprovidersbythesetdate.Atthistime,CouncilalsodeterminedtocontinueactivitiesforactiveandfrailagedpeopleattheWaverleyCommunityandSeniorsCentre.TheserviceispreparingtotransitiontothenewCommonwealthHomeSupportProgram(CHSP)inNovember15withathreeyearfundingagreementandastrongfocuson‘enablement’.AllCHSPserviceswillneedtopreparefortheintroductionofconsumerdirectedcareby2018.Formanyservices,theywillneedtodeveloparobustbusinessmodel,requiringreviewofstaffingandfinancialstrategies,andtailoringofservicestoindividuals.ManyofthesmallercommunityserviceswillcontinuetorequireCouncilsupportwithsocialplanningandservicedevelopment.

HOMECAREPACKAGES

AllpackageproviderswhoarefundedtocoverWaverleyalsocoveratleasttwoormoreoflocalgovernmentareasintheregion.Somepackagesarealsorestrictedtoveteransortopeoplefromspecificculturalandlanguagebackgrounds.ThenumberofagedcarepackagesfundedthroughtheAustralianGovernment'sAgedCareApprovalsRound(ACAR)intheSouthEastSydneyRegionhasgrownsignificantlysince2005from463packagesdeliveredby6serviceprovidersto1107packagestobedeliveredby10providersin2013/14fundinground.TheAustralianGovernmenthasindicatedthattheyintendtocontinuethegrowthoftheHomeCarePackageprogramtomeetincreasingcommunitydemandforin-homesupport.AccordingtotheMyAgedCarewebsite,thereare30organisationsprovidingHomeCarePackagestoresidentsintheWaverleyLGA.Theseservicesrangefromhomemaintenanceandmodificationservicestohomedeliveredmeals,alliedhealthcare,personalcareandcasemanagementservices.Asolderpeoplearechoosingtoremainintheirhomesforaslongaspossible,inhomecommunitysupportservicesiswherethegreatestdemandwillbeasthepopulationages.ThesupplyofHomeSupportservicesinWaverleywillneedtobemonitoredintothefuture.

ResearchReport-Page16

AGEDCAREPLACESINWAVERLEY

AgedCareplacesareplanned,approvedandallocatedonaregionalbasis.WaverleyislocatedintheSouthEastSydneyRegionwhichcomprisesBotanyBay,Hurstville,Kogarah,Randwick,Rockdale,Sutherland,CityofSydney,Waverley,WoollahraandLordHoweIsland.ThefundingratiosetbytheAustralianGovernmentiscurrently113placesper1000peopleagedover70years.ThisratioincludesthenumberofHomeCarePackagesdeliveredinpeople'shomesandthenumberofcareplacesdeliveredwithinresidentialfacilities.Anewtargetratioof125agedcareplaceshasbeenreleasedbytheAustralianGovernmentanditistobeachievedby2021-22.Theratiocomprises80residentialplacesand45HomeCarePackagesper1000residentsaged70yearsandover.

RESIDENTIALAGEDCAREINWAVERLEY

BelowisatableofresidentialagedcarefacilitiesintheWaverleyLGA.Therearecurrently16facilitiesprovidingresidentialagedcareinWaverley,RandwickandWoollahra,offering1,087beds.Twofacilitiesareunderconstruction,andanotherfacilityispendingapprovaltoprovideanadditional11beds. FACILITY&TYPE ADDRESS CURRENTBEDSAltonaNursingHome 40HenriettaStreet,Waverley 26BUPAatQueensPark(formerAmity) 142CarringtonRoad,Waverley 71EdinaNursingHome,UnitingCare 150BronteRoad,Waverley 40SummitCareWaverley-previouslyPhillipHouse 321BronteRoad,Waverley 67VaucluseAgedCare,HallandPrior 13YoungStreet,Vaucluse 63BondiWatersAdvantagedCare 47-51O'BrienStreet,Bondi 56CharingfieldHostel 282aBronteRoad,Waverley 55EdinaHostel,UnitingCare 150BronteRoad,Waverley 41IllowraHostel,UnitingCare 195BirrellStreet,Waverley 42WoollahraMontefioreHome 23NelsonStreet,Woollahra 50RonaldColemanLodge 88WallisStreet,Woollahra 63TheLittleSistersofthePoorMountStJoseph'sHome 70MarketStreet,Randwick 62SummitCareRandwick 15FrenchmansRoad,Randwick 94RandwickMontefioreHome 36DangarStreet,Randwick 276MilfordHouseNursingHome 2MilfordStreet,Randwick 51BrigidineHouse 7CoogeeBayRoad,Randwick 30TotalProviders:9 TotalBeds:1,087RESIDENTIALFACILITYPENDING

ADDRESS STATUS BEDS

Loreto-StVincent's

363BronteRoad,Bronte DAapprovedincludesdementiaplaces.UnderConstruction.

106

VaucluseAgedCareHallandPrior

13YoungStreetVaucluse DAunderconsiderationfor11extrabeds

11extra

MarkMoranVaucluse 46NewSouthHeadRoad,Vaucluse

Underconstruction

Total:117

ResearchReport-Page17

CouncilisawarethatthereareplansunderwaytoexplorethefeasibilityofanAboriginalandTorresStraitIslanderfacility.TheLaPerouseLocalAboriginalLandCouncilinconjunctionwiththefederalgovernmentandinconsultationwithAboriginalserviceprovidersiscurrentlyexploringwaysofmakingthishappen.

VACANCYRATES

Thestatusofresidentialbedvacanciesvariesfromdaytoday.InformationaboutvacanciesinaregionismonitoredbyhospitalsandcannowbefoundontheMyAgedCarewebsitewhichisupdatedonadailybasis.On17August2015,therewere6vacanciesin4facilitiesintheWaverleyLGA.

AGEDCARESUPPLYINWAVERLEY

Anacceptedmeasureofthesupplyofagedcareplacesacrossthecountryisthenumberofavailableagedcareplacesrelativetothesizeofthepopulationmostlikelytorequiretheseservices.ThenationaltargetforagedcareplacesissetbytheAustralianGovernmentata113placesper1,000populationovertheageof70years.

ThedifferencebetweenallocatedandoperationalplacesusuallyresultsfromthetimelagbetweentheGovernmentallocatingplacesandtheconstructionofresidentialfacilitiesintheregion.WiththeredevelopmentoftheLoretositeandtwofacilitiesontheborderofWaverleyinthenearfuture,thesupplyofresidentialagedcareintheareaislikelytobesufficientinthemediumterm.TheallocatednumberofresidentialagedcareplacesintheSouthEastSydneyRegionis105.1placesand27.7homecareplacesper1000peopleaged70yearsformingcombinedsupplyratioof132.8whichiswellovertheforecasttargetof125by2021/22.Ananalysisofagedcareplacesin2014byEasterSydneyMedicareLocalfoundthatWaverleyhas72%morecommunityagedcarepackagesper1000persons,20%morehighcareplacesand15%fewerlowcareplacescomparedtoEasternSydney.Thisdataappearstosupportthetrendtowardspeoplestayingintheirhomesforaslongaspossibleandenteringresidentialcareonlywheninneedofhighlevelsofcare.

Itshouldbenotedthatmanyintheindustrycontinuetoadvocatefortheremovalofservicerationingforallagedcareservices.Theimplementationofconsumerdirectedcarewillrequirecarefulmonitoring,especiallywiththetrendtowardsolderpeoplehavingtomeetmoreofthecoststhemselves.

At30June2014,intheSouthEastSydneyRegion,therewere7,649operationalresidentialagedcareplacesand2,473homecareplaces,equatingto85.9residentialagedcareplacesand27.7homecareplacesper1000people70yearsandoverandanoverallsupplyratioof113.6.Thisisin-linewiththenationaltarget.

ResearchReport-Page18

AnalysisAGEINGPOPULATION

Thepopulationisageingandpeoplearelivinglonger,therefore,theprevalenceofdisability,includingthenumberofpeopleexperiencingdementiaislikelytoincrease.Waverleywillrequireanadequatesupplyofagedcareservicesandaccommodationoptionsthatareaffordabletomeetthisgrowingdemand.Atthispointintime,thesupplyofagedcareservicesinWaverleyappearstobereasonablysufficienttomeettheneedsofthecommunity.Although,localgovernmenthaslimitedinfluenceovertheallocationofAustralianGovernmentfundingtotheagecaresector,itiswellplacedtoconsultwithandmonitorlocalcommunityneedandifrequiredadvocatetootherlevelsofgovernmenttoaddressgapsinservices.Throughahostofplansandpolicies,Councilsalsoimplementlegislativerequirementstoensureaccess,equitableshareofresources,andtargetedsupporttothosemostinneed.Localgovernmentalsoplayamajorroleinprovidingcommunityinformation,co-ordinatingandsupportinglocalcommunityservicesandaddressingbarrierswithinthebuiltenvironmentthatcanpreventolderpeoplefromparticipatingincommunitylife.Theadequatesupplyofserviceswillneedtobemonitoredintothefutureasthereformsarefinalised,servicestransitiontothenewsystemsandpeopleseekaccesstoservices.

DISABILITY

Theprevalenceofdisabilitywithinthecommunitywillgrowasthepopulationages,itisimportanttoanalysethepotentialimplicationsofthenewconsumerdirectedcaresystemonlocalservicesandconsumers.Whilethereformswillgivetheindividualmorechoiceandflexibilityintailoringpackagestobestsuittheirneeds,thecostsassociatedcouldbemuchhigherthanbefore,particularlyforthosewithcomplexorhighcareneeds.Thisissomethingthatwillneedtobemonitoredasservicestransitiontothenewmodel.WhileCouncil’sfocusonaccessandinclusioniscurrentlychannelledthroughtheAccessandMobilityPlan,newmandatoryrequirementswillsooncomeintoforceundertheDisabilityInclusionAct.By1July2017,andinconsultationwithkeystakeholders,CouncilswillneedtohavedevelopedanewDisabilityInclusionActionPlan.Councilwillcontinue

toplaceimportanceonensuringthatdisabilityaccessstandardsanduniversaldesignfeaturesareintegratedinallplanning,developmentandmaintenanceofpublicinfrastructure.Priorityshouldbegiventoensuringeaseofaccesstopublicandcommunitytransport,parking,residentialdevelopments,shoppingcentres,medicalhubs,parksandbeaches.Underthenewplan,thereshouldalsobeafocusonsupportingsocial,employment,recreationalandeducationalopportunities.TheBondiJunctionCivicHeartprojectisan

exampleofwhereCouncilhasanopportunitytosignificantlyimprovetheaccessibilityofthepublicdomainanddevelopinitiativesthatsupportolderpeopletoremainconnectedandengagedincommunitylife.

NewDisabilityInclusionActionPlans

in2017

ResearchReport-Page19

CARERS

AsignificantpercentageofolderpeopleinWaverleyprovideunpaidsupportorassistanceofsomekind.Whileforsomeolderresidentsthisinavolunteeringcapacity,manyareprovidingchildcaresupportorsupporttoapersonwithadisability.Grandparentsmaybetakingontheresponsibilityofcaringfortheirgrandchildrenasparentsoftenfeelpressuredtoreturntoworkandthecostofchildcarecanbeaburden.Someolderpeoplearealsotakingontheroleofcaringfortheirspousesastheyageintheirhomes.Carersoftenrequiresupportandrespitethemselves,haveadditionalexpensesattributedtotakingonthisrole,andtheirabilitytoworkcanbeimpededbytheircaringresponsibilities.Considerationsforthisgroupincludeaccesstoaffordablechildcare,accesstoservicesthatcansupportthemintheircaringrole,accesstoflexibleworkopportunitiesandaccesstoaffordablehousing.

SUPPORTINGAGEINGINPLACE

Asolderpeoplearechoosingtostayathomelonger,therewillbeincreaseddemandforin-homecareservices.Blockfundingofhomesupportserviceswillbephased,willbephasedoutandthereisastrongpossibilitythatserviceswilleventuallydeliveredthroughconsumerdirectedcareandindividualisedbudgetsallocatedtotheclient.Smallerserviceswillneedtolookatamalgamatingorriskbeingpushedoutbylargerorganisations.Councilwillneedtocontinuetosupportlocalin-homesupportservicestosuccessfullytransitiontoconsumerbasedcare.Withtheintroductionofmeans-testedcarefeesbasedonincomeandassets,olderresidentscouldenduppayingmoreforthecaretheyneedandsomemayberequiredtoselltheirhomeiftheyneedahighlevelofcareinaresidentialcaresetting.Thenewsystemwillmeanthatpeoplewhocanaffordtopaywillbecontributingmoretotheircare,butthosewhoarelesswell-offwillcontinuetobenefitfromGovernmentsubsidiesandwillnotbeexcludedfromreceivingalevelofcare.Somepeople,however,maybereluctanttopayforservicesthattheyperceiveasnotnecessarysuchassocialoutingsorhomemaintenance,especiallyiftheyneedtopayforhighlevelsofpersonalcareordomestichelp.Thiscouldalsopotentiallyincreasethesocialisolationofpeopleinthissituation.

AFFORDABLEHOUSING

Accordingtothe2011Census,thereisashortageoflowcostrentalhousingandsocialhousingintheeasternsuburbs.Considerationwillneedtobegiventoimprovingthissupplyasolderpeoplearechoosingtoremainathomelonger;onethirdofourolderrenterslivealone;onlyhalfareemployedandthemajorityofthoseemployedearnlessthanthemedianwage.Council'ssocialandaffordablehousingportfoliocurrentlyprovidesover100unitsofhousingforresidentsinWaverley.RecentchangestoCouncil'ssocialhousingpolicyhasloweredtheeligibilityageandallowedcarerstolivewithfamilymembersinthishousingwhichhasbeenapositivemove.Ongoingcommitmenttothisprogramwillbeimportantinmeetingtheneedsofpeoplewhodonotowntheirownhomeandareonalowincome.ThesituationintheWaverleyareareflectsnationaldemographictrends.WaverleyCouncilhasidentifiedtheageingofthepopulationandhousingaffordabilityastwoofitsmostsignificantcommunityissuesinitscurrentSocialPlan(WaverleyTogether3).AsinmanyotherpartsofAustralia,thereisashortageofhousingthatissuitableforolderpeople’schangingcircumstances.ThiscancreatemajordifficultiesforlongtermolderresidentsofWaverleywhen

Councilprovidesover100unitsofsocialand

affordablehousingstock

ResearchReport-Page20

healthproblemsmaketheirhousingunsuitable,especiallyforthoseonlowincomeswhohavemodestornoassets.Forlowincomehomeowners,theirhomerepresentsasignificantpotentialassetbutonethatmayonlybeabletoberealisediftheyarepreparedtomoveoutofthearea.Gentrificationoftheareaoverthelast20-30yearshasresultedinmajorincreasesinpricesandolderpeoplewhoownahousecertainlyhavemoreoptionsthandothosewhoownapartments.However,manyarereluctantorcannotaffordtomaintaintheirhomes,insomeinstancesputtingtheirsafetyatrisk.AlmosthalfofWaverley’slowerincomeolderhomeownerhouseholdsliveinapartments,manyinolderstyleblockswithoutlifts.Lowincomeolderrentersareunderveryintensepressureandarerapidlybeingforcedoutoftheareaaltogether.Councilcouldconsideradvocatingforgreatersupplyofsocialhousingacrosstheeasternsuburbs.

INDEPENDENTLIVINGOPTIONS

ThereareanumberofRetirementVillagesintheEasternSuburbs,butlargelythemodelhasbecomeoutdated andcanfosterseparationand‘otherness’ifthelocationanddesignisolatespeoplefromtheirfamily,friendsandinterests.Retirementvillagesaretypicallyamoreexpensivelivingoptionwithhighertransactionandlivingcosts.Theyoftenfeaturesmallerproperties,thereisalimitedchoiceoflocationsaswellasaccommodationproductsandthereisgenerallyapoorfinancialoutcomeforresidentsuponexit.Contemporarydesignfeaturesarebeingincorporatedwithinnewhousingdevelopmentssuchas,ahome-likeenvironmentandonsitecafesandshops.Agrouphomemodel,designedforpeoplewithdementia,operatedbyGroupHomesAustraliaandtheMarkMorandevelopmentcurrentlyunderconstructionareexamples,inthearea,thatfeatureahome-likeenvironment.Arguably,however,housingdevelopmentforseniorsisstilllargelydrivenbycompliancewithbuildingstandards,ratherthaninnovationindesigntoassistpeopletoageinplaceandremainengagedincommunitylife.Manyoftheoptionsintheareaarealsohighendandbeyondthereachofalargepercentageofpeopleonmiddletolowincome.Theareaislikelytocontinuetoattracthighenddevelopmentsastheareaislargelyviewedashometoanaffluentcommunity.ThelossoftheBenevolentSociety’sApartmentsforLifedevelopmenthasreducedavailableoptionsforlocalresidentswithmoderatemeanstoageinplace.AkeyfeatureoftheApartmentsforLifemodelisthatitofferspeopleachancetoremainintheirownhomeastheyagetoavoidhavingtomoveiftheirhealthdeclinesandtheyrequireincreasedlevelsofcareandsupport.Themodelalsoprovidedaffordableandsocialhousingunitsforthoseonlowtomoderateincomes.

Ashortageofsuitablydesignedhousingislikelytobeagrowingissue,especiallyforpeoplewhowishtodownsizeandremaininthelocalarea.Strategiestosupportandpromotethedevelopmentofinnovativehousingdesignwithaccessibleandadaptablefeaturestodevelopers,architectsanddesignerscouldbeexploredtoimprovehousingoptionsforolderpeopleinthearea,movingtowardsindividualisedfundingarrangementsforinhomeagedcare.

ResearchReport-Page21

AGEINGINPLACE-AWAYFORWARD

TheNewArchitectureforaNewAge(NANA)projectoffersanewwayofthinkingaboutthedesignofaccommodation,exploringhowarchitectscandesignbetterenvironmentsforpeopleastheyagethatimprovetheirenjoymentoflife.GuyLuscomb,anawardwinningarchitect,specialisingintheagedsector,studied13residentialdevelopmentsacrossEuropeaspartoftheNANAproject.Hearguesthat’creatingplacesthatareappropriatelydesigned,thataidhealthandwellbeing,promoteparticipationbyanincreasinglyelderlyworkforceandmakecitiesandneighbourhoodsmore‘agefriendly’,willnotonlybenefitindividualsbutwouldhavebottomlinebenefitsfortheeconomy,potentiallydecreasingtheprojecteddemandonhealthservicesandprovidingawholenewgroupofactivecitizens.’Keyrecommendationsfromtheprojectinclude:societyshouldviewolderageasthenormnottheexceptionandarchitectsshouldbetrainedonhowtoincludetheneedsofpeopleatallstagesoflife;designshouldembraceinclusivenessandequalopportunityandmoveawayfromacompliancedrivenapproach;theLiveableHousingGuidelinesshouldbeappliedtoallnewbuildings;andmultigenerationalhousinganddesignthatpromotecommunityshouldbeencouragedwithmorehousingandfacilitiesforseniorsincludedinurbancentres,connectedtofacilitiesandpublictransport.

ConclusionWaverley'spopulationisageingand,correspondinglyitcanbeexpectedtherewillbeanincreaseintheprevalenceofdisabilityandanincreasingneedforbothin-homesupportandresidentialagedcare.WithinWaverley'solderpopulationtherearevulnerablegroupswhichwillrequireadequateplanningandsupport,including:

• peoplefromculturallyandlinguisticallydiversebackgrounds;• peoplerequiringassistancewithcoreactivitiesorprovidingunpaidassistancetoafamilymember;• peopleintheworkforceearningbelowtheminimumwage;• peopleexperiencingrentalstress;and• peoplelivingalone.

Themainchangesasaresultoftheagedcarereformsforhomecareandresidentialagedcareincludeanemphasisonwellness,consumerdirectedcareandtheimplementationofmeans-testedcarefeesforpeopleaccessingtheseservices.Aspeoplearechoosingtoremainlivingintheirhomesformuchlonger,anaccessiblebuiltenvironmentandaccesstoanadequatesupplyofin-homecareservicesandpackageswillbeneeded.Thesupplyofagedcareplaces,bothresidentialplacesandhomecarepackages,intheareaisconsideredreasonablysufficientatthistimebutasthefulldetailofthereformsarenotyetknown,thelongertermimpactwillneedtobemonitoredandCouncilandthecommunitykeptinformedofdevelopments.Council’sCommunityandSeniorsCentreandassistedbywelltargetedpartnershiparrangementswillplayanimportantpartintheprovisionofbestpracticeinformation,referralandsupportservicesundertheConsumerDirectedCaremodel.Councilwillneedtocontinueitseffortstoensureuniversaldesignfeaturesareintegratedinallplanning,developmentandmaintenanceofpublicinfrastructuretoprovideeaseofaccessforolderpeoplewithinthepublicdomain,andstrategiestosupportsocialinclusionandcommunityengagementopportunities.Theconceptofhealthyageingis

ResearchReport-Page22

encapsulatedinanumberofdifferentways.Itincludesastrongfocusonmakingourpublicspaces,openandinviting.Italsoreferstoahostofsupportsthatenablepeopletostayactiveandwellastheyagethroughsocial,recreationalandculturalprograms.ThenewrequirementsunderthenewDisabilityInclusionActionPlanwillprovideaframeworkandfocustoplanandmonitortheprogressforCouncil’sworkinthisarea.Thereisashortageof,anddemandfor,innovative,affordableandwell-designedhousingoptionsforolderpeople.Although,localgovernmenthaslimitedinfluenceovertheallocationofagedcare,Councilcouldtakeaproactiveroleinpromotinggoodpracticeandbringingarchitects,urbanplannersanddeveloperstogethertoexploreideasonhowbesttoimprovethesupply,designandpromotionofinnovativedesigninhousingthatbettermeettheneedsofolderpeopleinthearea.

RECOMMENDATIONS

• Holdaforumtostimulateregionaldiscussionstofacilitatepartnershipsaroundinnovativehousingdesignoptionsforpeopleastheyage.Theforumwouldattractarchitects,urbandesigners,developers,governmentagenciesandplannerstoexploreaffordableoptionsandmultigenerationaldevelopmentsthatsupportcommunityengagementandageinginplace.

• Continuetomonitorthesupplyofresidentialcareandseniorshousingoptions• EndorsedevelopmentofaDisabilityInclusionActionPlantoidentifyactionsCouncilcantaketosupportpeople

toremainhealthy,activeandwell,andengagedincommunitylife.• ContinueserviceimprovementsattheWaverleyCommunity&SeniorsCentretobecomeacentreofexcellence

fortheregionundertheConsumerDirectedCaremodel.

ResearchReport-Page23

References• Agedcarepackagesinthecommunity2010-11:astatisticaloverview-AustralianInstituteofHealthandWelfare• AgeingandAgedCareDepartmentofSocialServicesonline-www.dss.gov.au• KeyFactsandStatistics:March2014–Alzheimer'sAustralia• Australia'sWelfareReport2013-AustralianInstituteofHealthandWelfare• CommonwealthHomeSupportProgrammeDiscussionPaperSubmission-HACCDevelopmentOfficersSouth

EastSydney• DementiaServicesFramework2010-2015-NSWHealth• DemographicSnapshotMetroSouthRegion-NSWDepartmentofFamily&CommunityServices• FallsInjuryPreventionPlan2013-2018-SouthEastSydneyLocalHealthDistrict• GuidetoAgeCareNSW&ACT-DPSPublishingonline-www.agedcareguide.com.au• HomeandCommunityCareCityofSydneyandEasternSuburbs-InnerSydneyRegionalCouncilforSocial

Development• MyAgedCareonline-www.myagedcare.gov.au• NewSouthWalesStateandLocalGovernmentAreaPopulation,HouseholdandDwellingProjections:2014Final

-2014AustralianBureauofStatistics• PopulationHealthSub-RegionalProfile2014WaverleyLocalGovernmentArea-EasternSydneyMedicareLocal• ReportonGovernmentServices2013-SteeringCommitteefortheReviewofGovernmentServiceProvision-

AustralianGovernmentProductivityCommission• ReportontheOperationoftheAgedCareAct1997,2013-2014-2012AustralianGovernmentDepartmentof

SocialServices• Residentialagedcareandagedcarepackagesinthecommunity2011–12-AustralianInstituteofHealthand

Welfareonlinewww.aihw.gov.au/home• TechnicalPaperonthechangingdynamicsofresidentialagedcarepreparedtoassisttheProductivity

CommissionInquiryCaringforOlderAustralians-2011DepartmentofHealthandAgeing• TheNANAProject-GuyLudscombe-ByeraHadleyTravellingScholarshipsJournalSeries,NSWArchitects

RegistrationBoard2015• 30June2014StocktakeTotalPlacesandRatiosbyAgedCarePlanning-TheDepartmentofHealth

ResearchReport-Page24

Appendix1

Governmentresponsibilitiesinagedcareservices

LEVELOFINFLUENCEINAGEDCARE

KEYFUNCTIONS

FederalGovernment

Primaryresponsibilityforagedcare

NationalRegulationandfundingofresidentialcareandhomesupportservices.Setsnationaltargetforallocatedplacesforresidentialcareandhomesupport.

StateGovernment

Limitedinfluenceoveragedcare.RegulationandfundingfordisabilityinclusionuntilNDISrolloutiscomplete.

NSWAgeingStrategysetsoutactionsthatstategovernmentagencieswilltaketosupportanagingpopulationeg:SeniorsCardNSWDisabilityInclusionAct2014requiresStategovernmentagenciesandCouncilstodevelopaplantosupportandpromotetheinclusionofpeoplewithdisabilityincommunitylife.

LocalGovernment

Limitedinfluenceoveragedcare

Urbanplanningandimplementationofaccessimprovementstothebuiltenvironment.MaydirectlyprovideservicesandsupportsforolderpeopleUndertakessocialplanning,communityconsultationandadvocacytoaddressneedsandinformCouncil’sstrategicplanning

Developmentandoperationofagedcarefacilities

Agedcarefacilitiescanbedevelopedandoperatedbygovernment,privatebusinessandnotforprofitagencies.

ThedevelopmentofagedcarefacilitiesrequirecompliancewithbasicbuiltenvironmentstandardsAgedCareprovidersmustcomplywithagedcarequalitystandardsandstringentfundingrequirements.