The elephant in the aged care room

Change the model or nothing changes

As aged care advocates, we are encouraged that reforming the aged care system is still high on the agenda for government and for Australians. However, we are concerned that the current program of reform is not addressing the elephant in the room, or more to the point, the elephant in the rooms.

Put simply, the current model of institutionalised aged care fails as a model for ageing well.

Large multi-bed facility living is the reality for most in residential aged care under our current aged care system. For many there is no alternative. To really fix aged care this needs to change.

As we somewhat provocatively commented for a recent story about deinstitutionalising aged care in The Australian newspaper, worryingly, older Australians and prisoners are the only remaining cohorts supported in institutional settings. The disability and mental health sectors saw the benefits for people moving to community-based living and support decades ago, so why is residential aged care one of the last bastions of the institution?

Institutionalised care tends to foster the things we don’t want for people in residential aged care. A loss of autonomy, freedom and purpose, as well as feeling isolated, and in worst case scenarios, abuse and neglect.

While aged care providers strive to deliver person-centred models of care in these environments, the above issues don’t stem from intent but rather from the flaws inherent in institutional living – the need for routine, rules and a ‘one size fits all’ approach which can easily be applied to supporting large numbers of people through their day.

There needs to be political will for deinstitutionalisation of the aged care system but also importantly investment in innovation and planning for development and change.

I am calling on the Australian Government to quarantine just 10% of the aged care reform funding for this purpose to promote innovation – what would it take to move away from institution-like facilities being the mainstay of residential aged care?

The Older Persons Advocacy Network’s (OPAN) Position Statement Deinstitutionalisation in Aged Care calls for a multifaceted approach to deinstitutionalisation which considers both the provision of adequate care and services in the home, and the need for greater investment in a diverse range of affordable, safe and accessible housing options to support older people to age in their community.

Care at home

We know older Australians want to remain in their own homes as long as possible. An effective and nimble home care program will support the preference to age in place and is a much more cost-effective model of care compared to residential care.

We are eagerly waiting for the Australian Government to reveal the new-look home care program from 1 July next year, which we hope addresses a number of issues. People often end up in residential aged care because there is no other choice. The transition between hospital and inhome care fails multiple times each day. In-home support should be available when you need it and have the flexibility to easily scale up and down as needed.

We would also like to see the new home care program cater for older people who want to share supports in shared housing. The Aged Care Royal Commission made specific reference to the cohousing model, where multiple people live in one dwelling and share living spaces.

Investment in affordable and accessible housing

If you watch TV it can be easy to think there are lots of options for modern resort style retirement living where care is available as you age and may need it. However, this is assuming that older people own their own home and/or are self-funded retirees. For those on low incomes, residing in social housing or private rental accommodation, this is not an option. These older people are often overlooked or viewed as a small minority despite the rate of home ownership among older people decreasing.

The Australian Housing and Urban Research Institute (AHURI) advise there is an urgent need for innovation in the Australian housing market and suggest alternative housing models for low-income older Australian’s that may include accessory dwellings, mobile and manufactured homes, collaborative housing, rental retirement villages, home share arrangements, and dual key housing, and that this will require commitment by both federal and state governments.

There are some examples of innovation in aged care and housing across the country, such as development of dementia villages, builds of new smaller facilities, and collaborations to build social housing for older people who are homeless or at risk of homelessness. But these are the exception rather than the norm.

Changing current facilities

The Aged Care Royal Commission made recommendations for improving the design of aged care accommodation for older people. This will help for future builds but what can we do to change the facilities we have now?

There are examples of positive impacts which have been achieved with good interior design and refurbishment to make the most of space, light, colour, indoor and outdoor spaces.

Similarly, other things that make a facility feel more like home, such as being able to make your own cup of tea or coffee, sit in a reading room, or keep to your own schedule for personal care and meals would help with creating a greater sense of autonomy, choice and dignity for residents.

Of course, providing support safely in residential aged care facilities is a priority but one size does not fit all. Currently, there is little dignity of risk afforded to residents. Giving choice and control comes with more inherent risk which has to be accepted as part of being human.

Deinstitutionalisation of aged care is complex, but like those sectors that have gone before us, it is possible and necessary. If we don’t take this opportunity to really change how we think about and deliver aged care, I fear we will end up with more of the same. Albeit an improved version, but one which remains the same at its core leaving us susceptible to yet another aged care crisis in the future.

Geoff Rowe

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