The Australian Hospital & Healthcare Bulletin Summer 2011/12 - Industry Q&A 2

By John Connole
Saturday, 06 October, 2012

Rod Young, CEO of Aged Care Association Australia, spoke to Australian Hospital and Healthcare Bulletin about the changing aged care landscape.

What was the Aged Care Association’s reaction to the reform measures outlined in the 2011 Productivity Commission’s (PC) report, Caring for Older Australians?
Broadly we were highly supportive. It recognises a lot of the existing difficulties within the industry, and came up with some fairly innovative and novel ways to address those, particularly issues such as consumers’ concerns about being forced to sell their family home. And the credit release and savings account scheme that the PC has recommended is certainly an innovative alternative to having people who are required by the scheme to pay a lump sum contribution for their accommodation, who have to sell their family home if they don’t have to.

When you ask the average person in the community what their preference is, the average person wants to maintain their independence, and part of that independence relates to living in some form of independent accommodation. What I think we as an industry, and more broadly, government, the community and the media, need to do is to start to convince older Australians to think about alternative and more appropriate accommodation where they can get a range of services delivered to them far more efficiently. Trying to deliver community-based services to individual households on quarter-acre blocks is very inefficient; and given the numbers of people who may desire to do so, it’s going to be almost impossible for us to be able to find sufficient workers to deliver it. Somehow we’ve got to convince Australians – who tend to move about five times between the age of 20 to 55-60 and when they get to 60, they refuse to move at all for the next 25 to 30 years of their life – to look at the options, to make choices earlier and to take advantage of making those choices so they can obtain homebased care for the longest possible time.

What are the implications of the PC Report for Australia’s aged care workforce?
Certainly there is a need for all of us – unions, government and employers – to find additional resources that can be applied to the salaries and wages of nurses, and carers in particular. The carers are certainly one of the lower paid workforce groups in our economy, and in our opinion undertake one of the most important and difficult tasks. For historical and structural reasons they have always been paid a relatively poorer wage, in part because carers have traditionally not had to have qualifications. There has been a gradual change in the industry over the last 20 years where over 80 per cent of carer employees now have at least a Certification 3 qualification. The difficulty of all of that is that 70 per cent of our income comes from government, and 70 per cent of our income goes straight into salaries and wages; therefore you’ve got to look to government as to how the additional resources might be secured, and then a reasonable proportion of that flows into salaries and wages. We can demonstrate that over the last 12 years roughly the same proportion as a percentage of total income has continued to go into wages over that period.

When do you expect that the measures outlined in the PC Report will be implemented?
The PC Report has put a fairly long timeframe for implementation. In fact, they have three stages: the first stage is the first two years; then the next three; and the third stage beyond five years. We’re anticipating that some of the reforms will take that long to implement. Prime Minster [Julia Gillard] has on several occasions committed her government to address aged care reform in the second term; and we are certainly saying to the government that should be within the context of no later than the 2012 budget, because given that 2013 is an election year, I don’t think any government of any political persuasion is likely to commit to significant reform in a year in which they’re going to go to the polls.

Does the 2011 Federal Budget package for mental health satisfy the demands for elderly, especially those suffering from dementia and Alzheimer’s?
In short, no. The reform packages are a substantial step forward, but in the context of addressing age-specific reform and age-specific mental health reform, I think that there is still a way to go. The government needs to do both things: they need to continue, as they have committed, to do their mental health reform in the last budget; they need to now take the next step and that is the aged care component. Of course there is a third arm – that is the National Disability Scheme – which should also get addressed in the next budget. If you do all three, although to many people there may not appear to be too much connectivity, it is in fact considerable. I think all three need to be in sync to achieve the best outcomes for the economy overall.

What are the implications of the National Disability Insurance Scheme on the aged care sector?
It basically provides an additional funding stream that doesn’t exist at the moment, as an identifiable component, and the discussion to date have all been that the Commonwealth would take responsibility for all persons over an agreed age, let’s say 65, and that the Disability Scheme would take responsibility for persons over 65 in various situations. Obviously there is going to be some need to clarify what happens to a disabled person who gets to 65, how will the funds flow, who will be responsible, and will they need to change providers; most of the discussions to date is that they should continue on the same scheme, there should just be simply exchanging of funding resources between one level of government and another, because the delivery of service for disabilities under 65 would remain at state level, and all the other things such as HACC (Home and Community Care), community care etc. would all migrate to the Commonwealth level. It does provide us with an opportunity to simplify the relationships to make them more streamlined, to clarify, particularly for the public, where you go to access information and services in all of these different offerings, and hopefully make the access a much more simpler one than it is today.

How do you see e-health affecting aged care?
The aged care sector, if resourced appropriately over the next few years, will be one of the greatest beneficiaries of a fully implemented e-health initiative. If you start thinking about 2.8 million Australians over 65 today and around 7.4 million over 30 years’ time, and you start thinking about workforce, one of the few strategies we’ve got available to us that is going to provide us with sufficient workforce resources is to basically consider connecting every person who starts receiving home-based care with an e-health capability. In other words, we need to be saying to everyone that we need frail-aged chronic-diseased older persons to take maximum responsibility for managing their own health. That means putting diagnostic tools into people’s homes, providing the data monitoring of those tools so that the care professional knows what is happening, and the care professional then has some direct linkages back to the health professional such as the GP. I keep on pointing out to people that the Commonwealth is in the process of transferring 650,000 frail-aged HACC clients, plus about 60,000 existing community aged-care package clients that are already under Commonwealth jurisdiction; so 700,000 currently receive either HACC, community aged care packages in their home.

There are already examples of e-health used in this way, for example Silver Chain in Western Australia, the biggest single provider of community care in that state; they’ve got a 500-person virtual hospital, and 200 people at home being self-monitored. They take responsibility for analysing the self-monitoring data and when appropriate referring the outcomes to the servicing GP. But lots of other service providers can’t, so we need to provide the infrastructure to help all of our community-care providers provide that sort of connectivity and be able to be able to deploy that range of diagnostic devices into people’s homes. You’ve got to be quite frail or cognitively impaired not to be able to put a cup on your arm, press a button, and have it record on your computer, or go on the web to a data collection point, to check what your blood pressure reading is today. Similarly with oximeter – it’s just a small device on the end of your finger; it’s digitised, it links in wirelessly or via cable, and goes down the computer and you can be fed into to be connected once a day, week, etc. The big thing for us is that a doctor might see a patient once a month, whereas our guys are going into someone’s home often more than once a day: as carers, cleaners, helping with dressing, cooking, etc. We’ve got the major contact with this client base but there is often almost no existing linkage between GPs and those carers who are seeing this person often every week; that’s where we need to improve.

Would the National Broadband Network (NBN) be beneficial in improving in the facilitation of home diagnostic technologies?
There is no simple answer. It varies considerably upon your location. If you are in a metropolitan area the chances are that your current infrastructure will be satisfactory; it mightn’t be as fast as you like but it will transmit data quite readily. If you’re out in the bush it’s unlikely, unless you’re fortunate enough to be in a well-serviced regional area; therefore in this case, NBN becomes crucial to be able to deliver this sort of health monitoring services. I call this type of service the true PCEHR (Personally Controlled Electronic Health Record), because when you give people devices where they can manage their own health, they know what’s happening, they need the support of a carer or health professional to sometime make decisions, that they’re really engaged. That’s the only way I think that we’re likely to get enough workers by making people selfemploy themselves, in managing their health. The next level of this, and this is where NBN becomes crucial, is many of these services really need to be supported by video link, telehealth. And until you’ve got NBNequivalent broadband speeds, telehealth really doesn’t work: you don’t get good picture quality, you regularly have voice and video not linking properly and that can be quite distressing for some people.

Rod Young

Rod has more than 30 years’ experience working in the health and aged care industries. His experience includes:

  • Ten years in health service management; and,

  • Eleven years in aged care.

During his career Rod has had extensive experience in managing complicated infrastructure projects, managing a teaching hospital complex, working on health systems re-design, developing health and aged care policy reform.

He has a Bachelor of Law from UNSW and a Bachelor of Health Services Management also from UNSW.

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