The Changing Face of Community and Aged Care. Challenges for the future.

A/Prof Michael Fine

Department of Sociology

Centre for Research on Social Inclusion

Macquarie University

Sydney NSW

michael.fine@mq.edu.au

Setting the scene

Ten Years Time? Big question - Data is missing

The future is unknown and unknowable.

Generally a way of talking about today.

Starting point: the foundations of today.

Major challengesAgeing: Longevity Society

Climate change - from ‘prediction’ to management

Globalised world

Social change. From - modern industrial society to - post-modern, post-industrial society?

Economic sustainability

Proportion of the population in select age groups, Australia, 1901-2101 (%)

Year/Age group

1901 1947 1971 2002 2021 2051 2101

0-14 yrs 35.1 25.1 28.7 20.3 16.1 14.0 13.8

15-64 yrs 60.8 66.8 63.0 67.1 64.9 58.9 57.2

65+ yrs 4.0 8.1 8.3 12.6 19.0 26.1 28.9

Source: (ABS 2006: 114, Table 5.16, in Borowski and McDonald, 2007: 30)

The demographic shift

Ageing associated with affluence, high living standards. Australia still well behind most N. European Countries

ageing of the population, fertility rates below replacement level.

National Strategy for an Ageing Australia (2003); Intergenerational Report (2002, 2007)

For every (Italian child) under five. In Italy in 1950, there were 8.5 children under five: 1 over 80 year old. In 1995 the ratio had fallen to 1.3: 1 By 2050 there may be 1: 6 over 80-year olds and 1: 18 over 60-year olds

(Golini, 1997: 54)

The Need for Care

Epidemiology 3 scenarios: 1. Compression of Morbidity hypothesis (Fries, 1980;

Fries, Green and Levine, 1989)

2. Expansion of Morbidity (Gruenberg, 1977; Kramer, 1980; Olshansky et al., 1991)

3. Postponement of Morbidity (Manton, Stallard and Corder, 1995; Manton and Land, 2000)

Epidemiological Evidence

1. Very moderate or no gains in disability on the whole – Australia, the Netherlands and the United Kingdom;

2. Mixed or moderate results – Canada, Sweden;

3. Significant gains – Germany, France, Japan and the United States. (Jacobzone et al., 1998a: 16)

Likelihood of better prevention etc, but continuing need for care.

Dementia: 2007-2050

2007 220,000 people affected

2050 731,000 expected.

Dementia numbers: increase of 327%

Total population: increase less than 40%

Table 1 Long-term Care Arrangements for Older People (aged 65+) Australia, 2003-04

Number Pct 65+(a) Workforce(b)

Care arrangement

Residential Aged Care Services (High Care) (c)

89,922 3.45 86,761

Residential Aged Care Services (Low Care) (c)

47,785 1.83 44,469

Extended Aged Care at Home (EACH) (c)

646 0.02

Community Aged Care Packages (CACP)(c)

25,722 0.99

At Home with HACC or VHC(c)(d) 598,737 22.99 51,792

Living at home with unpaid care only 345,500 13.26

Total people aged 65+ 2,604,900 100.00

Key issues in aged care

The Availability of (unpaid) Carers

Future workforce planning

Future models of service delivery

Funding options

Availability of carers

Australian projections - AIHW (1998-2013),

NATSEM (2001-2031)

Suggest declining availability of ‘primary carers’ in coming decades.

UK projections (Pickard et al. 2001) suggest improvement in availability of carers due to improved rates of marriage and cohabitation amongst older people.

Formal Care Staff

Less projections done, less data available NILS Study (2004) of existing residential care

workforce suggests current staffing not in crisis, but increasingly under threat. 94 pct female; Mainly part-time (66 pct); 25 pct casual/agency staff; Fewer nurses; more low paid personal carers; Increased reliance on migrant staff

National Aged Care Workforce Strategy (2005)

Projected Number of Direct Care Workers Needed for Aged Care Accommodation and All LTC services, Australia: 2003-2031

Source: Hugo, 2007: 177. Calculated using ABS 2005 Projections, Series B and ABS Survey of Disability, Ageing and Carers, Catalogue No. 4430.0, + authors calculations

Year No. of Older Persons Needing Care

Accommodation

Residential care No. of Direct Care

Workers Needed (fte)

Percent Change p.a Residential and Commy Care

All LTC Staff (ft & pt) 2003 144,000 68,400 183,022 2011 370,848 176,153 12.6 471,343 2021 495,315 235,275 2.9 629,539 2031 611,292 290,364 2.1 776,944

Future Care Workforce Planning

Will the shortage of care staff experienced in Europe affect Australia?

Already major concerns about lack of wage parity with comparable staff. Can we afford better pay? Can we afford not to pay better?

Concerns also about changing staffing mix. What is right?

Should existing specialised division of labour be maintained?

National Aged Care Workforce Strategy

1. WORKFORCE PROFILEStrategy 1: Know the Workforce Profile

Strategy 2: Link Workforce Profile to Supply and Demand

2. WORKPLACE PRACTICE MODELSStrategy 3: Identify and Develop Effective Workplace Practice Models

Strategy 4: Link Workplace Practice Models and Workforce Demand

3. LEADERSHIP AND MANAGEMENTStrategy 5: Develop and Sustain Workplace Leadership

Strategy 6: Develop and Sustain Effective Management

National Aged Care Workforce Strategy (Cont’)

4. EDUCATION, TRAINING AND DEVELOPMENT

Strategy 7: Provide Effective Training Design

Strategy 8: Provide Effective Training Delivery and Opportunities

Strategy 9: Ensure Specialised Training

Strategy 10: Support Access to Training and Re-entry

Strategy 11: Support Continuing Education and Professional Development

5. A RESPONSIVE WORKFORCEStrategy 12: Strengthen Supply of Staff and Monitoring the Client

Profile

Strategy 13: Attract and Recruit Staff

Strategy 14: Retain Staff

National Aged Care Workforce Strategy (Cont’)

6. STATUS AND IMAGEStrategy 15: Create a Preferred Image

Strategy 16: Communicate the Image

7. EFFECTIVE LINKAGESStrategy 17: Maintain Linkages with Other Relevant Strategies, Policies

and Plans

My concerns

Positive: Planning framework.. Thinking about issues. Recognition of likely problems.

Issue: Assuming current system and developments provides template for the future.

Fear: McDonaldized CareCasualised, underpaid staffing model extended into

future,

Increasing ‘flexibility’ for employers,

Insecurity for staff,

Uncertainty for clients, potential service users

Future models of service delivery

New constellations of care Biggest users of health care services are aged people. Health care and aged care increasingly likely to interact. Integration of different services increasingly important. New functions

for residential care e.g. as sites of clinical excellence, for intermittent, short term use - complementing hospitals and home care.

Substitution principle to manage increasingly expensive care interventions.

Existing emphasis on care at home will need to be continued, enhanced.

Technology Increasing use of everyday technologies to assist, monitor to

Our future as cyborgs

Models of service delivery (Cont’)

What can be learnt from new home based services? Hybrid care.

Individualised care - case/care management.

Home-based care innovations. Further development inevitable:

- Increased intensity of service

- New organisational and financial technologies: eg - direct payments

- enhanced access to case management/ care co-ordination

3. Funding options

Hogan’s vision of a mature industry: Corporate care, with a minimum safety net. Asset run down implied.

What are the options?Leave it to the market?

Other forms of user pays -

death duties;

social insurance?

Continuation of existing system of means and asset tested subsidies?

Re-imagine the future of aged care.

Workforce planning, development and education is key.

The future is NOT pre-determined. Challenge is to imagine the ideal future and make it

happen. ‘Think Globally; Act Locally’. Aged care’s time has come. Must be the real

‘cutting edge’ of the future. Challenges major, good people can make a

difference on this scale.

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